Transcript: Why Optometrists are Fighting the Province | Sep 28, 2021

Steve Paikin sits in his home office. Framed pictures of The Ontario Legislative Building and Walter Cronkite hang on the wall. A calendar is opened to September. Paikin wears a white button-down shirt and a shiny crimson tie.

Text reads, “Optometrist Turn OHIP Patients Away”

Paikin begins,
STARTING SEPTEMBER 1ST,
OPTOMETRISTS IN THIS PROVINCE
BEGAN A WORK ACTION THAT MEANS
SENIORS AND CHILDREN CANNOT
BOOK APPOINTMENTS TO GET THEIR
EYES CHECKED.
WITH US NOW FOR THE DOCTORS'
PERSPECTIVE IN THIS FIGHT WITH
THE PROVINCIAL GOVERNMENT,
WE’RE JOINED, IN HAMILTON, ONTARIO:
DR. SHELDON SALABA, PRESIDENT OF
THE ONTARIO ASSOCIATION OF
OPTOMETRISTS.
DR. SALABA, IT'S GOOD TO HAVE
YOU WITH US ON TVO TONIGHT.
CAN WE JUST START BY HAVING YOU
TELL US IN YOUR VIEW WHAT LED TO
THE JOB ACTION?

Text reads, “Optometrists Turn OHIP Patients Away. The Path to Action”

Dr. Sheldon Salaba sits in front of a shelf filled with model airplanes. He wears black scrubs. His blonde beard grows to grey under his chin.

Text reads, “Dr. Sheldon Salaba, Ontario Association of Optometrists”

Dr. Salaba replies,
YOU KNOW, WE'VE BEEN WORKING WITH
THE FORD GOVERNMENT TO TRY TO
GET THEM TO COME TO THE TABLE
AND WORK WITH US TO FIGURE OUT A
SUSTAINABLE EYE CARE SYSTEM FOR
PATIENTS IN THIS PROVINCE SINCE
THE BEGINNING OF THEIR MANDATE,
BUT WE'VE BEEN MET WITH SILENCE.
AND LAST YEAR IN DECEMBER OF
2020, WHICH WAS YOUR LAST
COMMUNICATION WITH THEM UNTIL
AUGUST OF THIS YEAR, YOU KNOW,
WE DID EVERYTHING THAT WE COULD
POSSIBLY THINK OF TO GET THE
GOVERNMENT TO PAY ATTENTION TO
THIS ISSUE AND WE WERE MET WITH
RADIO SILENCE FOR EIGHT MONTHS.
AND BACK IN MARCH OF 2021, WHEN
THERE WAS NO FUNDING
ANNOUNCEMENT FOR PRIMARY CARE
SERVICES IN THE PROVINCE IN THE
BUDGET, WE SET A SERVICE
WITHDRAWAL DEADLINE OF
SEPTEMBER 1ST, AND WE'RE HOPING
THAT THE GOVERNMENT WOULD ENGAGE
WITH US TO COME TO SOME TYPE OF
SOLUTION, AND THEY LEFT
EVERYTHING UNTIL THE ELEVENTH
HOUR.
WE HAD SOME BRIEF INTERACTIONS
WITH THEM OVER THREE DAYS IN
AUGUST, AND THEY WOULD NOT
COMMIT TO PAYING THE OPERATING
COST FOR THE SERVICES THAT WE'RE
PROVIDING, AND UNFORTUNATELY
SERVICES WERE WITHDRAWN.

Paikin asks,
OKAY. JUST CONFIRMING THERE ARE
NO TALKS HAPPENING AS OF THIS
MOMENT; IS THAT RIGHT?

Dr. Salaba answers,
THAT'S CORRECT. WE HAVEN'T HEARD
OFFICIALLY FROM THE GOVERNMENT
SINCE AUGUST 29TH.

Paikin responds,
ALL RIGHT. SHALL WE -- I MEAN, I
PRESUME THERE'S TWO POSSIBLE
EXPLANATIONS FOR THIS.
ONE IS THEY REALLY HAVE IT OUT
FOR YOU GUYS AND THEY DON'T LIKE
YOU, AND THE OTHER IS WE'RE IN
THE MIDDLE OF A GLOBAL PANDEMIC
AND THEY THINK THEY HAVE BIGGER
FISH TO FRY. IT IS MORE THE
LATTER THAN THE FORMER?

Dr. Salaba says,
WELL LISTEN, VISION IS OUR MOST
IMPORTANT SENSE, AND REGARDLESS
OF WHETHER OR NOT WE'RE IN A
PANDEMIC, I THINK YOU HAVE TO
CONSIDER THAT THESE ARE
ESSENTIAL HEALTH CARE SERVICES
AND THEY'RE SERVICES THAT NEED
TO BE DEALT WITH AND MANAGED.
I THINK WHAT WE'RE SEEING HERE,
THERE'S A HISTORY OF THIRTY-TWO
YEARS OF ONTARIO GOVERNMENTS
NOT TAKING ACTION AROUND
PRIMARY EYE CARE SERVICES, AND I
THINK THAT'S WHERE THE REAL
PROBLEM LIES.

