Latest news with #CSFs
Yahoo
01-05-2025
- Health
- Yahoo
Acute Care Alberta extends contract with private surgery clinic at centre of conflict of interest probes
The Alberta agency overseeing acute care has granted a six-month contract extension to a private surgical clinic whose previous provincial government contracts are the subject of several ongoing probes. In a $1.7-million wrongful dismissal lawsuit filed in February, ousted former AHS CEO Athana Mentzelopoulos alleges she received political pressure to renew contracts with chartered surgical facilities (CSFs) that she believed were overpriced. Her lawsuit alleges she had been fired after launching an investigation into various contracts with links to government officials. Alberta's auditor general, Alberta Health Services (AHS) and a retired Manitoba judge appointed by the province are among the agencies investigating the province's health procurement and contracting processes. Mentzelopoulos raised concerns about several issues with different contracts, including a orthopedic surgery contract signed with an Edmonton-based company, Alberta Surgical Group (ASG). She alleges AHS was paying higher rates per procedure compared to other vendors. Alberta Health Minister Adriana LaGrange and AHS have filed statements of defence in the Court of King's Bench, denying the allegations. They said Mentzelopoulos was fixated on suspicions of wrongdoing, and standing in the way of the government's plan to restructure Alberta's health system. Mentzelopoulos has refuted these claims. Neither Alberta Surgical Group, nor any of the company's owners, responded to requests for comment about the contract extension on Wednesday. The company has previously denied any conflicts or wrongdoing. Health minister says Edmonton needs surgical capacity When the allegations became public in February, an AHS spokesperson said the authority had paused the awarding of surgical contracts under review, then later clarified that the pause was limited to "new surgical contracts." ASG was under contract from November 1, 2022, to April 30, 2025, to perform orthopedic surgeries in the Edmonton area. The maximum value of the contract for the entire time period is listed at about $70.5 million, but details of each procedure's cost are redacted from the publicly posted agreement. Alberta Surgical Group has a private surgical clinic in Heritage Valley, on Edmonton's south side. It has contracts with public health agencies to perform publicly funded orthopedic and ear, nose and throat surgeries. (Jamie McCannel/CBC) On April 1, the government transferred the authority to sign surgical contracts over to the new Acute Care Alberta agency, which will be responsible for overseeing hospital-based care and CSFs in the province. On Monday, LaGrange's press secretary said Acute Care Alberta had extended ASG's contract for six months. In the legislature on Tuesday, Premier Danielle Smith said the many ongoing investigations had delayed the startup of a new private surgical centre scheduled to open on the Enoch Cree Nation, just west of Edmonton. "We're not going to cancel thousands of surgeries for hip and knee replacements," she said. LaGrange told reporters Wednesday the Enoch facility had already won a bid to provide surgeries in the Edmonton area once it was up and running, which it is expected to be in 2026. Her press secretary said in a statement that extending the contract with ASG for six months gives Acute Care Alberta time to finish contract negotiations with Enoch, and allows retired Manitoba Justice Raymond Wyant's government-ordered investigation to conclude. LaGrange said Wednesday the province needs to keep thousands of surgeries going at ASG to tackle the long wait times for orthopedic procedures. "While we are completing over 60 per cent [of surgeries] in clinically approved times, we want that number to get to 100 per cent," she said. Cost of contract extension not public The details of the contract aren't yet public. Alberta Health Services has posted copies of previous CSF contracts online, including details such as the estimated total cost, and the maximum cost the vendor can charge for services. Neither LaGrange nor Acute Care Alberta would say how much the contract is for, the cost per procedure, or the volume and type of procedures ASG is expected to perform. Acute Care Alberta spokesperson Holly Budd said a version of the contract will be posted publicly once it is "fully executed." LaGrange said Alberta is moving to a health funding model where service providers are paid based on the volume of work they do partly to shed more light on the cost of care. NDP health critic Sarah Hoffman told reporters Wednesday it is "completely inappropriate" for a provincial agency to extend a contract with ASG while so many related investigations are underway. Hoffman said health agencies had time to formulate a backup plan to provide surgeries elsewhere. "We have hospital operating rooms that aren't working full capacity. They could staff up and properly move forward with public health care, but they're choosing to continue full speed ahead at privatization, and that's wrong," she said. While criticizing public hospitals' ability to complete more surgeries, the government has also made it more difficult for AHS to do procedures, Hoffman said, including an unwillingness to pay for overnight coverage for patients to have joint replacement surgeries at the Royal Alexandra Hospital's Orthopedic Surgical Centre. Keeping secret the details of the contracts also fosters public distrust, Hoffman said.
