A panel of health experts is urging Ontario to adopt tighter controls over the people and clinics that perform X-rays, ultrasounds and other diagnostic exams in a bid to curb unnecessary testing, a strain on both wait times and provincial coffers.
The recommendations, presented recently to Health Minister Deb Matthews, include introducing guidelines that better define when tests are needed, requiring independent accreditation of diagnostic facilities, and ensuring medical workers who perform and interpret tests are properly trained.
"Our hope is that this will lead to appropriate testing, and that anything that might be inappropriate, whatever that is, would be minimized or eliminated," said Barry Rubin, a vascular surgeon in Toronto who was chairman of the expert panel. "If you're only doing appropriate tests ... that would free up resources and potentially decrease wait times for diagnostic studies."
Costs were not a factor the group considered, Dr. Rubin stressed, but are very much on the mind of the deficit-laden Ontario government.
The province established the 15-member panel in June to review the state of diagnostic testing after physicians balked at a plan to reduce fees paid to doctors who refer patients to clinics in which they have a financial interest, known as self-referral testing. The proposed cut of 50 per cent was one of several fee changes the province introduced in the spring after negotiations with the Ontario Medical Association (OMA) broke down.
The OMA and the Ontario government agreed last month to restart talks on a new fee agreement. The panel's recommendations on diagnostic testing will be part of the negotiations, said Zita Astravas, the health minister's press secretary.
The expert group has also recommended the government not move forward with the cut for self-referral testing, saying it could place unnecessary stress on the health system and negatively affect access to tests in smaller communities.
Bill Hughes, president of the Ontario Association of Cardiologists, said the self-referral cut should be axed. The association has warned patient care would suffer and many heart specialists would leave for other provinces if it goes through.
There are no hard numbers on how many diagnostic tests each year are unnecessary. The Canadian Association of Radiologists estimated in 2009 that as many as 30 per cent of CT scans and other imaging procedures were inappropriate or contributed no useful information.
Among the expert panel's 12 recommendations is a call to gather more information on why exams are being ordered and who is ordering them so policy-makers can better understand the rapid increase in some diagnostic tests. One area that has seen substantial growth is echocardiograms. The province says 850,000 heart ultrasounds were performed in 2010, an 88 per cent increase from 2004.
Ontario is one of few provinces that doesn't have regulations for echocardiograms and the accreditation of clinics that perform them, the expert group noted. The panel is encouraging the province to adopt standards recently proposed by the Cardiac Care Network and supported by the Ontario Association of Cardiologists.
"These recommendations will result in a greater level of assurance on the part of both the public and the ministry that the tests are being done for the right reasons by the right people on the right patient in the right place at the right time," Dr. Hughes said.
While the province and the OMA mull the first batch of proposed reforms, the expert group plans to start evaluating other areas of diagnostic testing, including emergency-room ultrasounds, sleep studies, peripheral vascular exams and prenatal ultrasounds. More recommendations may follow, Dr. Rubin said.