OHIP JOB ACTION

Optometry OHIP Dispute Fact Sheet with respect to Ministry of Health Discussion Points:

A “fair and reasonable proposal” designed to take immediate action to address years of neglect and
represent a starting point for further discussions.

Fact: The OAO has been clear since March 2021 of their reasonable ask to move forward with finding a solution for a sustainable eye care system in Ontario: a commitment to a legally binding negotiation process whereby optometrists are no longer required to subsidize OHIP-insured
services.

Fact: It is not fair nor reasonable to expect optometrists to pay out of pocket to provide OHIP-insured services.

Fact: Unlike other publicly funded service providers (ex. physicians, nurses, teachers, etc.), optometrists have NEVER had a mechanism to have regular, scheduled negotiations with the government. The government does not have a legal mandate to negotiate with optometrists therefore thegovernment has never formally negotiated with optometrists.

Fact: In the mid-2000s, the government offered optometrists a one-time lump-sum payment and a
small increase as a “starting point” for continuing negotiations. Optometrists accepted this
apparent “good faith” gesture; however, the government did not honor their “proposal” for
negotiations and instead chose to ignore optometrists once again.

Fact: In 2021, the Ministry of Health has again offered a one-time lump-sum payment and a small
increase as a “starting point” for continued negotiations, again, without any commitment. After
decades of government neglect, optometrists do not have trust in the government that this
“offer” without commitment is any different than that of the mid-2000s.

Fact: The current proposal does not ensure a sustainable primary eye care system for Ontarians.
A one-time payment of $39 million to compensate for a decade of underfunding which optometrists asked for.

Fact: Ontario optometrists provide over 4 million OHIP-insured eye care services ANNUALLY. In the last decade, Ontario optometrists provided over 34 million OHIP-insured eye care services. $39 million divided among 34 million services is ~ $1.15 per service.

Fact: Optometrists currently subsidize $173 million ANNUALLY for OHIP-insured eye care services. In the last decade, optometrists have subsidized over $1 billion for OHIP-insured eye care services.

Fact: Optometrists did not ask for a retroactive payment at all but instead asked for any payment be put toward investing in a sustainable eye care system for the future.

Fact: Almost 2200 optometrists wrote to the Minster of Health to say they want a fair deal, not a onetime payment.

Fact: The government imposed the payment but did not consult with optometrists as to how to
distribute the payment. The government sent money to optometrists who have moved to other jurisdictions, retired and deceased.

Fact: The one-time payment does nothing to solve the eye care crisis and is a waste of taxpayers’
dollars. An immediate OHIP fee increase of 8.48%, retroactive to April 1, 2021, to reflect a “catch up” of fee increases similar to what physicians received between 2011 and 2021. This is to compensate optometrists for “as they requested, the same rate of increase that physicians would have received between 2011 and the present”.

Fact: An 8.48% increase on $44.65 per exam equates to $3.79 per exam, requiring optometrists to
subsidize exams by ~40% instead of the ~45% that they do currently.

Fact: Optometrists did not request retroactive payments or compensation increases at the same rate of increase as physicians.

Fact: Physician compensation and optometrist compensation is not an “apples-to-apples” comparison for various reasons. One such reason: Ontario physicians are the second-highest paid physicians in all of Canada; meanwhile, Ontario optometrists receive the lowest compensation rates across the country.

Proposal to set up a joint working group to understand overhead costs that optometrists incur in
delivering insured services to Ontarians.

Fact: The Ministry of Health was asked to participate in a cost analysis study of overhead expenses for providing eye exams in December 2020; however, the Ministry of Health declined to participate.

Fact: In 2021, BDO conducted a cost analysis study of overhead expenses for providing eye exams in Ontario in 2019 (without compensation to the doctor) and found the overhead cost to be $75.51 (in 2019 dollars) per exam. The study specifically excluded aspects of optometry practices unrelated to the provision of eye examinations (Ex. staff/rent/utility expenses related to the retail of eyewear or provision of other services such as vision therapy, etc. were excluded from this
study). The Ministry of Health has been provided with a copy of this study.

Fact: Data on how other provinces fund eye care is publicly and readily available. The OAO has provided the Ministry of Health with this information. This data shows that Ontario optometrists are funded the least amount per service rendered compared to all other provinces that have similar, per-service public funding models to Ontario. Compensation to Ontario optometrists would need to increase by nearly 70% to reach the level of second lowest funded province, Manitoba.