CBC
01-05-2025
- Health
- CBC
Acute Care Alberta extends contract with private surgery clinic at centre of conflict of interest probes
The Alberta agency overseeing acute care has granted a six-month contract extension to a private surgical clinic whose previous provincial government contracts are the subject of several ongoing probes. In a $1.7-million wrongful dismissal lawsuit filed in February, ousted former AHS CEO Athana Mentzelopoulos alleges she received political pressure to renew contracts with chartered surgical facilities (CSFs) that she believed were overpriced. Her lawsuit alleges she had been fired after launching an investigation into various contracts with links to government officials. Alberta's auditor general, Alberta Health Services (AHS) and a retired Manitoba judge appointed by the province are among the agencies investigating the province's health procurement and contracting processes. Mentzelopoulos raised concerns about several issues with different contracts, including a orthopedic surgery contract signed with an Edmonton-based company, Alberta Surgical Group (ASG). She alleges AHS was paying higher rates per procedure compared to other vendors. Alberta Health Minister Adriana LaGrange and AHS have filed statements of defence in the Court of King's Bench, denying the allegations. They said Mentzelopoulos was fixated on suspicions of wrongdoing, and standing in the way of the government's plan to restructure Alberta's health system. Mentzelopoulos has refuted these claims. Neither Alberta Surgical Group, nor any of the company's owners, responded to requests for comment about the contract extension on Wednesday. The company has previously denied any conflicts or wrongdoing. Health minister says Edmonton needs surgical capacity When the allegations became public in February, an AHS spokesperson said the authority had paused the awarding of surgical contracts under review, then later clarified that the pause was limited to "new surgical contracts." ASG was under contract from November 1, 2022, to April 30, 2025, to perform orthopedic surgeries in the Edmonton area. The maximum value of the contract for the entire time period is listed at about $70.5 million, but details of each procedure's cost are redacted from the publicly posted agreement. On April 1, the government transferred the authority to sign surgical contracts over to the new Acute Care Alberta agency, which will be responsible for overseeing hospital-based care and CSFs in the province. On Monday, LaGrange's press secretary said Acute Care Alberta had extended ASG's contract for six months. In the legislature on Tuesday, Premier Danielle Smith said the many ongoing investigations had delayed the startup of a new private surgical centre scheduled to open on the Enoch Cree Nation, just west of Edmonton. "We're not going to cancel thousands of surgeries for hip and knee replacements," she said. LaGrange told reporters Wednesday the Enoch facility had already won a bid to provide surgeries in the Edmonton area once it was up and running, which it is expected to be in 2026. Her press secretary said in a statement that extending the contract with ASG for six months gives Acute Care Alberta time to finish contract negotiations with Enoch, and allows retired Manitoba Justice Raymond Wyant's government-ordered investigation to conclude. LaGrange said Wednesday the province needs to keep thousands of surgeries going at ASG to tackle the long wait times for orthopedic procedures. "While we are completing over 60 per cent [of surgeries] in clinically approved times, we want that number to get to 100 per cent," she said. Cost of contract extension not public The details of the contract aren't yet public. Alberta Health Services has posted copies of previous CSF contracts online, including details such as the estimated total cost, and the maximum cost the vendor can charge for services. Neither LaGrange nor Acute Care Alberta would say how much the contract is for, the cost per procedure, or the volume and type of procedures ASG is expected to perform. Acute Care Alberta spokesperson Holly Budd said a version of the contract will be posted publicly once it is "fully executed." LaGrange said Alberta is moving to a health funding model where service providers are paid based on the volume of work they do partly to shed more light on the cost of care. NDP health critic Sarah Hoffman told reporters Wednesday it is "completely inappropriate" for a provincial agency to extend a contract with ASG while so many related investigations are underway. Hoffman said health agencies had time to formulate a backup plan to provide surgeries elsewhere. "We have hospital operating rooms that aren't working full capacity. They could staff up and properly move forward with public health care, but they're choosing to continue full speed ahead at privatization, and that's wrong," she said. While criticizing public hospitals' ability to complete more surgeries, the government has also made it more difficult for AHS to do procedures, Hoffman said, including an unwillingness to pay for overnight coverage for patients to have joint replacement surgeries at the Royal Alexandra Hospital's Orthopedic Surgical Centre.
