Ontario flags specialist MD billing issue
More t han 500 doctors billed Ontario’s health insurance plan more than $ 1 million each last year, with one ophthalmologist charging what the province’s health minister called “a staggering” $ 6.6 million. Of the top five billers, two are ophthalmologists, two are radiologists and one is an anesthesiologist, but their names and where they work are not being released. The million- dollar club included 154 diagnostic radiologists, 85 ophthalmologists and 57 cardiologists. “It ’s not our emergency room physicians who are earning this kind of money,” Health Minister Eric Hoskins told reporters Friday. “It’s not our neurosurgeons who are billing over a million. It’s a very narrow category of specialists.” The top- billing doctors represent less than two per cent of physicians in the province, but cost $677 million a year, or more than six per cent of the $ 11- billion Ontario spends each year on physician compensation.
The Ontario Medical Association says physicians have already seen a 6.9 per cent cut over the last year, but the province wants to rein in fees for radiologists and other specialists.
The release intends to debunk a recent ad campaign from the OMA arguing the province’s efforts to cut certain types of doctors’ fees is hurting patient care.
Yet, it’s not family doctors’ fees and their practices that Hoskins wants to see reduced, but the most costly billing by specialists.
“If necessary we will be forced to make those changes,” he said.
Hoskins said he wants to create a more equal system that doesn’t go over budget every single year, as has historically been the case.
“Our doctors must remain well paid … they deserve it and so do their patients,” he said. “The way we pay our doctors — the unpredictability — the way it can reward volume over value. That must change.” There are “a great number” of doctors who prescribe methadone for people with opiate addictions “clus- tered around the milliondollar mark” in part because they are paid $ 35 for a urine dipstick test that cost $ 2 to $ 3, said Hoskins. “We found that in many cases physicians were earning more than half of their total billings from that one procedure,” he said. “We pay our community labs $10.”
The average doctor’s gross pay is $ 368,000 a year. And though the OMA argues that often doesn’t account for overhead and staffing costs, the province also subsidizes pay in many indirect and direct ways, including allowing doctors to incorporate, which reduces tax and liability burdens.
Ontario, unlike many provinces, covers 80 per cent of doctors’ liability insurance. Hoskins said the ministry even sometimes covers hardware costs like computers.
The data also revealed regional divides, with more than 100 of the highest-paid doctors working in Greater Toronto Area and just 10 working in, for example, the South East Local Health Integration Network.
Most doctors don’t appear on the Sunshine List, so the data release offers insight in what doctors actually cost the province and what specialties are eating more than a lion’s share of public funds. NDP health critic France Gélinas has tabled a bill to add physicians to that list.
She also says Ontario could follow British Columbia and release all doctors names with their annual billings attached. She doesn’t buy the minister’s privacy argument.
“He put information out there that could be very inflammatory … without giving the full picture,” she said. She also wondered how prodding the doctors in such a public way will encourage them to return to the table.
Hoskins says his goal is to make things more equal and better distribute the money going to certain specialists whose work has got easier. MRIs and CT scans used to take an hour, now they take 20 minutes. Same with cataract surgery — that’s why diagnostic radiologists and eye surgeons are so disproportionally represented on the list.
Progressive Conservative health critic, Jeff Yurek, says the “attack” comes just a day before a doctors’ group planned a massive rally against cuts. He calls it a “distraction tactic” and says the government should be working with the OMA instead of making cuts that hurt patient care.
In 2012 and 2015 the prov- ince has previously changed the fee schedule on its own. For example, doctors used to bill $ 35 for a urine dip test that costs around $ 3 to administer and for which private clinics charge $ 10. The province dropped that to $15.
The OMA f or i ts part argues doctors are “ready and willing” to negotiate whenever the province is ready to sit down, but are unwilling to take any cuts. The organization has repeatedly called for a binding dispute resolution and accuses the province of “unilaterally” cutting fees last February.