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.
|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