CBC
18-03-2025
- Health
- CBC
How province kept rein on health contracting, despite what Danielle Smith says
Social Sharing The provincial government has for years kept a hand in the contracting-out of private surgeries through Alberta Health Services, despite repeated comments by the premier and health minister that any potential issues with procurement are AHS's own responsibility. Multiple documents obtained by CBC News show direct interventions by Alberta's health minister into AHS contracting matters, as well as entities specifically set up to give the health ministry more oversight and influence in recruiting and dealing with private contractors. The RCMP, auditor general and the government itself have launched investigations into AHS contracting in the wake of allegations made by former AHS CEO Athana Mentzelopoulos, including those in a wrongful dismissal lawsuit. Statements of defence from both Health Minister Adriana LaGrange and the agency say Mentzelopoulos was terminated not because she was investigating contracting issues, but because she was failing to carry out her duties. Both Premier Danielle Smith and LaGrange have insisted several times in recent weeks that any improper procurement decisions made regarding chartered surgical facilities would fall to the health agency instead of government. "This is all internal to AHS. This is all AHS procurement," the premier told reporters on Feb. 19. "They were the ones who drafted the directives. They were the ones who went out and received the bids. They were the ones who chose the proponent. And then they were the ones who were charged with the task of negotiating the terms of the agreement. The only role that the minister or government had was saying, 'Are you done yet? Have you got to the finish line yet?'" But four months before the premier's remark, LaGrange issued a ministerial directive that specifically ordered AHS to extend a contract with an Edmonton private surgery clinic, and laid out the specific surgery volumes as well as the prices Alberta Surgical Group (ASG) would be paid per procedure — up to $10,500 for each knee or shoulder surgery. According to a copy obtained by CBC News, LaGrange's directive on Oct. 18 also allowed her department to "direct and lead any negotiations that AHS is having, or will have, with respect to any agreements or possible agreements touching on or concerning CSFs." In late December — weeks before Mentzelopoulos was terminated — an Alberta Health senior official wrote to the then-CEO that based on the directive, the ministry would take over all "due diligence" regarding proponents of proposed chartered surgery centres in Lethbridge and Red Deer, according to a letter CBC News obtained. According to LaGrange's statement of defence, the minister took action because the ex-CEO was "dragging her heels" on health reforms and the contract with Edmonton's ASG was set to expire at month's end. With the directive, the minister "intervened and expedited the removal of the contract with ASG from AHS's oversight" and "to mitigate the obvious adverse effects on patients" due to there being no alternative surgical capacity if ASG's contract expired. In LaGrange's legal statement and during question period, she's said she had to issue several directives during Mentzelopoulos's tenure at AHS to get the CEO to carry out provincial reforms. But over the same period, the province was making structural reforms to assume control over AHS procurement. In November 2023, when LaGrange announced the dismantling of AHS into four different oversight agencies (and before Mentzelopoulos became CEO), the province launched a Procurement and Systems Optimization Secretariat to manage contracting for those agencies and AHS. "As part of the stand-up of the secretariat, certain functions from contracting, procurement and supply management have transferred from Alberta Health Services to Alberta Health," LaGrange spokeswoman Jessi Rampton said in an email. This transfer has been occurring incrementally since late 2023, she added. LaGrange's procurement secretariat and directives are not the full extent of the minister's or government's interventions into AHS's contracting with private vendors. It's gone back several years, and even several health ministers, to the earlier days of the UCP government. In 2020, when Tyler Shandro was health minister, the department created a different secretariat. This one, called the Health Contracting Secretariat, had a stated mandate to "advise on the design and implementation of innovative procurement approaches, contracts and funding models for