Doctor relishes position as reformer

The 1970s were in full swing, the NDP was in government, and Les Vertesi, a young emergency doctor, was first bitten by the innovation bug. At 29, Dr. Vertesi found himself medical director of the province's new ambulance service, one of many legacies from B.C.'s initial foray into socialism.

He quickly devised training courses for the spanking-new paramedics, who then had to be officially certified for duty. Over lunch, Dr. Vertesi told a deputy minister what was needed. The deputy wrote it down on a paper napkin. Within a week, Dr. Vertesi recalls with relish, the required regulations were in place, and certified paramedics were on the job. The training standards he set in place were eventually followed across the country.

There were further, medical-planning breakthroughs along the way, plus a book, Broken Promises, about the need to reform Canada's health-care system.

"I've always been a person who likes to start things, to change things," Dr. Vertesi says.

And now, decades after his pioneering work with the ambulance service, the passionate physician may have left his most significant mark yet on the delivery of health care.

For the past three years, Dr. Vertesi has spearheaded a groundbreaking program aimed at changing the way money-gobbling B.C. hospitals have been funded since medicare began.

Known as patient-focused funding, the program rewards hospitals for specific operations and meeting performance targets, such as moving more patients through emergency within a certain time. This was a big change from the traditional practice of government simply handing over huge chunks of money to the province's hospitals, regardless of how they spend it.

Given his background, it was no surprise that Dr. Vertesi was chosen to take on the task, which was run through an independent arm of government with the ungainly title of the B.C. Health Services Purchasing Organization.

Although the money doled out by the HSPO since its launch in 2010 has been relatively modest, totalling less than 2 per cent of the billions still provided to B.C. hospitals in the old way, results were impressive.

With cash incentives for participating hospitals, waiting times for surgery were cut, more patients were treated quicker in emergency wards, and many frail, elderly patients were kept out of hospital beds, after the HSPO began paying $90 a day per patient for home care.

"We tried to use money in a different way, putting more focus on patients getting actual services," Dr. Vertesi says. "It puts the patient in the driver's seat."

The experiment in patient-focused funding, commonplace in Europe, has attracted interest from across the country, and Dr. Vertesi is a regular participant at conferences on Canada's health-care system.

But it hasn't been easy. Dr. Vertesi has gone through four health ministers since the program was launched. There have been some kinks, some ruffled feathers among those not enamoured by Dr. Vertesi's approach, and not every health authority embraced the idea. In fact, somewhat surprisingly, the HSPO was unable to spend about a third of its budget.

Rather than a flaw, however, that illustrates the program's virtue, Dr. Vertesi says. You only got the money if you provided a specific service. If you didn't, the money stayed with the HSPO, he points out.

Despite the HSPO's achievements, however, the government has now decided to wind down the organization and administer its program within the Health Ministry, placing more emphasis on financial penalties for not meeting targets than rewards for exceeding them.

Health Minister Terry Lake insists the move had nothing to do with any perceived shortcomings of the vanguard program, but was prompted rather by its success.

"Les has taught the health authorities and the ministry how this works, and now it will be the norm," Mr. Lake says.

While somewhat disappointed his tenure at the HSPO is at an end, the 67-year-old Dr. Vertesi, who still works shifts in emergency, is convinced the genie of patient-focused funding can't be stuffed back into the bottle.

"Hospitals now measure things better and understand the value of a dollar better. This was new for Canada, and we were able to start it in B.C.," Dr. Vertesi says. "There is still a huge amount of interest in this. The conversation has started."