Paikin replies,
LET'S DO SOME OF THE MATH HERE
BECAUSE I THINK PEOPLE
NEED TO HAVE A BETTER
UNDERSTANDING THAT IF, FOR
EXAMPLE, THEY ARE GOING TO SEE
YOU AND THE ONTARIO HEALTH
INSURANCE PLAN REIMBURSES YOU
FOR PART OF THE COST OF THE
SERVICE THAT YOU ARE PROVIDING,
LET'S DO THE MATH.
WHAT DOES IT COST AND WHAT DOES
OHIP ACTUALLY REIMBURSE YOU FOR?

Dr. Salaba responds,
SO WE HAVE MULTIPLE DATA
POINTS THAT INDICATE THAT THE
COST TO PROVIDE A COMPREHENSIVE
EYE EXAM IN THE PROVINCE ON
AVERAGE, IS AROUND $80.
AND OHIP ON AVERAGE IS PAYING
$45.
THAT $45 NUMBER HAS ONLY
INCREASED $5 SINCE 1989, AND AT
THAT TIME, WE WERE BEING PAID
$39.15.
SO IF YOU TAKE THAT $39.15 AND
INFLATE IT OVER THREE DECADES,
YOU'RE ARRIVING AT A NUMBER
THAT'S CLOSE TO $80 AND, YOU
KNOW, WE'VE DONE STUDIES, WE
LOOK AT OTHER JURISDICTIONS.
THERE ARE FOUR OTHER PROVINCES
IN CANADA THAT PROVIDE PUBLICLY
FUNDED EYE CARE SERVICES, AND
WHEN YOU COMPARE APPLES TO
APPLES ON WHAT IS BEING
PROVIDED, THE NEXT LOWEST
REIMBURSED PROVINCE IS MANITOBA
AT $77.
FOLLOWING THEM IS QUEBEC AT $106.
AND FOLLOWING QUEBEC IS ALBERTA
AT $137.
SO WE DON'T UNDERSTAND WHY ALL
THESE OTHER PROVINCES HAVE BEEN
ABLE TO FIGURE OUT HOW TO
RESOURCE THESE IMPORTANT
SERVICES, AND THE ONTARIO
GOVERNMENT CAN'T.

Paikin asks,
SO JUST SO I UNDERSTAND, IS
THIS TO SAY THAT EVERY TIME
YOU DEAL WITH A PATIENT WHO
NEEDS TO USE THE HEALTH
INSURANCE PLAN TO SEE
YOU, YOU'RE LOSING MONEY?

Dr. Salaba answers,
YES, WE'RE PAYING TO SEE
THOSE PATIENTS, THAT'S CORRECT.

Paikin adds,
HOW DOES THAT MAKE SENSE?

Dr. Salaba says,
IT DOESN'T.
THAT'S WHY SUCH A DRASTIC ACTION
IS BEING TAKEN BECAUSE WE WANT
TO -- WE HAVE TO BREAK THIS
LOGJAM WITH THE GOVERNMENT.
THEY NEED TO UNDERSTAND FROM THE
PUBLIC THE IMPORTANCE OF THESE
SERVICES TO PEOPLE, AND THEY
NEED TO RESOURCE THEM CORRECTLY.
YOU KNOW, OPTOMETRISTS IN THIS
PROVINCE ARE OFFERING TO STILL
WORK FOR FREE.
SO THE OPTOMETRIST ISN'T GOING
TO RECEIVE COMPENSATION.
BUT IF THEY'RE REIMBURSED AT THE
$80 LEVEL, THAT'S GOING TO COVER
THEIR COSTS LIKE RENT, STAFF
SALARIES, INSURANCES, EQUIPMENT
RENTAL, UTILITIES.
THAT IS WHAT IT COSTS TO PROVIDE
A TWENTY-MINUTE TO HALF-HOUR
SERVICE TO PATIENTS IN THIS
PROVINCE.

Paikin replies,
LET'S ALSO UNDERSTAND THE KINDS
OF PATIENTS THAT YOU SEE.
NOW, THE KIND OF DISPUTE YOU'RE
HAVING WITH THE PROVINCE RIGHT
NOW WOULD NOT COVER, FOR
EXAMPLE, SOMEBODY WHOSE EYE CARE
IS COVERED BY A WORKPLACE
PRIVATE INSURANCE SITUATION,
RIGHT?
THIS IS ONLY FOR THE PEOPLE WHO
RELY ON OHIP TO GET THESE
SERVICES; IS THAT FAIR TO SAY?

Dr. Salaba says,
YEAH, BUT THAT'S A LARGE
PORTION OF THE PATIENTS WE SEE.
ON AVERAGE 70% IN OUR PRACTICES.
SO YOU'RE TALKING CHILDREN,
SENIORS, AND ADULTS WITH MEDICAL
CONDITIONS, AND THAT'S A VERY
LARGE PORTION OF THE POPULATION.

