Two provinces are seeking fee reductions for cataract surgery after the Canadian government's move to cut wait times for key medical procedures has unwittingly enriched ophthalmologists - some billing more than $2-million annually.
In British Columbia, where 13 ophthalmologists billed more than $1.5-million in the last fiscal year, ending March 31, 2010, officials are seeking to have the "artificially high" fees reduced, said its Health Ministry spokesman Stephen May. On a per-minute basis, he noted the specialists are paid $28.17 for cataract surgery, compared to orthopedic surgeons at $4.89 for a hip replacement.
Improvements in technology have made cataract surgery quicker and safer: removing a cataract and implanting a new lens took about an hour a decade ago; today it can be done in about 15 minutes, according to Mr. May. And yet, the fee of $533.73 in British Columbia has remained unchanged at least since 2002. He said the issue has been raised with the province's medical association.
Eight of 20 Ontario doctors who billed medicare more than $2-million from April 1, 2009, to March 31, 2010, were ophthalmologists, according to figures obtained by The Globe and Mail under freedom-of-information legislation.
Ontario's Health Minister Deb Matthews said she will be seeking a fee reduction in cataract surgery in upcoming talks with the Ontario Medical Association, saying it will definitely be on the negotiating table.
"When technology increases the productivity of the doctors," Ms. Matthews said in a telephone interview, "then I think we all need to benefit from that."
High billings to medicare are a "natural consequence" of the federal government's $41-billion health accord, according to Lorne Bellan, chair of University of Manitoba's ophthalmology department. Designed to whittle down wait times in five areas, the fix for a generation, brought in by former prime minister Paul Martin, expires in 2014.
"I never heard of anybody billing $2-million before the accord," Dr. Bellan said in a telephone interview from Winnipeg. "And $2-million seems like an awful lot to me for any doctor in our system."
Charles Wright, a councillor of the Health Council of Canada, said technological advances have made cataract surgery quicker and safer so it's "almost like an assembly line.
"Has the fee changed? No, which is completely ridiculous."
Dr. Wright said physicians require a mixed payment system - not solely fee-for-service where doctors today are paid for each procedure they do - to remove huge disparities between specialists and help ensure the sustainability of the health-care system.
In Ontario, where new accountability legislation for hospitals, known as the Excellent Care for All Act, ties CEO salaries to quality of care, it has created an environment where value for money is a key focus for government.
Ontario pays doctors $491.05 for a cataract removal and lens implantation. However, unlike British Columbia, it has twice reduced fees: first in 2009 and then again this September, when it will be dropped to about $451.75. The Ontario Medical Association said its section on ophthalmology initiated and recommended the latter fee drop.
The freedom-of-information figures, obtained following an appeal and subsequent mediation by The Globe and Mail, revealed eight ophthalmologists billed $20.4-million in fiscal 2009, ending March 31, 2010. Another dozen doctors - anesthesiologists, internists, obstetricians and gynecologists, diagnostic radiologists, cardiologists and general practitioners - also billed more than $2-million during the same time period.
In total, the 20 doctors billed OHIP more than $54-million in fiscal 2009, ending March 31, 2010, which is more than double the amount two years earlier, when nine physicians billed $24.9-million in fiscal 2007, ending March 31, 2008.
Ontario's legislation does not allow the identification of individual doctors so The Globe and Mail, in its FOI request, did not seek it. By comparison, British Columbia and Manitoba both publish billings of doctors by name every year.
Manitoba is not specifically seeking a reduction in cataract-surgery fees, which have increased ever year since 2005; doctors are reimbursed $513.05 for the operation and lens implantation, according to Jack Marquardson, communications coordinator for Communication Services Manitoba.
Neala Barton, spokeswoman for Ontario's Health Minister Ms. Matthews, stressed ophthalmologists have high overhead costs and billings represent what OHIP reimbursed doctors and not take-home pay.
And Ms. Matthews said Ontario's doctors do excellent work and they should be fairly compensated. However, she said she was surprised to see the $2-million billing figures, adding: "I think it does underline the importance of really taking a good look at what's behind that."
Sharon Shore, senior manager for BC Medical Association, said it is currently collecting data but it has no position on the issue of reduced fees for cataract surgery.