clinical services with independent providers." CBC News has learned the ministry's secretariat was overseen by a steering committee, composed of senior officials from the ministry and AHS. Several committee briefing presentations and action logs obtained by CBC News detail the various occasions on which a minister or the ministry influenced the contracting process. In fact, decisions from the secretariat required approval from both the AHS board and minister until March 2021, at which point the minister only needed to be "consulted as needed." But even weeks after that, a "decision by minister" led to expand the scope of services for a chartered orthopedic surgery contract. The document mentions several "minister requests." Among them for the secretariat to discuss contract bidding opportunities with the then-chief of Enoch Cree Nation — where one contracted facility is slated to be located — to craft procedure cost comparisons, and to explore the feasibility of a short-term contract for surgeries in Lethbridge. In a written statement, Shandro confirmed the secretariat gave "advice and oversight" on contracted surgical facilities, which the UCP had intended to bring in to help lower surgical wait times. "In particular, the secretariat provided market research to help advise on business terms that would bring predictability and stability to ensure that multiple proponents bid on RFPs," said Shandro, who was health minister from 2019 until fall 2021. But according to one former AHS executive who was on the secretariat's steering committee, its role was more extensive and wide-ranging. "The government was very involved with the whole contracting-out process, and the health contracting secretariat was their vehicle to move that along," said Braden Manns, interim vice-president for provincial clinical excellence until he left AHS in 2023. "One of its main jobs was to manage and increase surgical contracting to for-profit surgical facilities. What kinds of services would they contract out? How would the process of review happen? What information would the reviewers see?" Manns, who has been critical of AHS restructuring since leaving the agency, calls Smith's assertion that procurement is all internal to AHS "absolutely false." The ministry's contracting secretariat continued when Jason Copping took over the health portfolio after Shandro. It would help guide AHS as it contracted out home-care services and some diagnostic procedures. "Pause potential endoscopy procurement based on minister direction — prioritize and focus on completion of regional CSF procurement(s)," stated a July 6, 2022 briefing to the secretariat's steering committee. The following week, another steering committee got a debrief of a meeting with the minister which confirmed what sort of chartered surgical facility AHS would procure in Red Deer and Lethbridge, and that it wouldn't pursue a private provider for the health zone north of Edmonton. Copping did not reply to a request for comment. After Smith replaced Jason Kenney as premier in late 2022, the health contracting secretariat continued to oversee AHS procurement. An internal AHS report in late November 2022 updated officials on bids for the proposed Red Deer chartered surgery centre. Included in "next steps" recommended before selecting a developer: "Informing Health Contracting Secretariat." Although it does not appear the contracting secretariat had a hand in AHS's procurement of Turkish ibuprofen and acetaminophen in 2022, Copping had issued a ministerial directive on Dec 1, 2022. It ordered AHS to secure the medication, and guaranteed the ministry would fund the purchase. This was five days before the purchase was announced publicly by Smith and Copping. Smith and LaGrange have both declared they want the investigations to reveal if anything went wrong with procurement. "If there is a problem with procurement, it is a problem internal to AHS. This health minister is trying to get to the bottom of it," Smith said during question period last month. LaGrange called AHS "a big black box that we have not been able to look into for a very long time, and that has to end." Alberta Health decommissioned the Health Contracting Secretariat in mid-2023, shortly after LaGrange became health minister, Rampton confirmed last week. This was months before the minister would set up a new secretariat to gradually assume all contracting responsibilities from AHS. Rampton did not directly answer a question about how to reconcile the various directives and secretariat-related activities with statements by the minister and premier that the procurement