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CBC Manitoba (OCT 04): WRHA reinstates outpatient occupational, physiotherapy at HSC

The Winnipeg Regional Health Authority is reversing course on a decision it made this summer that would have seen some Manitobans paying out-of-pocket for outpatient physiotherapy and occupational therapy starting this month.

In July the health authority announced it would be "moving adult outpatient physiotherapy and occupational therapy clinics out of hospital to private-practice providers by mid-October."

But in a reversal announced Tuesday at a CBC News Town Hall on the state of the province's health care system, the WRHA said a plan to create a "means indicator test" to assess people's income for free outpatient services at HSC has been cancelled. 

"We have had an opportunity to re-look at some of the decisions around the outpatient occupational therapy and physical therapy services," said WRHA vice-president of inter-professional practice Lori Lamont. "We have identified that it's possible to actually improve some of the efficiency without going down the means-testing road that we were anticipating going down." 

Lamont added that finding an appropriate "means test" (a way of assessing someone's ability to pay) was difficult, and would cost money to administer. 

Instead, clinical conditions have been identified to determine who gets the treatments. Lamont noted that outpatient physiotherapy services at HSC will still be consolidated, with more details coming in the next days and weeks. 

Lamont was responding to a question from Gloria Taylor at the town hall, who called the means test "humiliating."

Speaking to CBC after the meeting, Taylor said she needed physiotherapy after a knee-replacement surgery, and will need it again after a scheduled surgery on her other knee in the coming months.

She called physiotherapy and occupational therapy "absolutely essential," and said she was glad to hear the WRHA had changed course.

"I simply purchased insurance, but there will be many people who live right up to their incomes and they won't qualify for the free service and they'll have difficulty paying for all the treatment that they need," said Taylor. "I appreciate that they're taking another look at the means test because that is just too humiliating of a byproduct of the privatization."

Real Cloutier, interim president and CEO of the WRHA, told CBC News after the town hall the updated plan is still in the planning stages and couldn't give specific details.

He said he expects more details to be released publicly in the coming weeks.

It's those details — including what specific conditions will be included under the new testing system and how many jobs the move may keep off the chopping block — that Bob Moroz, president of the Manitoba Association of Health Care Professionals (MAHCP) was left asking after hearing about WRHA's abrupt reversal Tuesday night.

Moroz says no one from the WRHA reached out to give the MAHCP — which represents physiotherapists and occupational therapists — a head's up that things were changing or that they would be announced publicly Tuesday night.

"On one hand it's good news for the people of Manitoba, on the other hand I don't have any details in terms of what that means," he said. "What does that mean for the physiotherapists who were told in July that outpatient services were being eliminated?

"I'm at a point now where we don't know the details and they've now made it public and we don't know what impact that's going to have."

Moroz said the MAHCP originally estimated between 20-24 equivalent full-time physiotherapist positions would be deleted under the plans announced in July, and doesn't know how those numbers may change under the the new plan.

Specialty rehabilitation services — such as those provided by a spine clinic, specialized neuro-services and amputee services — were never part of the planned change. Those services will continue out of the Health Sciences Centre, the WRHA said back in July.

Brenda McKechnie, registrar and executive director with the College of Physiotherapists of Manitoba, said HSC will be the only Winnipeg hospital where outpatient physiotherapy and occupational therapy services will be offered after the coming changes to the city's hospital system are complete. 

She said when physiotherapy and occupational therapy are provided in hospital they're covered under Manitoba Health, but patients are expected to pay either out-of-pocket or through private insurance when using private practices.

She said the College of Physiotherapists of Manitoba supports the new plans announced Tuesday.

"If they're going to use clinical criteria instead, I think that is a positive step," she said.

"I think the switch to clinical criteria has probably been [after] some pressure from physiotherapists and surgeons who want to see their patients do very well after the surgery."

McKechnie said the College of Physiotherapists of Manitoba has been working with its members to push the WRHA to change the original plan.

McKechnie said she and others had been concerned about patients needing physiotherapy after things like hand surgeries, and knee and hip replacement surgeries.

"Once they've got a new joint you want to keep that joint mobile," she said. "If person isn't able to afford outpatient services or private practice therapy … or doesn't have insurance, then the surgery may not be as successful because they're not getting the exercise program to keep that range of motion."

Moroz is also concerned the new clinical condition will leave patients who require physiotherapy or occupational therapy for arthritis or an undiagnosed condition at risk of not being covered for the services.

"Where is the WRHA going to draw that line? Who is going to be considered as clinically needing these services?" he asked. "This changes the entire conversation when it comes to outpatient physio and occupational therapy services … our members simply need to know the details and experts who are in the field on the frontline everyday need to know those details."​

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