Paikin responds,
OKAY. THE PROVINCE SAYS THAT IT
HAS OFFERED A $39 MILLION LUMP
SUM PAYMENT AND AN 8% INCREASE
IN THE AMOUNT PAID AND TO ALIGN
FUTURE INCREASES WITH WHAT OTHER
PHYSICIANS GET. THEY SAY THAT'S
WHAT THEY PUT ON THE TABLE.
WHAT'S YOUR REACTION TO THAT?

Dr. Salaba states,
YOU KNOW, LINKING US TO
PHYSICIANS IN THE PROVINCE ISN'T
FAIR BECAUSE PHYSICIANS HAVE
BEEN TREATED THE WAY WE HAVE
OVER THE LAST THIRTY-TWO YEARS.
SO IT'S NOT REALLY AN
APPLES-TO-APPLES COMPARISON.
IF THEY WANT TO LINK US TO
FUTURE PHYSICIAN INCREASES, I
THINK THEY HAVE TO GO BACK
THIRTY-TWO YEARS, NOT TEN, AND
GIVE US THE SAME INCREASES AND
DECREASES THAT PHYSICIANS HAVE
EXPERIENCED OVER THAT PERIOD OF
TIME, AND THEN WE'RE GOING TO
COME OUT AT SOMETHING THAT'S FAIR.
AND THAT NUMBER IS AGAIN GOING
TO LAND AT AROUND $80.
THEY OFFER A $39 MILLION LUMP
SUM PAYMENT THAT IS RETROACTIVE
FOR THE LAST DECADE.
WE PERFORMED THIRTY-FOUR MILLION
SERVICES IN THE LAST DECADE.
SO THAT NUMBER REPRESENTS ABOUT
A DOLLAR PER SERVICE THAT WE
PROVIDED.
THE 8.84% INCREASE ON OUR
EXISTING FEE CODES WOULD
REPRESENT ABOUT A $4 INCREASE.
SO IF YOU LUMP THOSE TWO
TOGETHER, YOU'RE GOING TO SEE ON
AVERAGE THE REIMBURSEMENT FOR AN
EYE EXAM MOVE FROM $45 TO $50,
AND THAT'S STILL GOING TO SEE
THE OPTOMETRIST PAYING $30 TO
SUBSIDIZE THOSE COSTS TO SEE
PATIENTS.
SO THAT IS NOT A SUSTAINABLE
SYSTEM THAT WE'RE CREATING HERE.
THE OTHER THING I'D LIKE TO SAY
ON THAT POINT, IF I CAN, YOU
KNOW, THE GOVERNMENT SAYS THAT
THEY ARE TRYING TO LAY A
FOUNDATION TO WORK REASONABLY
WITH OPTOMETRISTS IN THE
PROVINCE, AND I JUST WANT TO
POINT OUT THAT IN AUGUST WE HAD
A TWO-HOUR MEETING WITH THEM ON
AUGUST 5TH, AND THEN WE HAD TWO
DAYS OF MEDIATION.
THEN THEY RELEASED THE
$39 MILLION AND 8.48% OFFER
PUBLICLY. THAT IS AN ACT OF BAD
FAITH BARGAINING.
WHAT THEY OFFERED US INSIDE OF A
CONFIDENTIAL MEDIATION PROCESS
AND TWO HOURS AFTER THE
MEDIATION ENDED THEY PUT THAT
NUMBER OUT PUBLICLY.
THE OTHER THING THAT I'D LIKE TO
POINT OUT IS THE $39 MILLION THAT
THEY'RE OFFERING IS A BARGAINING
TACTIC, AND IT'S A WASTE OF
TAXPAYERS' MONEY.
UNDER TYPICAL COMPENSATION
NEGOTIATIONS BETWEEN SERVICE
PROVIDERS AND THE GOVERNMENT,
IT'S UNLAWFUL FOR THEM TO BE
ABLE TO OFFER AN OFFER LIKE THIS
PUBLICLY DURING THIS TYPE OF
COMPENSATION NEGOTIATION.
SO NONE OF THE ACTIONS THAT
THEY'RE TAKING ARE PROVIDING ANY
TRUST TO US THAT THEY ARE
ACTUALLY INTERESTED IN EVER
FUNDING WHAT IT COSTS TO PROVIDE
THESE SERVICES.

