Clawbacks-It Could Get Ugly

It’s been two months since the Government of Ontario abandoned negotiations and implemented a series of unilateral cuts to health care and physician fees.

One thing is clear; the Government has rejected the Ontario Medical Association’s final offer of a two-year freeze on fees.

On February 1, the government cut physicians fees by 2.65% and there are nine other targeted cuts to hospital on call, chronic disease management and to family physicians. The nine items add another 1.85% in cuts for a total cut of 4.5%. Some physicians will be cut more than others.

Many doctors think that they will be able to protect their revenue by working 2.65% harder. However we must remember that there is now a very hard cap on payment for physician services. If billings for medical services exceed this hard cap, then the excess will be clawed back from physicians. This is over and above the existing payment discounts.

One can only imagine 25 thousand hamsters running faster and faster on a wheel trying to catch up to their own tails.

The OMA has no idea how clawbacks will occur. Will an equal clawback apply to every physician, or will the clawback occur at a community or specialty level?   Will the entire clawback occur over a single month or will the clawback be spread out over several months?   Will salaried physicians be clawed back for increases to fee-for service billings and will fee-for-service physicians be clawed back if more salaried physicians are hired?

Who knows? The government has already demonstrated that they can and will act on their own, without regard to patient care.

This is not the first time that Ontario physicians have faced hard caps and clawbacks. Between 1993 and 1998 there was a hard cap on the physician service budget and clawbacks. I remember them all too well. For those of you too young to remember or have repressed the gruesome details here is a summary of past clawbacks.

Date                                                    Clawback

October 1/93 to March 31/94 4.8%
June 1/94 to October 31/94 2%
Nov 1/94 to Nov 30/94 4.8%
Nov 1/94 to Nov 30/94 2.0%
Dec 1/94 to March 31/95 6%
October 1/95 to Feb 29/96 10%
Feb 1/96 to Feb 28/96 varied
March 1/96 to April 30/96 10%
May 1/96 to Oct 31/96 3.5%
May 1/96 to Oct 31/96 6.5%
Nov 1/96 to Feb 28/98 2.9%

As you can see between October 1 1995 and September 30 1996 Ontario physicians paid back 10% of all their billings. This is an example of how ugly it can get.

This is the scary part of the unilateral Government action. This is why the OMA Board of Directors unanimously rejected the notion of a hard cap. This is why our members (and their patients) should be outraged.

The Government of Ontario has abandoned all responsibility for growth in funding for physician services

Want new funding for a pet project of the Minister? No problem. The Docs will pay.

Cost overruns because a new MRI machine is purchased to shorten wait times? No problem. The Docs will pay.

An Influenza pandemic? No problem. The Docs will pay.

This Government has a lot of ideas for health system reform. Some are good and some are bad They have earned the right to implement them.

They should also pay.

Scott Douglas Wooder, MD

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9 thoughts on “Clawbacks-It Could Get Ugly”

  1. My husband is waiting on back surgery for a severely herniated disc, agony every day and thanks to the Liberals, his surgeon is capped out and now we are pushed back another 4 months on top the year he is waiting. You can bet it if was Kathleen Wynn’s family they would get their surgery. Who voted these clowns in???? I am retired and he is our only income and he goes to work each and every day with pain meds on board.

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  2. A very nice forceful and factual article showing the horrors of how it was before and how we are being held responsible for increased utilization unfairly. History has a tendency to repeat itself and here we are again…some of us are not surprised.

    In my opinion, the OMA has done a fairly lousy job so far of highlighting the cutbacks to the media. What other job or profession would actually stand for this happening to them. OMA needs to counter the media spin and so far it is just not getting the traction that the government has gotten so far

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    1. Thanks for the feedback Paul.

      Have you written you your MPP? Have you visited your MPP. What about a letter to the Editor?

      We need our members to stay involved and communicate to politicians, the Press and the Public. If you have done any of these things, thank you. If you haven’t then please get busy. The OMA will help with the mechanics. We just need a little bit of your formidable energy.

      Scott

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  3. Thanks for this summary Dr. Wooder. We’ve been billing for Ontario physicians since those previous mid-90s clawbacks and remember acutely the negative impact they had on morale and mood across the province. For younger physicians in particular, this article is a good reminder of what might be coming.

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  4. Great note, Scott!

    Are we sharing your clawback data on the roadshows? Are members really understanding what the 2012-present-future cuts mean to their net income? Are we missing the big picture by focussing on the 2.65% cut?

    Are we missing the forest for the trees?

    Finally, it looked bad that we let some of our higher paid members take a substantial hit in 2012 without taking to the streets in protest. Many doctors felt it was “relativity by government” and not so bad. Now we have even bigger cuts to many of our lowest paid and most vulnerable members politically.

    The days of polite debate between gentlemen passed sometime after upper and lower Canada became one nation. Without sharp, boisterous protest by enraged politicians in question period, or by physicians raising the issue by marching, our protest does not match public expectations of disagreement.

    In a post-modern world, passion determines credibility. No passion; no message; no change.

    Thanks again for your note. I hope it inspires some passion.

    Cheers

    Shawn

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    1. Hi Shawn

      I don’t think we’ll see much public support because we have been given a fee cut

      Public outrage will occur when they feel the effects of the cuts-service cuts.

      Service cuts will be felt when people can’t access the kind of primary and specialty care they need. That may take some time.
      And if course the Government will make a mess of things, they usually do.
      That’s when we’ll see a change.
      The next election which seems so far away now, will sneak up on very quickly.

      Scoot

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      1. Hi Dr Wooder,

        Just to reply to the public feeling the cuts when service become unavailable comment.
        I am nurse who works in a family health team, sadly already we have been hearing the complaints that services are not available to them as they start with wait times, but in the patents eyes its never the government’s fault but the doctors, nurses and clerk’s who are at fault. They dont know any better. Most have no clue how the government is even involved in their health care. Until the general public are educated on how the Ontario Health care system works they will never be able support any change.

        Thanks!
        Christina

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