‘Ottawa’ Waste in Ontario’s Health Care Sickening
TORONTO – WARNING: Auditor general Bonnie Lysyk’s report on waste, mismanagement and potential fraud in health-care billings may be hazardous to your health.
Do not read this column if you suffer heart palpitations, dizzy spells or frequent bouts of nausea.
May also cause hysteria in less stable taxpayers.
Lysyk blasted the government on everything from a Hwy. 401 bridge built upside-down to faulty asphalt to doctor billings in her exhaustive report released Wednesday.
The province’s move to a new method of paying doctors for their services has been a disaster and has cost the health ministry hundreds of millions of dollars in payments for care of patients who never visited their doctor.
As of March 31, 2016, 8,800 of the province’s 14,100 family physicians had opted for the new enrolment model over the traditional fee-for-service model.
Under the enrolment model, doctors receive $3 per patient per month — whether the patient visited them or not.
This has resulted in higher costs without improving care.
Wait times to see family doctors are increasing. In 2015-16, 57% of Ontarians waited two days or more to see their family physician. In 2006-07, that number was 51%.
More than half of patients find it difficult to obtain care on evenings, weekends and public holidays without going to an ER — despite the fact that doctors are required under the new deal to provide coverage.
Patients enrolled in family health teams routinely seek care at walk-in clinics and hospitals — even though their family health team is being paid to care for them. And the ministry makes no efforts to recoup that money from that doctor. So we’re paying twice for that patient’s care.
The ministry’s billing system shows 40% of those enrolled in group practices went to walk-in clinics or physicians outside that group. The health ministry did not probe any “anomalous” physician billings, yet the auditor found cases where doctors’ billings exceeded the standard number of working days.
“The ministry needs to investigate problematic physician billings and put in place a cost-effective enforcement mechanism to recover inappropriate payments from physicians,” Lysyk told reporters.
All of which had Health Minister Eric Hoskins barely disguising his glee. His government is locked in a brutal negotiations stand-off with the province’s doctors, after physicians rejected a tentative deal. He said that deal had provisions to ensure access.
“We’ve been aware for some time of some of the challenges patients face in getting access to their primary health-care provider, their family doctor, specifically,” Hoskins told reporters.
There’s a solution to this. OHIP should send us a statement every month or every year of the services billed on our behalf by physicians.
You value what you pay for. And while we pay through our noses for health care — it’s more than half the provincial budget — we’re not getting value for our health buck.
It’s a muddled system that’s rife with mismanagement.
Then again, if we demand we get bills so we can see how much we’ve charged the health system, it will simply spawn another inefficient bureaucracy for the AG to report on.
And that’s truly sickening.
HEALTH HIGHLIGHTS OF THE AG REPORT:
• During 2014-15, about 243,000 visits were made to ERs for conditions that could have been treated by family doctors.
• The health ministry estimated those visits cost $62 million, of which $33 million was incurred by patients enrolled in family health organizations — that had already been compensated for patient care.
• In questionable billings by doctors, the AG found nine specialists each worked more than 360 days in 2015-16.
• One respirologist worked 361 days in 2015-16 and billed the province $1.3 million — close to five times higher than the upper expected limit, and billed for close to 12,400 services that year.
• One cardiologist worked 354 days in 2015-16 and billed the province $1.8 million — three times higher than the upper expected limit for doctors in the same category.
• One cardiologist billed $2.5 million during 2014-15 for performing more than 68,000 services — six times the number delivered by the average cardiologist.
• In 2014-15, each physician in a family health organization worked an average of 3.4 days per week, while each doctor in a family health group worked an average of four days per week.
• The “capitation” health model, where physicians are paid a fee for each patient enrolled, paid those doctors an extra $522 million in 2014-15, money that would not have been paid under the fee-for-service model.