Text reads, “Optometrists Turn OHIP Patients Away. Public Perception”

Paikin responds,
NO, I HEAR YOU. BUT THE TRICKY
PART OF THIS, OF COURSE, IS THAT
THIS IS NOT JUST A NEGOTIATION AT
A BARGAINING TABLE. IT'S ALSO A
PUBLIC RELATIONS FIGHT.
AND AT THE MOMENT YOU'RE TELLING
PEOPLE, SENIORS, YOUNGER PEOPLE,
FOR EXAMPLE, THAT BECAUSE OF
YOUR FIGHT WITH THE PROVINCE OF
ONTARIO, THEY'RE GOING TO HAVE
TO GO SEEK THEIR EYE CARE IN
EMERGENCY DEPARTMENTS IN
HOSPITALS WHERE (A) IT'S
INFINITELY MORE EXPENSIVE AND
(B) THERE'S PROBABLY A WAIT
LIST UP THE YING YANG FOR ALL
THE BACKLOGS FOR PROCEDURES
THAT HAVE BEEN DELAYED BY CoVID.
HOW IS THAT CONSISTENT WITH THE
BEST CARE OF YOUR PARENTS WHICH
I KNOW YOU FOLKS LIKE TO GIVE?

Dr. Salaba states,
YOU KNOW, YOU HAVE TO
UNDERSTAND THAT IN A SYSTEM LIKE
THIS, WE AREN'T ABLE TO DELIVER
THE BEST CARE THAT PEOPLE IN
ONTARIO DESERVE.
AND WHAT WE'RE DOING IS FIGHTING
FOR OUR PATIENTS' RIGHTS TO BE
ABLE TO HAVE ACCESS TO THESE
HIGH-QUALITY SERVICES.
THIS IS NOT AN IDEAL SITUATION.
I'M SHOCKED THAT THE GOVERNMENT
WOULD BE SO CAVALIER AND LEAVE
THIS TO THE LAST MINUTE AND THEN
BEHAVE IN A WAY THAT DOES NOT
INSTIL TRUST IN US AS SERVICE
PROVIDERS IN WANTING TO WORK
WITH US REASONABLY TO ENSURE
THAT PRIMARY CARE SERVICES IN
THIS PROVINCE ARE NO LONGER
FUNDED THE LOWEST IN CANADA.
SO I FEEL BAD AND SO DO ALL OF
MY COLLEAGUES THAT WE'RE NOT
ABLE TO TAKE CARE OF OUR
PATIENTS RIGHT NOW BECAUSE WE'RE
DOCTORS.
WE WANT TO BE ABLE TO HELP
PEOPLE SEE, MAKE SURE SENIORS
CAN LEAD INDEPENDENT LIVES, YOU
KNOW, TREAT EYE DISEASES, ALL OF
THOSE TYPES OF THINGS.
BUT AT THIS POINT IN TIME,
BECAUSE OF THE ACTIONS THAT THE
GOVERNMENT ARE TAKING, WE'RE NOT
ABLE TO DO THAT, AND SO THAT
PEOPLE THAT HAVE BEEN SCHEDULED
FOR ROUTINE CARE ARE GOING TO
EXPERIENCE DELAYS.
WE'RE GOING TO MAKE EVERY EFFORT
WHEN PATIENTS CALL US IF THEY
ARE HAVING AN EMERGENCY, WE'RE
GOING TO MAKE SURE THAT THEY'RE
TAKEN CARE OF PROPERLY.
BUT REALLY, THE GOVERNMENT NEEDS
TO COME BACK TO THE TABLE AND
MAKE A COMMITMENT TO ENSURE THAT
PRIMARY EYE CARE SERVICES IN
ONTARIO ARE NO LONGER FUNDED AT
THE LOWEST RATES IN CANADA.

Paikin replies,
NO, I TAKE YOUR POINT ON THAT.
BUT LET'S FINISH UP ON THIS
THEN, DR. SHELDON. YOU KNOW,
YOU GUYS ARE WELL PAID.
YOU SHOULD BE WELL PAID.
YOU SPENT A LOT OF TIME GOING TO
SCHOOL TO DEVELOP THE EXPERTISE
TO PERFORM THE SERVICES WE NEED
YOU TO PERFORM.
AGAIN, GOING BACK TO THIS AS A
PUBLIC RELATIONS FIGHT, IF THE
GOVERNMENT IS ABLE TO PORTRAY
YOU AS SIX-INCOME PEOPLE WHO ARE
PUTTING YOUR FINANCIAL NEEDS
AHEAD OF THOSE OF YOUR PATIENTS,
HOW EXACTLY DO YOU COME OUT OF
THIS WITH ANY GLORY?

