Healthy Skepticism Library item: 916

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Publication type: news

Freguson R.
MD deal aims to trim drugs for poor $50M fee hike if $200M in costs cut: Secret accord in tentative Ontario pact
The Toronto Star 2004 Oct 3

Full text:

Doctors and the Ontario government have agreed to try to cut the taxpayer-funded prescription drug costs of the poor and elderly by $200 million over the next four years, the Star has learned.
If the cuts are made, doctor fees will be increased by $50 million under the agreement.
The secret deal is part of a letter of understanding between Health Minister George Smitherman and Ontario Medical Association president John Rapin under a tentative agreement reached in contract talks with doctors last month.
A copy of the letter, which outlines how doctors will “improve prescribing practice and medication use” under the Ontario Drug Benefit program, was obtained by the Star. The drug program cost taxpayers $2.3 billion last year.
Better prescribing practice would lead to “improved patient health outcomes, high quality and safer care and, in some cases, savings on medications,” the letter said.
Under the deal, doctors could be given “confidential feedback” regarding their prescriptions. There is no indication whether the two sides consider the overprescribing of drugs a major problem or whether the aim is to get doctors to prescribe cheaper versions of drugs.
“It is agreed that if the target of $200 million in savings is reached by March 31, 2007, to the satisfaction of both parties, an investment of $50 million will be available in 2007-08 for physician services.”
The fee increase won’t amount to a significant bump in the almost $7.1 billion in fees the province now pays to doctors annually.
The money will be part of the next round of negotiations between the OMA and the province.
The Institute for Clinical and Evaluative Science will measure the impact of cost-cutting measures on patients and drug costs.
One doctor warned the deal means putting the poor and elderly who get free drugs through the program on cheaper alternatives, such as long-standing medications that must be taken several times a day instead of once.
That can be risky, especially with the elderly, said Dr. Douglas Mark, head of the Coalition of Family Physicians of Ontario.
“Patients will forget” to take the extra pills, he said. “They could actually get sicker.”
The Ontario Medical Association and Smitherman’s office, which have refused to make details of their tentative deal public, would not comment on the agreement yesterday.
“Right now, the organization is focused on ensuring that each and every physician in the province has an opportunity to consider and review the proposed agreement,” said OMA spokesperson Patrick Nelson.
Smitherman’s office did not return a telephone call.
Mark questioned whether the proposal is even feasible, given the rapidly increasing number of seniors and rising drug prices.
Opposition politicians condemned the deal, which goes to a vote of doctors in mid-November.
“It is completely outrageous,” said NDP Leader Howard Hampton.
“It is pretty clear, this is a direct transfer out of the pockets of the elderly and the poorest Ontarians into the pockets of physicians.”
Conservative MPP John Baird (Nepean-Carleton) said Smitherman’s secret accord with the doctors is deeply troubling and raises “a huge ethical dilemma.”
“The fact that it’s a secret side deal, it looks manipulative,” he said, adding that giving doctors “a cut of the savings” unfairly targets seniors and the poor.
“It’s almost an incentive to underprescribe inappropriately.”
Baird, his party’s health critic, warned that he plans to raise the issue when Smitherman testifies before the Legislature’s audit committee on Monday.
Meanwhile, family doctors are angry at the overall deal the medical association struck with the province because it doesn’t give them a fee increase for another 18 months, Mark said. “The OMA board did not even approve of this agreement. They put it out and said `We’ll see what the doctors say.’”
Mark said it appears as though family doctors don’t see an OHIP pay increase until October, 2005.
The deal was reached in mid-September and kept quiet until last weekend, when the Star learned negotiations had been completed. Some details were posted on the OMA’s website yesterday, but were only accessible to doctors with the proper entry codes.
But Doris Grinspun, executive director of the Registered Nurses Association of Ontario, believes the doctors have negotiated a fabulous deal.
For example, she said, the deal makes way for doctors to receive an annual fee of $15, added to the normal patient visit fee, for having a chat about how to quit smoking, starting in 2006.
“Nurses could do this. And we don’t charge a penny, it’s part of our practice,” she said.
“Let’s make sure that nurses get as good a deal,” Grinspun said. “We have a shortage of both doctors and nurses in this province, but proportionately, it is much more serious on the nursing end,” she said last night.
Ontario’s nurses, represented by the Ontario Nurses Association, are in contract negotiations with the health ministry.
It is unclear in the 114-page agreement, which took nine months of negotiations between the province and the Ontario Medical Association to prepare, how much of a percentage increase doctors will get.
There are two letters of understanding attached to the deal: The first concerns the professional incorporation of doctors and the second is on the savings target of $200 million concerning the Ontario Drug Benefit program.
New Democratic Party health critic Shelley Martel said she found the changes to the drug program particularly disturbing. “How could the government ever be considering, essentially, delisting of drugs from the formulary and forcing people to be paying out of their own pockets? For me it’s just shocking,” she said.
Highlights of the deal include:
A recognition that the OMA is the official bargaining agent for the doctors.

The creation of two new committees, the Primary and Community Care Committee and the Physician Hospital Care Committee.
The primary-care committee will evaluate primary-care initiatives outlined in the deal and develop recommendations to ease the integration of interdisciplinary teams and collaborative team practice.
The physician hospital-care committee will advise the ministry of health for the “purposes of strategic planning and the effective and efficient delivery of hospital-based care in the province of Ontario.”
The creation of a new monthly patient-care incentive and special on-call program for long-term care and chronic-care hospitals.
The deal also talks about thresholds and an agreement that all doctors’
billing caps will be eliminated no later than Jan. 1, 2008. It adds that these thresholds will be adjusted by the parties annually to reflect the impact of fee changes.
Improved benefit programs for doctors, including health insurance and pregnancy and parental leave programs.