process is internal to AHS. "By the letter of the law, that's the way it ought to be, though not necessarily the way that it is," said Tom Noseworthy, professor emeritus in health policy and management at University of Calgary. A former AHS executive himself from 2011 to 2015, Noseworthy said in an interview that government interference in the agency's operations predates the UCP coming to power, and that he believes most of his past colleagues would agree. "If they're ever honest with you, they'd say hardly a day would pass without some sort of interference, intervention, a phone call or some sort of problem associated with Alberta Health riding herd on Alberta Health Services," said Noseworthy, who was an associate chief medical officer. He was disheartened that it's going on in procurement, "where objectivity and high-quality due diligence and non-interference from political sources is quintessential," he said. "You risk having political choices rather than evidence-based choices that are in the best public interest." A government's best role is to set broad goals for procurement or other functions of a hospital agency, and systems to keep an agency accountable, but they should avoid deeper involvement, said Rosalie Wyonch, lead of the health care policy initiative at the C.D. Howe Institute. But politics cannot be fully removed because it's the provincial government's responsibility to administer the public health system. "Eventually the buck stops with the health minister," Wyonch said. In last October's directive on chartered surgical centres, LaGrange notes that the Provincial Health Agencies Act allows the minister to "do any thing the minister considers necessary to carry out the minister's responsibilities for the strategic direction of the health system." That directive came after her frustration with the pace of progress of chartered surgical contracts whose successful bidders were confirmed years earlier, before she was minister. "All of these contracts are pre-me," LaGrange said in question period last month. "But, again, I want to notify everyone that I had to submit 18 directives to AHS to get information and co-operation."
CBC
26-02-2025
- Health
- CBC
Ousted Alberta Health Services boss warned of private surgery prices, documents show
The former head of Alberta Health Services Athana Mentzelopoulos tried to caution the government about the potential impact of chartered surgical facilities on the provincial health-care system months before she was fired, CBC has learned. Mentzelopoulos earlier this month filed a $1.7 million wrongful dismissal suit alleging she faced government pressure to sign off on commitments for new chartered surgical facilities (CSFs). One of those was an approval of a contract extension for one vendor, Alberta Surgical Group (ASG), despite concerns she had that the costs were high compared to other contractors. In a draft letter obtained by CBC News and referenced in her statement of claim, Mentzelopoulos wrote that "AHS remains committed to supporting CSFs and their role in the health system and recognizes the value that they bring including additional surgical capacity and improved access for scheduled surgeries." But she also noted there are challenges as well. She said that in addition to chartered surgical facilities costing more than the public system, there was concern they could siphon off critical staff from hospitals. "These disruptions will have negative consequences for patients and communities, limiting timely access to emergent, urgent and medically complex surgeries such as cancer, general surgery, orthopedic and vascular surgery," she wrote The Oct. 1 letter was emailed to Darren Hedley, who at the time was associate deputy minister of health. The letter was addressed to Health Minister Adriana LaGrange but Mentzelopoulos, in her email, suggested that it should be sent to then-deputy health minister Andre Tremblay. CBC News has not verified whether LaGrange or Tremblay viewed the letter. Mentzelopoulos wrote that "[chartered surgical facilities] continue to demand higher pricing than the equivalent comparable cost within AHS and with other surgical providers." She added health-care staff may choose to work in those private facilities over the public system because they can offer higher incomes, more flexible schedules and fewer on-call requirements. A limited workforce and budget will increase the chances of "acute care service disruptions" across the province, she wrote. Mentzelopoulos made several recommendations, such as ensuring chartered facility pricing "not exceed the validated AHS internal costs" and that funds "not be provided for services that do not occur." On Oct. 18, weeks after the letter was shared with Hedley, LaGrange issued a directive ordering the provincial government to take over contract negotiations with chartered facilities. 