Dr. Salaba responds,
WELL, I JUST THINK THAT
THAT'S SIMPLY NOT TRUE.
WE AREN'T ABLE -- LIKE,
PRACTICES ARE STRESSED OUT AND
WE'RE UNABLE TO PROVIDE THE SAME
QUALITY OF CARE THAT PATIENTS
RECEIVE IN OTHER PARTS OF THE
COUNTRY.
SO I DON'T THINK THAT THE
GOVERNMENT IS SUCCESSFULLY
PORTRAYING IT THAT WAY.
OUR PATIENTS ARE SUPPORTIVE.
THEY VALUE THE SERVICES THAT WE
PROVIDE.
THEY VALUE THE TIME THAT WE TAKE
WITH THEM.
WE HELP THEM NAVIGATE VERY
STRESSFUL SITUATIONS IF ANYTHING
EVER HAPPENS TO THEIR VISION AND
THEY APPRECIATE THAT.
THE PATIENTS ALSO UNDERSTAND
THAT A $5 INCREASE OVER
THIRTY-TWO YEARS IS RIDICULOUS,
AND THEY UNDERSTAND THAT THE
GOVERNMENT IS PLAYING GAMES.
SO, YOU KNOW, WE WANT TO WORK
WITH THE GOVERNMENT TO FIX THIS
PROBLEM, AND WE WANT TO BE ABLE
TO REINSTATE OUR SERVICES AND BE
ABLE TO START TAKING CARE OF
PATIENTS AGAIN.

Paikin says,
UNDERSTOOD. DR. SHELDON SALABA,
PRESIDENT OF THE ONTARIO
ASSOCIATION OF OPTOMETRISTS. WE
APPRECIATE YOU SHARING YOUR VIEWS
ON TVO TONIGHT. THANK YOU

Dr. Salaba replies,
THANK YOU VERY MUCH. TAKE CARE.

Text reads, “Optometrists Turn OHIP Patients Away. Tvo.org/theagenda AgendaConnect@tvo.org.

Paikin adds,
AND NOW, FOR THE OTHER SIDE IN
THIS DISAGREEMENT, WE WELCOME,
IN MIDTOWN OF THE PROVINCIAL
CAPITAL: ROBIN MARTIN,
PARLIAMENTARY ASSISTANT
TO THE MINISTER OF
HEALTH AND THE PC MEMBER FOR
EGLINTON-LAWRENCE.
ROBIN, IT'S GOOD TO HAVE YOU
BACK ON OUR AIRWAVES.
HOW ARE YOU DOING TODAY?

Robin responds,
VERY GOOD STEVE.
THANK YOU. HOW ARE YOU?

Paikin says,
GOOD TO HEAR IT. NOT TOO BAD AT
ALL. LET'S JUST HIT THIS RIGHT
OFF THE TOP. DO YOU THINK IN YOUR
JUDGMENT, THE PROVINCE OF
ONTARIO HAS MADE A FAIR OFFER
TO THE OPTOMETRISTS?

Text reads, “Optometrists Turn OHIP Patients Away. The Province Responds”

Robin sits in a brightly lit room. She sits in a high-back chair in front of the emblem for the riding of Eglington-Lawrence. She wears a red blazer, hooped earrings, and glasses.

Robin says,
AS YOU'VE POINTED OUT WE MADE
A $39 MILLION OFFER WHICH IS A
RETROACTIVE PAYMENT.
WHAT WE'RE TRYING TO DO IS SHOW
GOOD FAITH TO THE OPTOMETRISTS
THAT IT'S KIND OF A CATCH-UP FEE
FOR TEN YEARS, GOING BACK TEN
YEARS, SINCE THEY'VE HAD AN
AGREEMENT, WHICH ENDED IN 2011,
AND IT GIVES THEM $39 MILLION.
THEY'RE GOING TO SEE IT ON
OCTOBER 5TH IN THEIR REMITTANCE
ADVICE AND IT WILL FLOW ON
OCTOBER 15TH. AND THAT'S
REGARDLESS OF WHETHER THE OAO
COMES BACK TO THE MEDIATION
TABLE OR ANYTHING ELSE OR
WHETHER WE GET AN AGREEMENT.
HOWEVER, YOU KNOW, IT IS A SIGN
OF GOOD FAITH AND WE'RE HOPING
THAT THE OPTOMETRISTS WILL
RESPOND IN KIND, IN GOOD FAITH BY
CONTINUING TO PROVIDE WHAT
DR. SALABA IN THE INTERVIEW
YOU'VE JUST DONE HAVE SAID ARE
ESSENTIAL MEDICAL SERVICES FOR
SENIORS AND CHILDREN AND ALSO,
YOU KNOW, SHOW US THEIR COSTS SO
THAT WE CAN COME TO AN AGREEMENT
ABOUT WHAT IS AN APPROPRIATE
FEE.

Paikin replies,
I TALKED MATH WITH HIM SO LET ME
TALK MATH WITH YOU.
HOW DID YOU ARRIVE AT THE
$39 MILLION FIGURE?

