Time to end secret billings

So it’s come to this. Some doctors are asking the Ontario Medical Association to end its court battle against the Star and the Ontario privacy commissioner to keep the names of the province’s highest-billing doctors secret.

As the Star’s Theresa Boyle and Jayme Poisson reported this week, the doctors have argued on a Facebook group that they’re likely to lose the legal argument against making billing information public. Better, they wrote, to “minimize the damage” by publicly releasing it themselves.

It’s an idea that the OMA’s president, Dr. Shawn Whatley, appeared to welcome. “Definitely open to the idea. Better for us to control the message,” he wrote on the Ontario Doctors Discussion Forum.

The bottom line? If doctors are now privately conceding that they can’t win their legal battle to keep the information secret, they should drop it. The government should get on with publicly releasing the names of the province’s top 100 billing physicians — as it should have all along.

After all, both the province’s privacy commissioner and the Ontario Divisional Court have held that the public’s right to know where their taxpayer-funded OHIP payments go trumps the physicians’ view that their billings should be private.

“The rationale is that the public is entitled to information in the possession of their governments so that the public may, among other things, hold their governments accountable,” Justice Ian Nordheimer ruled in June.

His views echoed those of John Higgins, an adjudicator for the Office of the Information and Privacy Commissioner. Last year he ruled the province should release the information, saying the principles of transparency and accountability “require the identification of the parties who receive substantial payments from the public purse.”

How substantial? Ontario doctors collectively bill OHIP close to $12 billion a year. Transparency on exactly where that money goes would help to lift the curtain on any anomalies in billings.

For example, a health ministry audit for the 2014-15 fiscal year found the province’s 12 top-billing doctors received payments averaging $4 million apiece, with one billing for $7 million.

It also found six of them allegedly charged for “services not rendered,” five of them “upcoded” (or billed for procedures that cost more than they should), and three charged for services judged to be “medically unnecessary.” Six also claimed to have worked for 356 days or more in the one-year period.

Of course, as doctors always point out, OHIP billings don’t equal income. Doctors must pay staff salaries, rent, equipment costs and other expenses out of what they bill the province. And doctors working in fields that are under-serviced may in fact work almost every day of the year.

Still, that is not, as doctors have argued, beyond the public’s ability to understand. It can and should be fully explained as part of disclosure.

Ontario would be far from the first province to release the names and billings of individual doctors. British Columbia, Manitoba and New Brunswick already do that every year. So does the U.S. medicare program. And Newfoundland and Prince Edward Island are debating the issue.

Further, Ontario already discloses the names and salaries of doctors employed by public organizations, such as hospitals, in its annual Sunshine List of civil servants earning over $100,000 a year.

It’s time the OMA dropped its futile court fight and stopped treating this important issue like a struggle for PR advantage. The province should disclose the names and OHIP billings of all doctors — starting with the top 100.

Opening the system to public scrutiny can only enhance accountability and help build a stronger health-care system for patients and doctors alike.

For over two years, doctors have fought to keep their OHIP billings secret. Now some are conceding that it’s a losing battle. It’s time they dropped their case