Health Care Professionals

ColonCancerCheck


Colonoscopy Services and Funding


Why is the program providing more funding for colonoscopies right now?

An investment of $11 million was made in the spring of 2007 for additional hospital-based colonoscopies across the province for individuals at increased risk because of a family history of colorectal cancer, and those who have a positive FOBT. This funding is assisting hospitals to increase their capacity to meet the growing demand and target people who are at increased risk due to family history or who have had a positive FOBT result prior to the launch of the program branded FOBT kit in April 2008.

How big an increase is $11 million for additional colonoscopies?

The additional funding is for 34,421 hospital-based screening colonoscopies and represents a 15% increase in the number of hospital colonoscopies provided in 2005/06.

How much will hospitals receive for each additional procedure?

Based on a survey with participating hospitals and input from the program's Clinical Advisory Committee made up of experts from across the province, hospitals received funding of $320 per case for 2007/2008.

What does the colonoscopy funding cover?

The colonoscopy funding covers all hospital related expenses for a colonoscopy procedure. The procedure is defined as the full range of services required to complete the procedure, including patient interactions, room set-up, colonoscopic examination, clean-up and reporting. This refers only to screening colonoscopies, which are scheduled as day surgery procedures provided within an endoscopy suite (i.e., this excludes inpatients, and non-scheduled emergency cases treated in the Emergency Department). Colonoscopy procedure costs include the direct costs in the endoscopy suite (nursing, technicians, assistants, supplies, etc.) and for pathology processing of biopsy samples taken during the colonoscopy (lab staff, salaried pathologists, supplies, etc.). These costs exclude physician fees. The funding does not include equipment or capital – it is for operating costs only.

If costs are less than $320 per colonoscopy, can more procedures be done with the funds?

Absolutely. In the first year, progress is being tracked to obtain efficiency parameters and feedback from the hospitals is invaluable in helping to plan.

Does the funding include pathology for lab biopsies?

Yes.

Can colonoscopies be contracted out to private clinics?

No. The allocation of funding for additional colonoscopies is only for hospitals that meet certain standards and criteria.

What was the purpose of the Feb. 2007 survey to hospitals on colonoscopy activity?

The purpose of the February 2007 survey was to determine hospital-based colonoscopy capacity for 2007/08 to support the provincial colorectal cancer screening program. Participants were asked to provide input on their willingness and ability to increase the volume of colonoscopies, the estimated cost of increasing volume, and the status regarding wait times for colonoscopies for those undergoing screening and for those with symptoms. The purpose of the survey was to gather information. Submitting the survey did not automatically qualify a hospital for funding for additional screening colonoscopies.

How was it determined that hospitals received funding?

Eighty-six hospitals were invited to participate in the survey of colonoscopy activity and of those, 78 responded indicating their willingness and ability to increase the volume of colonoscopies as part of the colorectal cancer screening program. Of these, only 54 hospitals received funding to perform additional colonoscopies.

To be eligible for funding, hospitals needed to meet the following criteria :

What are the conditions for funding?

To receive the 2007/2008 funding, hospitals had to meet the following conditions :

When can hospitals expect funding?

The program plans to fund hospitals similar to the cancer surgery contracts, which occur twice a year. However, in this first year, CCO is working with the Ministry of Health and Long-Term Care and hospitals will receive funding once CCO receives the funding.

Will there be an opportunity within 2007/08 for hospitals that did not respond to the survey to receive any funding?

If any of the 54 hospitals are not able to perform the additional colonoscopies allocated to them, the funding will be reallocated within the LHIN based on consultation with the Regional Vice-President (RVP) for Cancer Care Ontario (CCO). If you are a hospital that did not respond to the survey, please contact your RVP who will contact CCO. Indicate your willingness and capacity to perform additional colonoscopies if funding is reallocated within your LHIN. You will be then be asked to complete a survey.

Is there any other funding that can be accessed, or will become available?

There will also be funding in Year 2 of the program, beginning in 2008/09.

If you did not receive additional funding for colonoscopies, do the new colonoscopy standards still apply?

Yes. The new Cancer Care Ontario Colonoscopy Standards were distributed to all hospitals in Ontario in July 2007. The standards were developed by the Program in Evidence Based Care to support Ontario's Colorectal Cancer Screening Program. As a condition of funding, hospitals are required to implement the standards as part of the program.

Will there be investment in capacity both for additional colonoscopies and to meet growth in colonoscopies for other conditions?

