Ontario should end secrecy over what doctors bill medicare
TheStar.com – Opinion/Editorials – For the sake of greater accountability and a stronger health care system, Ontario should end secrecy over what individual doctors bill the health care system.
Dec 11 2014. Editorial
It’s not about shaming the rich, fanning jealousy or feeding spite. Revealing what Ontario doctors bill the public would enhance accountability and ultimately build a stronger health-care system. For this very good reason the province should draw aside the curtain of secrecy that conceals what most physicians are paid.
As revealed by the Star’s Theresa Boyle, some doctors charge Ontario’s publicly funded health insurance plan for remarkable amounts. Nineteen billed the system for more than $2 million each in 2012-13.
The highest biller alone claimed more than $6 million, while the second and third-highest billers each charged more than $4 million. Not only were their names kept secret when the Star filed a request for information, even the medical specialty of big-billers was kept hidden.
For understandable reasons, physicians don’t relish having their revenue made public. Under existing rules release of such information is considered an invasion of personal privacy.
As a result, taxpayers funnel about $11 billion into doctors’ pockets each year but are told very little about who collects that money. This needs to change, and Ontario’s New Democrats have expressed a welcome willingness to back reform. Not only does the public have a right to know, there’s broad social benefit in disclosure.
People stuck in a packed waiting room, only to be seen for a minute or two while their physician scrawls out a prescription, might be interested to learn whether their doctor is an unusually high biller. It could signal substandard care from a physician who is increasing billings by churning patients through the office.
The cold, clear light of public disclosure would also cast into sharp relief certain historical anomalies in how doctors are paid. Some procedures, such as cataract surgery, were once far more complicated than they are now but the fee structure doesn’t take this change fully into account. So the system pays far more than it should for relatively simple surgery. Revealing the earnings of those who profit from the status quo could help build momentum for reform.
There’s ample precedent for openness. Manitoba and British Columbia make physician-identified billings public. And Ontario’s own Sunshine List reveals each year all public employees who earn more than $100,000.
Physicians paid under the province’s fee-for-service system are considered independent contractors — not employees — so they’re exempt from the Sunshine List. It’s also important to note that what these doctors charge the province is not a “salary.” Through their billings physicians must cover an array of expenses, including the cost of office space, staff salaries and equipment. Their take-home pay can be far less than what they bill.
Some, especially those working in underserved areas, routinely put in extremely long hours. Their higher-than-usual claims are evidence of dedicated public service. And some big-billers own clinics in which other doctors work, with everyone’s claims channeled into the system through the owner’s name.
Ontario Medical Association president Dr. Ved Tandan argues that, because of these complications, simple disclosure of physician billings would mislead the public rather than enlighten it. Others caution against publicly shaming doctors and warn that some in underserviced areas may be driven to cut their hours.
These are important considerations, to be sure. But, on balance, gains flowing from increased transparency and accountability outweigh any benefit from continued secrecy in physician billings.
The OMA is a powerful lobby group, well-funded and well-equipped to inform the public of the complications involved in assessing doctors’ incomes. Physicians remain among the most valued and respected professionals in the province. It’s appropriate that they be paid accordingly. But when a doctor’s billings are out of step with the norm — when claims appear excessive — it’s fair for patients to be made aware of that fact and receive an explanation.
That’s not an intrusion. It’s a recipe for a better health-care system.
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Tags: budget, Health, ideology, rights, standard of living
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