Fact: Ontario costs of living and operating a business are not less than those costs in other provinces.

Fact: A “proposal” for a joint working group is not a commitment to finding a solution to a sustainable primary eye care system for Ontarians.

The OAO is not at the “table”.

Fact: The OAO never left the NEGOTIATION table and still waits for the Ministry of Health to return to the NEGOTIATION table.

Fact: While it is accurate the OAO did not accept the terms of the mediation, optometrists stand
confident in that decision as those terms would have prevented optometrists from achieving the
goal of a long-term solution. At no point did optometrists anticipate the government to walk away after only one attempt at cooperation. Mediation is a costly process and the OAO is a small organization that does not have the infinite resources required to engage in a process where one of the parties is not taking it as seriously as the other. While mediation is a method that can be
used in a negotiation process, it is not in and of itself negotiation.

Fact: The OAO has not heard from the government of Ontario since August 29th. The negotiation team remains at the bargaining table awaiting the government’s attention to this critical health care issue.

Fact: The OAO has attempted to engage in meaningful negotiation regarding this issue with the current government since June 2018 and has presented multiple proposals to address the funding and sustainability of eye care issue while respecting the government’s fiscal constraints.

Fact: Unlike other publicly funded service providers (ex. physicians, nurses, teachers, etc.), the
government does not have a legal mandate to negotiate with optometrists. To date, the
government has not committed to formal, legally binding negotiation process with optometrists.
The government will continue to fund these optometry services through OHIP.

Fact: The government will continue to underfund these optometry services, requiring optometrists to pay out of pocket to see these patients and make care compromising decisions to sustain their small businesses.

Any decision to withdraw services is the decision of individual optometrists.

Fact: Optometrists have been forced to withdraw optometric services for OHIP-insured patients due to decades of neglect from previous governments and over 3 years of inaction from this current government. Due to this neglect, the quality of service that optometrists are able to provide is suffering because the current system is unsustainable for optometrists who are small
business owners. Optometrists have been left with no other choice but to stand up for their
patients and fight for sustainable access to quality eye care.

Fact: MPPs across Ontario received notice in March 2021 that optometrists would be forced to
withdraw optometric services for OHIP-insured patients if the government did not commit to a
legally binding negotiation process whereby optometrists were no longer required to subsidize OHIP-insured services. The current government chose to be radio silent and avoid all
communication attempts with the OAO between December 4th, 2020 and August 5th, 2021 on the
issue and declared an impasse after only two days of mediation with the OAO in August.

Fact: Optometrists want to be taking care of ALL their patients instead of trying to engage the
government on an issue that should have been resolved months ago.
The OAO declined the third-party mediator’s conditions that would allow resuming of mediation.

Fact: In late August, the OAO accepted an invitation to mediation with the Ontario government to fight for high-quality eye care for our patients. After only two days, it became abundantly clear that the Ministry of Health was not there to negotiate in good faith. Instead of focusing on a real, longterm solution, the government used the process as a publicity stunt. The government breached confidentiality when disclosing confidential information to the public, and imposed a one-time payment that was never negotiated. These actions demonstrate the government’s lack of commitment to a responsible bargaining process. While it is accurate the OAO did not accept the terms of further mediation, we stand confident in that decision as those terms would have prevented us from achieving our goal of a long-term solution. At no point did we anticipate the government to walk away after only one attempt at cooperation. The fact is, mediation is a costly process. The OAO is a small organization that does not have the infinite resources required to engage in a process where one of the parties is not taking it as seriously as the other. Eye care in Ontario has been left behind for over three decades because we have blindly trusted these same disingenuous outreaches by the Ministry of Health over the years. While they talk about
building a new and better relationship, to date there have been no commitments or indication of a thoughtful plan that will ensure quality access to eye care for everyone in Ontario today, and into the future. We need reassurances that this time it is truly different. Our phone lines remain open and we patiently wait for the Ministry to reach out and discuss a genuine path forward – one built on trust and constructive dialogues. The people of Ontario deserve no less.

Fact: The OAO’s ask for a commitment to a legally binding negotiation process whereby optometrists are no longer required to subsidize OHIP-insured services has not changed since March 2021. The OAO claims that under the current cost structures, the province reimburses 55% per OHIPcovered eye exam, forcing optometrists to pay the remainder.

Fact: Eye exams were reimbursed at $39.15 in 1989 and are reimbursed at $44.65 in 2021. This
represents a 14% increase in reimbursement since 1989.

