More than 500 doctors billed Ontario for more than $1 million in fees last year, health minister reveals
NationalPost.com – News
April 22, 2016. Ashley Csanady
The most expensive doctor in Ontario, an eye specialist, billed the province for $6.6 million last year.
We don’t know his or her name or where he or she practices, but we know how much that work costs taxpayers each year thanks to a release Friday by the Ontario government of the billing information of the province’s most expensive doctors.
Over the 2014 to 2015 time period, more than 500 doctors billed the province for more than $1 million in fees. They represent just two per cent of all doctors, but cost $677 million a year, or over six per cent of the more than $11-billion Ontario spends each year on physician compensation.
And many of them charge much more than $1 million, the government’s release shows. Thirty-six billed more than $2 million.
The release intends to debunk a recent ad campaign from the Ontario Medical Association (OMA) arguingthe province’s efforts to rein in certain types of doctors’ fees is hurting patient care. It’s all part of a years-long dispute over doctor fees that’s pitted MDs against the province in a war over patients’ (and voters) hearts and minds.
Yet, it’s not family doctors’ fees and their practices that Health Minister Eric Hoskins wants to see reduced, but the most costly specialists’ billings.
“It’s not our neurosurgeons who are billing over $1 million,” Hoskins said, “It’s a very narrow category of specialists.
The data released shows three specialties tend to bill the most of the 506 doctors who topped $1 million: 154 diagnostic radiologists made the list, 85 opthamologists (eye surgeons) and 57 cardiologists. Twenty-five of the highest billing doctors specialize in addictions and prescribing methadone.
The biggest billers
Physician Specialty Fees
Physician No. 1 OPHTHALMOLOGY $6,631,114.94
Physician No. 2 OPHTHALMOLOGY $5,232,740.15
Physician No. 3 DIAGNOSTIC RADIOLOGY $5,108,884.99
Physician No. 4 ANAESTHESIA $3,840,637.14
Physician No. 5 DIAGNOSTIC RADIOLOGY $3,821,125.62
Physician No. 6 INTERNAL MEDICINE $3,363,670.39
Physician No. 7 OBSTETRICS AND GYNAECOLOGY $3,203,952.22
Physician No. 8 OPHTHALMOLOGY $3,051,734.96
Physician No. 9 OBSTETRICS AND GYNAECOLOGY $2,569,766.43
Physician No. 10 CARDIOLOGY $2,527,701.28
He wants the OMA to return to the negotiating table and discuss lowering some of the 7,300 fees on the physicians’ pay schedule. He said the province has made no less than 80 offers since talks broke down two years ago — close to one a week — to no avail. If they don’t, he said he’s prepared to make another unilateral cut (even though the cuts imposed in 2015 have already sparked the second Charter challenge from the OMA this decade).
“If necessary we will be forced to make those changes,” he said.
Hoskins doesn’t want to cut back on all doctors’ pay, but create a more equal system that doesn’t go over budget every single years, as has historically been the case.
The way we pay our doctors… the unpredictability…the way it can reward volume over value. That must change
“Our doctors must remain well paid … they deserve it and so do their patients,” he said. “The way we pay our doctors… the unpredictability…the way it can reward volume over value. That must change.”
“The top biller, an ophthalmologist, billed more than $6.6 million last year. The top diagnostic radiologist billed more than $5.1 million and the top anesthesiologist billed more than $3.8 million,” a government fact-sheet states.
That’s far above the average doctor’s gross payment of $368,000 a year. And though the OMA argues that often doesn’t account for overhead and staffing costs, the province also subsidizes pay in many indirect and direct ways, including allowing doctors to incorporate, which reduces tax and liability burdens. Ontario, unlike many provinces, covers 80 per cent of doctors’ liability insurance. Hoskins said the ministry even sometimes covers hardware costs like computers.
The data also revealed regional divides, with over 100 of the highest-paid doctors workings in Greater Toronto Area and just 10 working in, for example, the South East Local Health Integration Network.