The goal of the program is to improve access for screening colonoscopies for those at increased risk and with positive FOBT tests, but not at the expense of other colonoscopies. Data will be used to measure and manage wait times based on assessment of patient need for colonoscopy. The program will also evaluate wait times along with other criteria, including geographic equity of access and new models of service delivery, to see where and how much additional capacity is required to meet the needs of the program and overall growth in colonoscopies. Efficiencies made as a result of investments in additional screening colonoscopies will benefit all colonoscopy services.

What percentage increase for colonoscopies is projected for each year during the five year rollout and beyond?

In 2005/06, the province provided about 300,000 colonoscopies. In Ontario, colonoscopy volumes have been growing at an average rate of 12%-13% per year since 1997/98 (excluding 2003/04 which was affected by SARS). This is greater than the population growth rate. The number of colonoscopies identified by the colorectal cancer screening program is a function of the population aged 50-74 and the rate of growth from this program is expected to be lower than the 12%-13% currently being observed.

Won't funding for colonoscopies divert surgeons', physicians' and nurses' time from other patients?

The funding agreements stipulate that these additional colonoscopies must be delivered using additional resources - space, equipment and people - and must not draw from other services, or result in a decrease in other hospital services. The agreement also includes a sign-back process whereby the hospital must indicate agreement with all conditions. The agreements follow the principles and approach of the province's Wait Times Strategy for contracting with facilities for additional volumes.

How will the colonoscopy base volumes at each hospital be measured for 2006/07?

Current base volumes for colonoscopies are based on the 2005/06 physician billing data (OHIP) and the rate of growth of colonoscopies since 1997/98. The OHIP data were supplemented with data from NACRS to identify the hospitals where the services were provided. Unfortunately, the NACRS diagnostic and procedure codes and practices do not definitively identify a colonoscopy, but this is being addressed for 2007/08 to make them more identifiable. We recognize that hospitals do not have access to OHIP data. CCO has a query for the MOHLTC Provincial Health Planning Database that allows LHINs to count colonoscopies using the OHIP-NACRS linkage approach. The program can share this with LHINs as requested.

Will colonoscopies for persons who have large bowel symptoms which may be caused by colorectal cancer receive extra funding? If not, how do we ensure that these and other patients who have clinical indications for colonoscopy are not side-tracked?

Patients who are referred because of symptoms are high priority and will continue to be. They are, however, not included as part of this program. They are included in the general obligations of hospitals that perform colonoscopy procedures. Hospitals will be reporting on total volume of colonoscopies performed to ensure that overall access is not compromised for colonoscopies done for diagnostic purposes.

If a patient has a family history and had a colonoscopy before, does he or she still qualify under this program and if so, is the timing five years from the last colonoscopy?

Patients with a family history who have had previous colonoscopies qualify for the program providing that a polyp was NOT taken in a previous colonoscopy. Patients with family history who have had a previous colonoscopy where polyps were removed should be marked as Surveillance (CN).

If a patient has a positive FOBT and previously had a colonoscopy, does he or she get another colonoscopy immediately or should it be five years from the last colonoscopy?

Physicians need to use their judgment to ascertain the best approach. For example, if the colonoscopy was complete and negative and the preparation was good, generally it would be a five year interval.

If a patient had a colonoscopy previously because of increased risk, he or she should not be completing an FOBT kit.

All patients who have had a positive FOBT should be referred for colonoscopy.

What about individuals with second degree relatives who have a history of colorectal cancer?

These individuals need to be assessed for individual risk by their family physicians.

What are the current wait times for colonoscopies?

At this time, comprehensive data is unavailable about how long patients are waiting for colonoscopies. Ontario's Colorectal Cancer Screening Program will develop a new information system to track, measure and eventually report colonoscopy wait times. Ontario's program will also increase capacity for colonoscopy to meet the demand.

What should the maximum wait times ideally be for colonoscopies?

The Canadian Association of Gastroenterology has published a Canadian consensus on medically acceptable wait times and set benchmarks which recommend a colonoscopy be completed within two months for those with a positive FOBT and six months for a screening colonoscopy.  ColonCancerCheck's program benchmarks (adapted from CAG Benchmarks) are eight weeks for those with a positive FOBT and 26 weeks for those with a family history of CRC.

Have targets been set for wait times? Will the program be using median or 90th percentile measures to calculate them?

While calculations have not been finalized, the program will measure wait times similarly to surgical wait times reporting, and include median and 90th percentile measures. The program will provide further details as they develop.

For More Information

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