Fact: Bank of Canada’s inflation calculator indicates that inflation increased 88.87% between 1989 and 2021. At the rate of inflation, a service that cost $39.15 in 1989 costs $73.94 in 2021. The government pays $44.65 of $73.94 = 60% of the cost. The balance (40%) is paid for by the
optometrist.

Fact: In 2012, BDO conducted a cost analysis study of overhead expenses for providing eye exams (without compensation to the doctor) and found the overhead cost to be $70 per exam. Bank of Canada’s inflation calculator indicates that inflation increased 17.08% between 2012 and 2021. At the rate of inflation, a service that cost $70 in 2012 costs $81.95 in 2021. The government pays $44.65 of $81.95 = 54% of the cost. The balance (46%) is paid for by the optometrist.

Fact: In 2021, BDO conducted a cost analysis study of overhead expenses for providing eye exams in Ontario in 2019 (without compensation to the doctor) and found the overhead cost to be $75.51 (in 2019 dollars) per exam. Bank of Canada’s inflation calculator indicates that inflation increased 4.24% between 2019 and 2021. At the rate of inflation, a service that cost $75.51 in 2019 costs $78.71 in 2021. The government pays $44.65 of $78.71 = 57% of the cost. The balance (43%) is paid for by the optometrist.

The cost analysis study commissioned by the OAO was not “independent”.

Fact: A 2021 cost analysis study paid for by the OAO was conducted by BDO. BDO is an independent accounting firm.

Fact: The Ministry of Health was asked to participate in a cost analysis study of overhead expenses for providing eye exams in December 2020; however, the Ministry of Health declined to participate. It would not be reasonable or responsible of the government to agree to any other fee increase without due diligence in validating the evidence used to support such an increase.

Fact: As taxpayers, optometrists agree with this statement. Thereby, the OAO has provided multiple consistent data points for the Ministry of Health to reference.
Fact: The Ministry of Health was asked to participate in a cost analysis study of overhead expenses for providing eye exams in December 2020; however, the Ministry of Health declined to participate.

Fact: The OAO continues to reasonably ask for a commitment to a formal negotiation process whereby optometrists are no longer required to subsidize the OHIP-insured services they provide. The OAO understands that the mechanism(s) by which the government can make this happen will require time and discussions once a commitment to a formal negotiation process and to cost recovery has been made. The Ministry requires more information from optometrists on their overall overhead expenses, as well as revenue, to have a proper understanding of overhead costs for delivering OHIP-insured services.

Fact: Total revenue is irrelevant with respect to overhead expenses for provision of OHIP-insured eye care services. Revenue received as reimbursement for the provision of OHIP-insured optometry services is relevant when compared to expenses incurred for the provision of these services when establishing what proportion of the cost is funded by the government vs. the optometrist.

Fact: The Ministry of Health has been provided with a copy of the 2021 cost analysis study on the
overhead expenses to provide an eye examination.

Fact: The 2021 cost analysis study specifically excluded aspects of optometry practices unrelated to the provision of eye examinations (i.e. staff/rent/utility expense related to the retail of eyewear was excluded from this study). By saying that we need to agree to cover overhead costs, the OAO is presupposing the outcome of the negotiation. Optometrists want the government to agree to a forgone conclusion.

Fact: The OAO continues to ask for a commitment to a formal negotiation process whereby optometrists are no longer required to subsidize the OHIP-insured services they provide as a first step in the negotiation process. The OAO acknowledges that there are various mechanisms by
which this can be achieved, which may include covering 100% of overhead costs if that is the
mechanism the government chooses to pursue.

Comparisons of funding models between provinces does not provide the full context of vision care in Canada. Insured optometry services vary considerably by province, including fees paid and other
restrictions (e.g., age, elements of service, frequency of coverage, etc.).

Fact: The OAO specifically included funding models for Manitoba, Quebec, and Alberta in their
comparisons as those provinces have the most similar publicly funded fee for service models to
Ontario.

Fact: On October 12th, Jack Hauen of QP Briefing reported his own independent findings which match those presented by the OAO.

Manitoba, who pays $77, insures eye exams every 2 years whereas OHIP insures exams every year.

Fact: Optometrists in Manitoba break even on providing eye exams to insured individuals once every two years while optometrists in Ontario pay $35.35 out of pocket annually per patient, thereby paying $70.70 to see that patient over the same time period. Ontario is also the only province where patients don’t have to pay an additional amount out of their own pockets to access insured eye care services.

