Exclusive:
Ontario government delisting medical services deemed ‘inappropriate’
Province will eliminate OHIP coverage for up to a dozen medical services it considers outdated and “inappropriate,”
Doctors and their patients can expect some changes in how conditions are diagnosed and treated as the Ontario government prepares to eliminate OHIP coverage for up to a dozen medical services it considers outdated and “inappropriate,” The Star has learned.
The move, called delisting, follows an order by an arbitration panel that settled a contract dispute between the province and the Ontario Medical Association last winter, rejecting a cap on how much physicians are paid and requiring both sides to eliminate $460 million in services no longer deemed worthwhile.
Details are expected soon but a senior government source said nerve block injections for pain, psychotherapy sessions with medical doctors and sedation for colonoscopies will continue to be covered under the Ontario Health Insurance Plan.
“Any service that’s being considered is because it’s the best expert evidence that tells us they’re duplicative, outdated or unnecessary,” the source told the Star, speaking on condition of anonymity to discuss internal matters.
“The government would never accept any proposals that would negatively impact patient care.”
A proposal for services to be delisted has been put forward by a joint committee of Premier Doug Ford’s Progressive Conservative government and the OMA, which represents Ontario’s 31,000 practising doctors.
The Star highlighted problems with unnecessary treatments as part of a recent series on physician billings.
The province’s representative on the joint committee is Dr. Joshua Tepper, a family physician and former assistant deputy minister of health who is now president and chief executive officer of North York General Hospital.
For the OMA, it is Dr. Paul Tenenbein, a neuro-anesthesiologist at Toronto Western Hospital and an assistant professor at the University of Toronto medical school.
“We’re confident that the proposals put forward are thoughtful and will actually improve the patient experience,” the government source added.
Recent changes in evidencebased care include a 2011 decision to replace sinus ultrasounds with CT scans or endoscopies because they proved more effective in diagnosing problems and, a year later, limiting coverage of routine presurgical electrocardiograms unless the heart test is deemed medically necessary.
In 2013, hyperbaric oxygen therapy was added as an OHIP-insured treatment for idiopathic sudden sensorineural (inner ear) hearing loss — more commonly known as sudden deafness — when treated concurrently with corticosteroids within 14 days of a diagnosis made or confirmed by an otolaryngologist.
OHIP services have also been cut for purely financial reasons, such as decisions by the McGuinty Liberal government to eliminate chiropractic care, optometry examinations and some physiotherapy as “less critical” services in its 2004 budget, cuts that it blamed on a steep budget deficit left by the previous PC administration.
As part of the province’s latest binding arbitration deal with the OMA earlier this year, a threemember panel headed by veteran lawyer and mediator William Kaplan directed both sides to form an “appropriateness working group” to look at cutting or limiting inappropriate or overused physician services worth $100 million this fiscal year and $360 million next year.
Both the Canadian Institute for Health Information (CIHI) and Choosing Widely Canada — a group formed five years ago to push for a reduction in unnecessary tests and treatments in health care — estimate as much as 30 per cent of medical services are inappropriate given the latest scientific evidence.
“It’s to realize better value for the money we are spending,” the government source said, adding that the changes could aid in lowering wait times.
In just one of dozens of examples on its website, Choosing Widely says X-rays for minor ankle injuries in adults are not necessary unless, among other potential red flags, the patient cannot bear weight for four steps. CT scans for minor head injuries have also been ordered excessively.
Other examples of unnecessary services on the group’s website, with citations of scientific studies, include:
> colonoscopies are not necessary for constipation in adults under 50 if there is not a family history of colon cancer;
> annual blood screening tests are not necessary unless “directly indicated by the risk profile of the patient;”
> routine pap smears are not needed for women under 21 or over 69;
> hospital dentists should not replace fillings just because they are old.
There is pressure on the government to cut medical costs given increasing pressures on the health system by Ontario’s growing and aging population.
Ontario pays doctors $12 billion in compensation every year, accounting for about 22 per cent of the health ministry’s $56-billion budget.