Provincial proposals on OHIP billing are a proven failure that will hurt patients

By Dr. Sohail Gandhi
President, Ontario Medical Association

Ontario doctors support an OHIP billing system that is accountable, fair and transparent.

But, as the old saying goes, the devil is in the details. Certainly the details of proposed legislation released by the provincial government in its Fall Economic Statement came as a surprise to us in the medical profession. The proposed legislation:

• Gives people with no medical background the right to decide whether or not a procedure was followed correctly, making doctors hesitate to order tests, diagnosis and treatment options they believe their patients may need;
• Allows people who are not doctors to access private patient medical records;
• Allows a civil servant to use any method to recover money from a physician without a hearing;
• Puts the onus on doctors to prove they have followed the rules;
• Allows a civil servant to decide whether or not a doctor is being “cooperative” and suspend OHIP payments;
• Allows the government to unilaterally cancel contracts of doctors who working in teaching hospitals or academic settings; and
• Lets the government publish the names and details of an audit of a physician, a public shaming that has had disastrous consequences in the past.

Simply put, the provincial government will treat every doctor in Ontario as guilty until proven innocent.

We've been down this road before under the previous government with disastrous consequences – bankruptcies, doctors cutting back on service, leaving the profession, or even worse.

Here’s what former Supreme Court Justice Peter Cory found in 2005 when he was asked to look into the situation at the time:

The medical audit system in Ontario has had a debilitating -- and, in some cases, devastating -- effect on the physicians of Ontario and their families. In turn, it has had a negative impact on the delivery of health services in the province. It has undermined Ontario's attractiveness as a place to practice medicine and has led some physicians to curtail their practices so as to stay within average billing patterns.

That system was scrapped. Some of the provisions in this legislation are even worse.

This is not about accountability or money. The Ontario Ministry of Health says it has concerns about approximately 100 doctors. There are 31,577 physicians in Ontario. This legislation puts every one of them under a cloud.

There is a better way. The Schedule of Benefits includes more than 7,000 different billing codes that doctors use to bill OHIP. They are confusing, not specific and written as guidelines.

Ontario doctors see more than 340,000 patients every day in a system that is underfunded and stretched to the limits. No wonder mistakes can be made.

The Ontario Medical Association has offered to sit down with the government for the past 10 years to update the Schedule to make it simpler and clearer.

Instead of doing the hard work needed to update the Schedule as a permanent solution to the issue, the provincial government has introduced legislation that the Ontario medical profession, indeed no other professional or private citizen, could or should accept.


Used with permission from The Toronto Star, www.thestar.com Copyright The Toronto Star. All rights reserved