Robin answers,
WELL, IT'S BASICALLY GOING
BACK AND LOOKING AT THE
INCREASES THAT PHYSICIANS HAVE
HAD OVER THE TEN YEARS AND DOING
THE EQUIVALENT FOR OPTOMETRISTS.
SO IT'S A CATCH-UP KIND OF A
FEE.
WE'VE ALSO OFFERED TO INCREASE
THE OHIP FEE IMMEDIATELY THAT
THEY'RE BEING PAID BY 8.48%,
WHICH GIVEN THE CONSTRAINED
FISCAL ENVIRONMENT IN WHICH
WE'RE OPERATING RIGHT NOW DURING
A PANDEMIC IS GENEROUS, I THINK,
AND IS A GOOD STARTING POINT FOR
DISCUSSIONS.
WE'RE NOT SAYING THAT'S THE END
OF IT, BUT WE NEED TO SEE
EVIDENCE TO GO OVER, IN DETAIL
WHAT THEIR COSTS ARE.
REMEMBER THAT OPTOMETRISTS IN
ONTARIO PROVIDE OHIP INSURED AND
PATIENT PAID SERVICES LIKE
SELLING CONTACT LENSES AND
GLASSES AND NON-PUBLICLY INSURED
SERVICES, AND SO THEIR COSTS ARE
KIND OF COMPLEX TO CALCULATE,
RIGHT?
THEY WOULD BE DIFFERENT
DEPENDING ON PATIENT MIX, THE
TYPES OF PATIENTS THEY GET,
THEIR RENT, HOW MUCH TECHNOLOGY
THEY USE, ANY NUMBER OF THINGS
WOULD FACTOR INTO WHAT THEIR
COSTS ARE AND WHAT THEIR
REVENUES ARE, AND, YOU KNOW,
WE'RE HAVING AN INCREASINGLY
DIGITAL HEALTH CARE SYSTEM.
IT'S REALLY BURGEONING WITH
DIGITAL TECHNOLOGIES.
AND THAT'S ALSO IMPACTING HOW
OPTOMETRIC SERVICES AND OTHER
HEALTH SERVICES ARE PROVIDED.
SO WE NEED TO GO OVER ALL THIS
IN GREAT DETAIL WITH THEM.

Paikin responds,
NO, I APPRECIATE THAT.
GOING BACK TO THE MATH, LET'S
SEE IF YOU AGREE WITH HIS BASIC
PREMISE, WHICH IS THAT IT COSTS
THEM $80 TO PROVIDE THE SERVICE
AND OHIP BASICALLY REIMBURSES
$45 OF THAT.
IN OTHER WORDS, THEY'RE LOSING
MONEY EVERY TIME THEY SEE THOSE
PATIENTS.
DO YOU ACKNOWLEDGE THAT?

Robin says,
I HEAR YOU, STEVE, BUT HONESTLY
WE DON'T KNOW WHAT IT COSTS.
THAT'S WHAT THEY'VE SAID IT COSTS.
BUT WE DON'T KNOW WHAT IT COSTS
BECAUSE THAT'S WHY WE HAVE TO
GET BACK TO THE TABLE AND DO
THAT WORK AND LOOK AT ALL THOSE
SERVICES THAT THEY'RE PROVIDING
AND ALL OF THOSE THINGS I JUST
WENT THROUGH.
WE DON'T KNOW WHAT IT COSTS.
WE CAN'T JUST TAKE THEIR WORD
FOR IT.
THAT WOULDN'T BE FISCALLY
RESPONSIBLE AS STEWARDS OF
TAXPAYER DOLLARS, AND FRANKLY,
YOU KNOW, THEY'RE BEING A BIT
DISINGENUOUS ABOUT THE WAY THEY
REPRESENT THE COVERAGE OF EYE
CARE OR VISION CARE ACROSS THE
COUNTRY.
I MEAN, MANITOBA MAY HAVE A
HIGHER FEE, BUT IT PAYS IT ONLY
ONCE EVERY OTHER YEAR, NOT
COVERING EVERY YEAR, AS WE DO IN
ONTARIO.
SO THERE'S A LOT OF OTHER THINGS
TO CONSIDER.
A LOT OF PROVINCES DON'T INSURE
OR COVER OPTOMETRIC SERVICES AT
ALL, SIX OF THEM DON'T PROVIDE
SENIORS' EYE EXAMS, FIVE OF THEM
DON'T PROVIDE ANNUAL EXAMS THAT
ARE INSURED FOR CHILDREN, AND I
THINK ONTARIO IS THE ONLY
PROVINCE WHERE YOU DON'T HAVE TO
PAY FOR AN INSURED SERVICE,
PUBLICLY INSURED SERVICE, OUT OF
YOUR OWN POCKET.
SO THERE'S A LOT OF DIFFERENCES
TO CONSIDER.
AND WE'RE NOT GETTING THE FULL
PICTURE IN THE TALKING POINTS
FROM THE OAO, AND I THINK IT'S
IMPORTANT THAT WE UNDERSTAND ALL
OF THOSE THINGS SO WE CAN COME
TO AN AGREEMENT AND, YOU KNOW,
MAKE EYE CARE SUSTAINABLE ACROSS
ONTARIO, AS WE WANT TO DO.
WE WANT TO CONTINUE TO FUND
THESE SERVICES.
WE KNOW THAT THEY'RE IMPORTANT
TO PEOPLE.
I THINK DR. SALABA HIMSELF SAID
THAT THESE ARE ESSENTIAL
SERVICES.
SO NOT PROVIDING THEM AND
SENDING PEOPLE TO EMERGENCY
ROOMS IN HOSPITALS IN THE MIDDLE
OF A PANDEMIC IS VERY
DISCONCERTED.