Most doctors don’t appear on the Sunshine List, so the data release offers insight in what doctors actually cost the province and what specialties are eating more than a lion’s share of public funds. NDP health critic France Gélinas has tabled a private members bills to add physicians to that list. She also says Ontario could follow British Columbia and release all doctors names with their annual billings attached. She doesn’t buy the minister’s privacy argument.
He put information out there that could be very inflammatory… without giving the full picture
“He put information out there that could be very inflammatory… without giving the full picture,” she said. She also wondered how prodding the doctors in such a public way will encourage them to return to the table.
Hoskins says his goal is to make things more equal and better distribute the money going to certain specialists whose work has gotten easier. MRIs and CT scans used to take an hour, now they take 20 minutes. Same with cataract surgery — that’s why diagnostic radiologists and eye surgeons are so disproportionally represented on the list.
His progressive conservative health critic, Jeff Yurek, says the “attack” comes just a day before a doctors’ group planned a massive rally against cuts. He calls it a “distraction tactic” and says the government should be working with the OMA instead of making cuts that hurt patient care.
In 2012 and 2015 the province has previously changed the fee schedule on its own. For example, doctors used to bill $35 for a urine dip test that costs around $3 to administer and for which private clinics charge $10. The province dropped that to $15.
The OMA for its part argues doctors are “ready and willing” to negotiate whenever the province is ready to sit down, but are unwilling to take any cuts. The organization has repeatedly called for a binding dispute resolution and accuses the province of “unilaterally” cutting fees last February.
“The government’s unilateral actions of an almost seven per cent cut to the payments for physician services since February 2015, which goes toward all the care doctors provide to patients in Ontario, are simply not sustainable. These cuts threaten access to the quality, patient-focused care Ontarians need and expect,” a recent press release states.
The government said those cuts were actually imposed limits to annual billing increases as recommended by a third-party arbitration from Justice Warren Winkler, but the OMA says it amounts to a 6.9 per cent cut to its members’ bottom line.
— with data and files from Monika Warzecha
_______________________
Amount of doctors who billed $1M or more, by specialty:
Specialty Amount of doctors Sum of Fees
DIAGNOSTIC RADIOLOGY 154 $198,895,432.57
OPHTHALMOLOGY 85 $132,896,672.16
CARDIOLOGY 57 $79,251,000.86
INTERNAL MEDICINE 42 $55,804,540.11
ADDICTIONS/METHADONE 25 $33,823,483.34
PAIN/NERVE BLOCKS 17 $22,289,807.43
OBSTETRICS AND GYNAECOLOGY 15 $21,611,960.53
GASTROENTEROLOGY 14 $16,039,029.96
ANAESTHESIA 10 $15,046,760.63
GENERAL SURGERY 13 $14,308,273.21
OTHER 8 $11,577,440.70
PAEDIATRICS 6 $7,519,161.90
ORTHOPAEDIC SURGERY 6 $7,357,597.07
DERMATOLOGY 5 $6,565,437.82
FAMILY PRACTICE AND GENERAL PRACTICE 6 $6,453,091.24
VASCULAR SURGERY 4 $5,700,953.93
UROLOGY 5 $5,578,424.76
OTOLARYNGOLOGY 4 $5,127,430.54
NEUROSURGERY 4 $4,934,137.74
NEPHROLOGY 4 $4,853,872.53
CARDIOTHORACIC SURGERY 4 $4,640,280.30
EMERGENCY MEDICINE 3 $4,208,882.70
NEUROLOGY 3 $4,059,286.28
PSYCHIATRY 3 $3,821,123.20
RESPIRATORY DISEASE 3 $3,328,406.49
PLASTIC SURGERY 2 $2,443,827.04
MEDICAL ONCOLOGY 1 $1,428,163.44
ENDOCRINOLOGY 1 $1,185,479.18
THORACIC SURGERY 1 $1,180,177.91
RHEUMATOLOGY 1 $1,138,161.87
____________________________________
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