QUEEN’S PARK – Getting access to house calls from doctors, MRI and CT scans for your joints or having your ear wax removed, as these and several other medical procedures considered “medically unnecessary” by the Ontario Medical Association (OMA) and the province, are slated for delisting from the Ontario Medical Health Insurance Plan (OHIP).
The announced delisted services are part of an attempt to pull $83 million out of the publically-funded health system this year, but Island doctors suggest that the changes will have minimal impact on Manitoulin residents.
“Most of the delisted procedures are ones that a panel of the OMA and the province determined have little proven efficacy,” noted Dr. Stephen Cooper. “These are procedures that will impact very few people here on Manitoulin. The panel made their decision based on best practice and on consultations with experts.” Dr. Cooper explained that the changes may even have a positive impact in that scarce resources could be freed up for those who need them.
“Patients with uncomplicated hip and knee pain will have a more difficult time getting an MRI or CT scan and that should open up access for the more medically urgent patients,” he pointed out.
One aspect of the announced changes that was causing some local concern was the reduction in house calls that qualify as billable, but Dr. Cooper said that he had been in conversation with geriatric doctor Roy Jeffrey recently and an early reading of the changes does not appear to impact his practice.
“For instance, a patient being housebound is one of the exceptions,” said Dr. Cooper. Most of the geriatric calls involve individuals with very limited mobility that precludes their travelling to a doctor’s appointment. Scrapping premiums paid to physicians who perform house calls, unless the patients are frail and elderly or housebound comes with a savings of $18.5 million.
The delisting of procedures that are considered medically unnecessary came about through an order by arbitrator William Kaplan. Mr. Kaplan ended a long-running contract dispute between the Ontario government and OMA when, in February, the arbitration panel directed the OMA and the province to set up an “appropriateness working group” to find $100 million in savings for the remainder of this fiscal year.
This is the first shoe to drop on the delisted services, however, as the panel has been instructed to find another $360 million in savings next year. This year’s items were described as “low hanging fruit” by interim Liberal leader John Fraser.
Missing from the announced list were controversial changes contained in a trial balloon the Ministry of Health proposal had sent up earlier this year. Those OHIP coverage changes were for deep sedation during colonoscopies and psychotherapy or nerve-block injections for chronic pain.
Dr. Cooper pointed to the avoidance of unnecessary X-rays to diagnose sinus problems as another positive impact on the delivery of health services. “This will save the system an estimated annual savings of nearly two million dollars,” he notes. Even more money will be saved by eliminating loop recorders. “The working group determined this was an older and outdated technology when it comes to evaluating electrical activity in out-patients—that alone is expected to save the system more than eight and a half million dollars.”
The government has set up a province-wide system of musculoskeletal rapid-access clinics where specially-trained physiotherapists, nurses and doctors can evaluate patients to separate those who need an MRI or CT scan and/or surgery from those who don’t.
Not only will the new system reduce unnecessary exposure to radiation, it comes with a $12 million estimated savings to the system.
Not requiring a patient to see a doctor for a referral to a specialist if they had recently seen the specialist for the same problem will remove a redundancy that should save around $6.6 million. “That’s a change that just makes sense,” suggested Dr. Cooper.
Much has been made in the media about the delisting of ear-wax removals, limiting them to cases in which the wax buildup causes hearing loss or can’t be treated with over-the-counter remedies, for a savings of $2.6 million, but Dr. Cooper notes there are better and more efficient ways to deal with those procedures than taking up real estate on a doctor’s schedule.
Other changes include: ending unnecessary preoperative “history and physical” assessments prior to surgery for a savings of $6.16 million.
Ontario’s payroll budget for doctors is $13.6 billion for 2019-20 and accounts for roughly 21 percent of the province’s $63.5 billion health budget.