Paikin replies,
NO, I APPRECIATE YOUR POINT.
BUT HE WOULD ALSO SAY THAT THE
USE OF THE TERM "TALKING POINT"
FOR THE MONEY INVOLVED HERE,
WHICH THEY SAY IS A THIRD PARTY
ACCOUNTING FIRM-CALCULATED
NUMBER, THIS ISN'T THEIR, QUOTE,
UNQUOTE, TALKING POINT, IT IS
SOMETHING THAT A THIRD
INDEPENDENT PARTY CAME UP WITH,
THAT IT COSTS ANYWHERE FROM $75
TO $80 FOR THEM TO PROVIDE THAT
SERVICE, AND YET OHIP ONLY
REIMBURSES ABOUT HALF OF IT,
THAT, IN THEIR VIEW THAT'S NOT
FAIR.
I STILL THINK WE NEED TO GET
BACK TO THE ISSUE OF HOW YOU
WOULD CONVINCE THEM THAT THEY'RE
IN A FAIR SITUATION WHEN THEY'RE
LOSING MONEY EVERY TIME THEY SEE
A PATIENT?

Robin states,
BUT STEVE, I'M NOT TRYING TO
CONVINCE THEM THAT THEY'RE IN A
FAIR SITUATION AND THAT THERE IS
NOTHING ELSE TO BE DONE HERE.
I'M TRYING TO CONVINCE THEM TO
COME BACK TO THE MEDIATOR'S
TABLE, TO ACCEPT THE MEDIATOR'S
CONDITION AS THE MINISTRY AND THE
GOVERNMENT HAVE DONE.
AND TO BE THERE TO LOOK AT THOSE
COSTS IN DETAIL.
WE'VE PROMISED TO SET UP A JOINT
WORKING GROUP TO DO THAT.
AND ALL WE WANT TO DO IS LOOK AT
THEIR COSTS.
THEY SAY WE'RE NOT COVERING
THEIR COSTS.
LET'S SEE WHAT THEIR COSTS ARE.
IF THEY WANT US TO COVER THEIR
COSTS, SURELY THEY SHOULD HAVE
NO PROBLEM IN SITTING DOWN WITH
US AND GOING THROUGH THAT.
THE STUDY THAT THEY COMMISSIONED
IS A REPRESENTATIVE -- WELL, IT
MAY NOT BE A REPRESENTATIVE
EXAMPLE.
IT IS SEVENTY-FOUR OPTOMETRISTS
OUT OF TWENTY-FIVE HUNDRED.
ARE ALL THEIR COSTS THE SAME?
PROBABLY NOT.
I'M SURE, LIKE I SAID, THAT MANY
OPTOMETRISTS' COSTS DIFFER GIVEN
THE NATURE OF THEIR PRACTICES
AND THAT THERE'S A WHOLE LOT OF
THINGS THAT GO INTO THAT.
SO I THINK THAT'S WHAT WE NEED
TO GET TOGETHER TO TALK ABOUT.
I JUST WANT THEM TO COME BACK,
YOU KNOW, TO TALK WITH THE
MEDIATOR, A THIRD PARTY
INDEPENDENT MEDIATOR, WHO IS
WELL-REGARDED AND TO GO THROUGH
THIS WITH US INSTEAD OF HAVING A
FIGHT IN THE MEDIA ABOUT, YOU
KNOW, ESSENTIAL MEDICAL SERVICES.
YOU KNOW, WE WANT THOSE SERVICES
TO BE DELIVERED ON AN ONGOING
BASIS TO THE PEOPLE WHO NEED
THEM.

Paikin says,
ALL RIGHT. MAYBE YOU COULD SPEAK
TO THOSE PEOPLE RIGHT NOW THEN
BECAUSE IF -- IF THEY CANNOT GET
APPOINTMENTS WITH THEIR
OPTOMETRISTS IN ORDER TO GET THE
SERVICE THAT THEY HAVE RELIED ON
IN THE PAST AND IF THEIR
OPTOMETRISTS ARE NOW TELLING
THEM, GO TO YOUR EMERGENCY
DEPARTMENT AT YOUR LOCAL
HOSPITAL AND LET THEM HANDLE IT,
WHAT ADVICE WOULD YOU HAVE FOR
THOSE PEOPLE ON HOW TO HANDLE
THAT SITUATION WHEN ALMOST
CERTAINLY THEY'LL BE WAITING
SIX, TWELVE, WHO KNOWS HOW MANY
MONTHS FOR THAT SERVICE BECAUSE
OF THE BACKLOG AND EVERYTHING
ELSE RIGHT NOW?

