OHIP fee changes will be painful for patients, doctor predicts

HEATHER BOA Bullet News GODERICH – Family doctors in Huron County are still wondering who will pay for six weeks of X-rays, CT scans and MRIs they ordered in response to complaints of lower back pain by their patients, says the president of the Huron County Medical Society, which represents about 100 doctors across the county.

As part of the $338 million of health care savings to the $11-billion OHIP program in 2012-13, in early May the Ontario government said it would no longer cover these tests ordered by a doctor unless they meet a strict set of criteria. In addition, it said the change would be retroactive to April 1, which could leave doctors to pay the tab for these tests.

If it doesn’t meet the criteria, there is a provision in the wording that the cost of the tests will be reclaimed from the doctor regardless of what the finding is.

“I’ve declined people X-rays because even though maybe it’s reasonable because they no longer qualify I wasn’t prepared to pay for it and they don’t have the capacity to pay for it themselves,” said Dr. Stan Spacek, a family doctor who practices in Goderich.

As well, patients whose tests were ordered before the announcement were turned down by the radiologist because they no longer qualified and were sent back to their family doctor.

Changes to the OHIP schedule of benefits for doctors stipulates that tests for low back pain can only be ordered if a specific disease or condition is suspected or know, such as osteoporosis, infection or tumour. It’s meant to cut out patients who have chronic lower back pain that can be prevented through care.

“The entire belief of early prevention and detection is trumpeted through cancer screening and other modalities and throughout the health care system,” Spacek said. “This goes counter it. It also increases the liability and the legal aspect of the legal costs to the system because eventually patients will realize there was a delay because of government policy.”

He also said the change is restrictive, leaving no room for family doctors to make decisions based on individual circumstances.

“Making medicine a straight flow chart takes away the art and knowledge and some of the other things that come into play. It has to be individualized and leaving some room for that is necessary,” he said.

Spacek said the delisted services will have a greater impact in Huron County, which has a growing population of elderly people. By 2036, it is projected that 30 to 35 per cent of Huron County’s population will be over the age of 65.

“I think the impact is higher because back pain isn’t often just a strained muscle in the older group. There are other more sinister things that hide as back pain – cancer, nerve compression and so forth. Yes, I think the possibility of bad things being missed is greater in an older group because more sinister things show up as back pain,” he said.

Spacek said changes were announced after contract negotiations between the government cut off talks with the Ontario Medical Association, with the government refusing to come back to the table. He said a zero increase in fees for two years and $250 million in efficiencies the OMA suggested during negotiations were flatly rejected by the province.

The province announced earlier this year it is moving toward what it calls a wage freeze for the province’s 25,000 doctors in order to invest health care dollars in community care for families and home care for its seniors. It intends to update fees paid to doctors, which is how most of them earn their income.

Spacek said no one argues changes are required but he maintains doctors should be included in the process to find savings in the health care system. He said there are other ways to find savings, such as: limiting the coverage of medications, which are getting more expensive; developing guidelines for doctors, nurses, patients and all involved that are efficient and evidence-based; giving power locally for people to make decisions; educating the public so that their expectations are in line with costs; and providing the OMA with some leeway.

On July 9, Ontario’s doctors officially filed documents with the Ontario Superior Court to review the provincial government’s negotiating tactics. Dr. Doug Weir, who is president of the Ontario Medical Association, said the government has denied Ontario’s doctors’ right to negotiate in good faith under Canada’s Charter of Rights and Freedoms.

As a result, Ontario’s doctors will ask the Superior Court to confirm the OMA’s representational rights on behalf of doctors in negotiations with the government, reverse the unilateral cuts that were announced May 7, and order the government back to the table to engage in meaningful discussions with the OMA.

The HCMS is considering hosting a town hall meeting to explain the impact of changes on local residents, much like town hall meetings the OMA is hosting in urban centres.

The province has also reduced payment by about 70 per cent for lab work ordered by local doctors at the Maitland Valley Medical Centre. The change makes it unfeasible for the centre to run the lab, since it operated on a cost recovery basis. The only way to maintain status quo would be for doctors to subsidize the lab.

“That’s not the kind of charity we want to be told to do,” Spacek said.

The doctors are in talks with a private company, Gamma Dynacare Medical Laboratories, to consider whether it would run the lab, in which case the province would return the funding level back to 100 per cent, Spacek said.

“Gama Dynacare would charge the same amount that the family doctors charged.

It’s a shift in funding to private institutions of what was perceived to be going to the doctors,” he said.

If the lab closed, the Alexandra Marine and General Hospital would have to absorb the cost of increased use of its lab, since it receives set funding from the province.

The average Ontario doctor bills $385,000 and many specialists billing twice that much. From that, they pay all the administrative and overhead costs associated with running a practice. Those costs are somewhere between 25 and 40 per cent, according to estimates.


Written by on August 8, 2012 in Communities, Community News - No comments

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