Doctors to stop billing procedural fees in two Vancouver hospitals

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Some cardiologists at two Lower Mainland hospitals have been ordered to stop billing procedural fees that have cost the provincial health system hundreds of thousands of dollars in the past two years alone.

The doctors have been charging Vancouver General and St. Paul's Hospital procedural fees for a test that, in many cases, they do not physically perform.

Over the past two decades, the once-specialized test – known as a transesophageal echo, or TEE – has become more routine and is now conducted mostly by anesthesiologists, who bear the risk and liability for the procedure.

But a small group of doctors at Vancouver General and St. Paul's have continued billing procedural fees for the tests, even though such fees are not charged by doctors in at least two of the three other cardiac centres in the province.

The change in billing procedures came after management received correspondence containing complaints about the fees and after The Globe and Mail wrote about the concerns in a story last month.

"Vancouver Coastal Health ordered this billing practice stopped in early June," spokeswoman Anna Marie D'Angelo said in a recent e-mail.

Vancouver Coastal Health is the regional health authority that oversees Vancouver General Hospital. Providence Health, which oversees St. Paul's, has also ordered a stop to the billing of procedural fees for the tests, Ms. D'Angelo said.

Vancouver Coastal Health has also launched an investigation of billing practices related to the tests. Asked whether there would be any disciplinary measures taken in relation to the billing practices or whether the health authorities would try to recoup any of the money involved, Ms. D'Angelo said any such decisions would be determined through the investigation and that it would be "premature to suggest there was wrongdoing or inappropriate behaviour."

The procedural fee involved – $142.76 per test – is small change when viewed in the context of B.C.'s overall health spending, which is forecast to hit $17.4-billion this year. But transesophageal echocardiograms are part of nearly every heart operation, which number in the hundreds every year.

St. Paul's, for example, spent about $120,000 in procedural fees in each of the past two fiscal years, according to information provided by Vancouver Coastal Health. Vancouver General Hospital, meanwhile, spent about $70,000 last year and $80,000 the year before.

The billing practice has been in place since at least 2012, when it caught the attention of two program directors who had been asked to find potential savings to make up for the loss of revenue resulting from some heart surgeries shifting from the Lower Mainland to Kelowna General, which began providing cardiac surgeries in 2012.

That 2012 review concluded echocardiographers at both St. Paul's and Vancouver General were billing an "unanticipated" procedural fee per case, even though the tests were actually being done by anesthesiologists.

That review, a copy of which was provided to The Globe and Mail, featured several recommendations, including that "when cardiac echocardiographers do not perform the TEE procedure, they should not be paid the TEE procedure fee."

Victoria's Royal Jubilee Hospital does not pay a procedural fee for the tests. (Royal Jubilee, along with St. Paul's, Vancouver General, Kelowna General and Royal Columbian in New Westminster, is one of five cardiac centres in B.C.)

Neither does Royal Columbian.

"Fraser Health's echocardiographers do not bill for procedures they do not perform," Gerald Simkus, program medical director for Fraser Health, which oversees Royal Columbian, said in an e-mail.

"In the [operating room] setting and in the Cardiac Surgery Intensive Care Unit, it is typically the anesthesiologist, who has been trained in the procedure, who may perform a TEE as an informal real-time guide to care without additional billing."

Representatives for Interior Health, which oversees Kelowna General Hospital, were not able to provide billing information immediately.

More than 4,000 heart surgeries were performed in B.C. last year, according to Cardiac Services B.C. St. Paul's is one of the busiest heart centres in the province and does more than 1,000 cardiac surgeries per year.