Rosalie Hutchings-Hedin's bad heart landed her in a hospital's intensive-care unit a dozen years ago.Her family doctor had ordered two routine exams because she was having trouble breathing, but the wait back then for an echocardiogram and stress test was four months in her hometown of Cambridge, Ont.
As she waited, her condition worsened. When the tests were finally done in the hospital, doctors discovered her heart muscle was severely weakened, functioning at just 14 per cent of its original strength. It took months of therapy before she was strong enough to return home.
Today, those same tests no longer require months of waiting: Ms. Hutchings-Hedin can get them in a week at her cardiologist's clinic – or the same day, if the situation is urgent. Constant monitoring is essential for the 63-year-old widow's health, but she's worried the days of long waits will return under the Ontario government's plan to drastically cut fees paid to doctors who perform ultrasounds, X-rays and other diagnostic tests with their own equipment.
Her cardiologist, one of only two in Cambridge, has already scaled back his practice because of the cuts, reducing diagnostic testing by half, laying off six staff members, and returning several leased machines. Shekhar Pandey is one of the first to do so in the province since fee reductions were announced one month ago, but the Ontario Association of Cardiologists is warning other heart specialists will follow suit.
"It gives you sleepless nights because where are we going to go? What are we going to do?" Ms. Hutchings-Hedin asked anxiously. "I can't travel … so you're stranded."
The battle between Ontario doctors and the provincial government over physician fees has been building for months, but now patients such as Ms. Hutchings-Hedin are speaking out too. Ontario, like other provinces, is grappling with escalating health-care costs and a large baby-boom generation that's hitting retirement age.
However, unlike the resource-rich West, the McGuinty government is also facing a massive deficit, forecast at $14.8-billion in 2012-13. Reducing payments to doctors is part of the province's bid to rein in medical costs.
The 37 OHIP fee-schedule changes announced unilaterally in May focus heavily on a relatively small number of high-paid specialists, including radiologists, ophthalmologists and cardiologists, who unveiled a new website Wednesday to plead their case to the public.
The cardiologists' association contends patient care will diminish and lives will be lost as a result of the new OHIP payment scheme. Health Minister Deb Matthews has dismissed some of the doctors' warnings as fear mongering, but said in an interview she's open to revisiting the 50-per-cent cut to payments for self-referral diagnostic testing. The reduction, projected to save the government $44-million in 2012-13, is set to take effect July 1.
"We know that there is a big incentive to refer to yourself and this [fee cut] was a way of addressing that," said Ms. Matthews, who met with the cardiologists' association last week. "If there is a better way to do it, we want to work with doctors to get there."
The province has expressed concern about the growth in diagnostic testing, noting studies have shown doctors who have their own equipment are far more likely to order exams. Government statistics show the number of heart tests has been rising. In 2010, 3.5 million electrocardiograms were performed in Ontario, a 20-per-cent increase from 2004, while echocardiograms – 850,000 in 2010 – increased 88 per cent.
The Cardiac Care Network of Ontario, an advisory group that includes 18 hospitals, has recently proposed guidelines for heart testing, which the government is reviewing. The Ontario Association of Cardiologists has also presented recommendations aimed at ensuring echocardiograms aren't performed unnecessarily.
When Dr. Pandey set up his Cambridge clinic in 1998, he had to send his patients to the hospital for every test. Locally, there was nowhere else to send them.
Because the waits were months long for people like Ms. Hutchings-Hedin, Dr. Pandey decided to start a cardiac care centre in 2001, taking out a sizable loan to lease diagnostic equipment. The government encouraged heart clinics to do this, offering grants to help cover the high cost of the machines.
In turn, communities throughout the province have seen a dramatic drop in waiting times for tests – a reduction that Dr. Pandey believes has saved lives and improved the health of people living with heart disease.
Dr. Pandey said the decision to trim his staff and testing last month wasn't easy. However, after evaluating the financial effect of a 50-per-cent fee cut for diagnostic exams, which is retroactive to April 1, he said he had little choice. Under the new model, he would lose money on every echocardiogram done in his clinic that he referred. Yet, if he sends patients back to their family doctor for referral for testing in his clinic, he would get the full payment, $129.95 per exam.
"This is more than just … a cut. This changes the nature of how you work," the cardiologist said. "It changes how specialists manage a patient. Patients with advanced cardiac disease need ongoing monitoring. It's not a one-off thing."