Robin replies,
YEAH. I MEAN, IT IS A VERY
UNFORTUNATE SITUATION.
SO MY ADVICE WOULD CERTAINLY BE
TO LOOK FOR ANOTHER OPTOMETRIST
WHO IS PROVIDING THE SERVICE
BECAUSE SOME ARE PROVIDING THE
SERVICES ON AN ONGOING BASIS, OR
GO TO THE COLLEGE OF
OPTOMETRISTS. THE COLLEGE OF
OPTOMETRISTS REGULATES
OPTOMETRISTS AND, YOU KNOW, THEY
HAVE PROFESSIONAL OBLIGATIONS TO
PROVIDE THESE SERVICES, AND THE
COLLEGE HAS SAID THAT THEY WILL
HELP PATIENTS TO ENSURE THAT
THESE PROFESSIONAL OBLIGATIONS
ARE FULFILLED AND THAT THEY ARE
GETTING THE SERVICES THEY NEED.
SO THAT WOULD BE MY ADVICE.
AND FRANKLY, I'M SORRY FOR THE
INCONVENIENCE THAT PEOPLE ARE
GOING THROUGH, BUT HONESTLY I
DON'T UNDERSTAND HOW ANYONE CAN
EXPECT TO GET A DEAL WITHOUT
COMING TO THE TABLE AND TALKING
ABOUT THE VERY ISSUE THAT THEY
THINK IS THE ISSUE, WHICH IS
OVERHEAD COSTS AND HOW THEY'RE
BEING COMPENSATED FOR THOSE.
THEY CAN'T JUST EXPECT US TO
ACCEPT ON FAITH THAT, YOU KNOW,
WHAT THEY HAVE SAID IS THE
NUMBER, FOR SOMETHING THAT IS SO
COMPLICATED, AND ALSO, YOU KNOW,
WE DON'T HAVE ALL THE EVIDENCE.
WE DON'T HAVE ALL THE
INFORMATION.
WE DO THIS WITH OTHER HEALTH
PROFESSIONALS ALL THE TIME.
WE COME TO NEGOTIATED DEALS AND
OTHER HEALTH PROFESSIONALS,
FRANKLY, THEY'LL CONTINUE TO
PROVIDE THESE SERVICES AND THAT IS
THE USUAL PRACTICE WHILE WE'RE
NEGOTIATING.

Paikin responds,
ALRIGHT, JUST FINALLY, THEN, WOULD
YOU EXPECT THEM TO BE SATISFIED
BEING THE TENTH BEST PAID
OPTOMETRISTS IN THE WHOLE
COUNTRY, BECAUSE THAT'S WHAT
THEY SAY THEY ARE RIGHT NOW?

Robin answers,
YEAH. AGAIN, I THINK THAT WE DON'T
HAVE THE FULL PICTURE OF EVEN
HOW THEY'RE PAID BECAUSE, YOU
KNOW, THEY GET PAID FOR OTHER
OHIP-INSURED SERVICES, NOT JUST
THE EYE EXAM, WHICH IS THE ONE
THEY ARE REFERRING TO, AND WE
DON'T HAVE THE FULL PICTURE OF
WHAT THEIR COSTS ARE, AND, YOU
KNOW, WHAT THEIR REVENUES ARE
GENERALLY.
SO I THINK, YOU KNOW, OUR
OPTOMETRISTS ARE GREAT SERVICE
PROVIDERS, WE WANT TO HAVE A
DEAL WITH THEM, WE RESPECT THEIR
ABILITIES AND SERVICES, BUT
HONESTLY, HEALTH CARE IN ONTARIO
IS CHANGING, AND WE NEED TO SIT
DOWN WITH THEM AND UNDERSTAND
WHAT THEIR CURRENT COSTS OF
SERVICES ARE AND WORK THROUGH
THAT TOGETHER SO THAT WE CAN
COME TO SOME KIND OF A DEAL.
AND THAT'S ALL WE'RE TRYING TO
DO.
AND IF THEY DON'T COME BACK TO
THE TABLE, I DON'T KNOW HOW THAT
HAPPENS BECAUSE I THINK, YOU
KNOW, IF YOU WANT TO NEGOTIATE
SOMETHING, YOU'VE GOT TO BE
THERE TO NEGOTIATE IT.

Text reads, “Optometrists Turn OHIP Patients Away. Produced by: Cara Stern @carastern”

Paikin adds,
THAT'S ROBIN MARTIN,
SHE IS THE PARLIAMENTARY
ASSISTANT TO THE MINISTER OF
HEALTH FOR THE PROVINCE OF
ONTARIO AND THE PC MEMBER FOR
EGLINTON-LAWRENCE.
ROBIN MARTIN, WE'RE GRATEFUL TO
YOU FOR COMING ONTO TVO TONIGHT
AND SHARING THE GOVERNMENT'S
POSITION ON THIS.
THANKS.

Robin replies, THANK YOU, STEVE.

Watch: Why Optometrists are Fighting the Province