Fact: Patients in Ontario do not have to pay additional out-of-pocket fees for OHIP-insured services because the current reimbursement to optometrists requires optometrists to pay out of their pockets to provide these services.

The Government negotiates with health care providers all the time but no one has ever withdrawn
services.

Fact: Optometrists are not treated the same as other health care providers. No other health care
provider has been neglected for thirty-two years. No other health care provider does not have a
mechanism to formally negotiate with the government. Optometrists have not been fairly treated by the previous government.

Optometrists have not been fairly treated by both previous AND current governments.

Fact: Unlike other publicly funded service providers (ex. physicians, nurses, teachers, etc.), the
government does not have a legal mandate to negotiate with optometrists. To date, the
government has not committed to formal, legally binding negotiation process with optometrists.

Fact: The OAO has attempted to engage in meaningful negotiation regarding this issue with the current government since June 2018 and has presented multiple proposals to address the funding and sustainability of eye care issue while respecting the government’s fiscal constraints. In February 2020, the Ministry of Health informed the OAO that they did not wish to proceed with the association’s proposals to reform OHIP for eye care services.

Fact: In March-June 2020, optometry clinics were locked down due to the COVID-19 pandemic.
However, the College of Optometrists of Ontario required optometrists to ensure patients with urgent eye care concerns were managed appropriately. Countless patients depended on optometrists for their urgent eye care needs during this time and optometrists provided these tele-optometry and in-person services on a case-by-case basis to keep patients out of ERs. Despite
this, optometrists were denied tele-care billing codes for these virtual consultations and not given
priority access to PPE and instead the current Ministry of Health released an official statement at
the time stating that family doctors and nurse practitioners could provide necessary urgent eye
care services.

Fact: In June 2020, optometrists began job action as a way to re-engage the Ministry of Health in
discussions regarding the eye care crisis in Ontario. In August 2020, Doug Ford responded and
stated that the current government would work with optometrists to resolve the issue.

In November 2020, Minister Elliott met with the OAO herself and acknowledged the unfair
treatment of optometrists over the decades and stated: “It is not your responsibility (optometrists) to be paying out of your pockets for these services”. Despite this, the Ministry
of Health again failed to agree to a formal negotiation process with Ontario optometrists. On December 4, 2020, bureaucrats presented an informal proposal that would still require Ontario optometrists to subsidize over 40% of the cost of delivery. This proposal completely
ignored the core problem: service providers must not be required to cover the cost of delivering care to ensure a sustainable eye care model for the future.

Fact: Between December 4th, 2020 and August 2021, there was radio silence from this current
government despite many efforts from the OAO to engage in communication.

Fact: In March 2021, the Ontario Budget again ignored OHIP-insured eye care. Frustrated optometrists voted 96% in favour of withdrawing OHIP-insured eye care services on September 1st, 2021 if the government failed to act before that deadline. The current government made no attempt to return the OAO’s efforts at communicating until August 2021, 1 month before the service withdrawal deadline. Meanwhile, they widely shared misleading information with the public stating that they were “in discussions with optometrists” and that “funding continues to increase
year-over-year with utilization”.

Fact: In August 2021, the OAO accepted an invitation to mediation with the Ontario government to
fight for high-quality eye care for our patients. After only two days, the current government breached confidentiality when disclosing confidential information to the public, and imposed a one-time payment that was never negotiated.

Fact: These actions demonstrated the government’s lack of commitment to a responsible bargaining process and have left optometrists in a position whereby they are unable to trust this current government to resolve this issue without a binding commitment.
We don’t expect optometrists to pay out of pocket for the services that they provide.

Fact: Minister Elliott has now stated at least twice that she does not “expect optometrists to pay out of pocket for the services that they provide”. The OAO is asking for a commitment from the government whereby optometrists will not have to pay out of pocket for the services that they provide. Such a commitment will end service withdrawal. To date, the government has not provided such a commitment.

Reason for this impasse lays at the feet of optometrists, and, the government needs optometrists to “return to the table” in order to end this service withdrawal.

Fact: Optometrists never left the bargaining table. They did not agree to the third-party mediator’s
terms.

Fact: The government has the ability to end this service withdrawal today by committing to a legally binding negotiation process whereby optometrists are no longer required to pay out of pocket for the OHIP-insured services they provide.

Visit www.saveeyecare.ca and please sign our petition for adequate eye care funding for the province of Ontario.