House calls to non-housebound patients, outdated fertility testing and unnecessary earwax removal are among 11 health services being delisted or restricted from OHIP coverage, a committee tasked with modernizing Ontario’s taxpayer-funded insurance plan has announced.

Coverage for the services will be affected as part of a major update to the OHIP Schedule of Benefits aimed at freeing up money for higher-value physician services, increasing access to those services and cutting wait-lists, reporters were told Thursday.

The changes will result in savings of $83 million annually, said Travis Kann, the director of communications for Health Minister Christine Elliott.

But that falls $37 million short of the $120 million in savings the committee, known as the “appropriateness working group,” had been mandated to make.

The committee did indeed identify $120 million in savings, but the government has so far accepted only $83 million worth of them, said Kann.

“We have not rejected any of the proposals. We are currently accepting 11 that add up to $83 million,” he explained.

It is unclear who has the final say in making the cuts — the government or the appropriateness working group.

The working group was created in February following an order by an arbitration panel that resolved a contract dispute between the province and the Ontario Medical Association, essentially the doctors’ union.

The order gave the committee the mandate to “establish evidence-informed amendments to payments by eliminating or restricting inappropriate or overused physician services or physician payments.”

The working group was directed to “achieve a settlement,” with changes totalling $120 million, by May 1 this year. And it was ordered to reach a second settlement by Sept. 30 this year for an additional $360 million in changes to be made next year.

If the committee is not able to modernize the OHIP fee schedule as required, the arbitration board, chaired by veteran labour lawyer William Kaplan, will make the decisions, the order notes.

The arbitration process, which ended a four-plus year contact dispute, started in May 2018 under the previous Liberal government. Much of the discussions were devoted to addressing the issue of “appropriateness” of care.

“The (committee’s) work will ensure better use of health-care resources, as well as the anticipated outcome of shorter wait times,” a news release states. Waiting lists will be shortened if doctors devote more time to necessary services and less time to unnecessary ones.

As much as 30 per cent of medical services in Canada are thought to be unnecessary, according to Choosing Wisely Canada and the Canadian Institute of Health Information. Choosing Wisely Canada is part of an international education campaign aimed at having clinicians and patients talk about unnecessary tests, treatments and procedures.

The Star has highlighted problems with inappropriate care as part of an ongoing series about physician compensation.

The appropriateness working group is comprised of representatives from the health ministry and OMA, and is co-chaired by two doctors, one from each organization.

The changes will “ensure Ontarians have access to the most modern and effective tests and services,” said Dr. Joshua Tepper, the province’s co-chair. “Effective testing and treatment evolve as technology and knowledge improves,” he said, adding that OHIP coverage should evolve in tandem.

The coverage updates will “improve the quality of the health care system,” said Dr. Paul Tenenbein, the OMA’s co-chair.

https://www.thestar.com/news/gta/2019/08/22/from-ear-wax-treatment-to-sinus-scans-province-details-11-medical-procedures-to-be-delisted-or-restricted-under-ohip.html