'Recognized the risk' Mike Parker, president of the Health Sciences Association of Alberta, reviewed Mentzelopoulos's letter and said it raised red flags. "As an employee at that time, as the CEO of AHS, she recognized the risk in all of this conversation. She was doing her due diligence and reporting that risk into the ministry," Parker said. "Public health-care is for the patients and private surgical facilities are for the profits and they do not see eye to eye in their models." Stirling Bryan, a health economist at University of British Columbia, said the message of Mentzelopoulos's comments in the letter are "fair." "We're in a workforce crisis, that some people say, in health-care in Canada at this point," he said, adding there is a limited supply of workers. "Undoubtedly in the short-term at least, there would be some adverse consequences." However, he notes that publicly-funded private provision of health-care acts as a pressure valve for the health-care system. "We have long wait lists and people see this as an opportunity, potentially, to actually relieve waiting lists by having extra capacity for surgeries and for delivering care in the private sector to complement the services that are provided in the public sector," Bryan said. He said the procedures in the private system are typically more expensive than the public system but he said that it allows for more operations to be done, thereby easing wait lists. However, Bryan said private surgeries should be approached with caution. "It's a short-term fix that shouldn't be seen as something that can solve a systemic problem that we have in the system," he said. When asked about the concerns in the letter at an unrelated press conference Monday, Alberta Premier Danielle Smith said the public system is well resourced. Price comparison In the letter, Mentzelopoulos also includes a table that compares AHS costing for hip, knee and shoulder replacement surgeries with private providers like ASG and Clearpoint. While a hip replacement would cost $4,044 with AHS, it would cost $8,303 at ASG and $3,622 at Clearpoint. The table shows a shoulder replacement would cost $4,833 with AHS, $11,243 at ASG and $3,875 at Clearpoint. A knee replacement would cost $4,036 with AHS, $8,510 at ASG and $3,276 at Clearpoint. Rose Carter, a lawyer representing ASG, said the company's contract with AHS contains a confidentiality clause that prohibits it from disclosing anything related to the contract "Thus, ASG is unable to publicly defend itself," Carter said in an email. She instead pointed to numbers from Canadian Institute for Health Information (CIHI). "ASG's numbers are below those previously reported in the press," Carter said. When asked about the difference in pricing, Smith disputed Mentzelopoulos's numbers, saying that she relies on numbers from CIHI. That data, which includes inpatient costs, shows the mean cost of a hip replacement in Alberta in 2021-2022 was $10,737. The AHS data, according to the letter, excludes costs covered by the health authority, such as implant device costs, clinical lab services and diagnostic imaging. When pressed on the contrasting figures, Smith said Mentzelopoulos's numbers were incorrect. "When AHS claims that they have a lower cost structure and they only include half the cost, I'm sorry, there's no credibility to that," Smith said on Monday. "We can't be making up numbers with Alberta Health Services in order to make it look like chartered surgical facilities are more costly." When asked whether her government would be okay with paying more for surgeries in private facilities, Smith said she "would hope not." "The notion behind chartered surgical centres is exactly that, that they are supposed to be able to offer surgery at a lower cost. And so, I guess, that's the question is, what is the actual cost?" she said. Bryan, the health economics professor, also examined the chart and called the private cost of a procedure double what it is in the public system "a little surprising." He said, with confidentiality agreements normally part of contract signing, it is difficult to ascertain what the price differentials are. "I would be alarmed at that sort of differential if this was seen as a long-term fix for the health-care system and for the provision of elective surgery in an Albertan or Canadian context," he said.
