October 1, 2015 OHIP SOB Implemented

October 8, 2015

MSK and Scrotal Ultrasound Fees Amended to 20% Cut

Dear Colleagues:

It appears that as a result of the OAR letter sent to Health Minister Hoskins expressing concern about the unilateral changes to Radiology ultrasound and nuclear medicine fee codes and the increased professional and technical fee cuts, that MOH quietly changed the MSK and Scrotal ultrasound fee reductions (63% and 74% respectively) to a 20% cut in line with the other unilaterally imposed 160+ US and NM code reductions. No public statement was made by the MOH about this change or a recognition
that its unilateral actions would hurt patients. No notification or recognition of the change was provided to the OAR or OMA.

Many physicians, including radiologists are deeply concerned about the lack of information and inability to obtain answers from the Ministry of Health about how the many changes will have a direct clinical impact on patient care. There is a sense that no one at MOH is in charge of dealing with legitimate physician concerns about how these unilateral changes impact patient care and the chaotic situation it is creating on the front lines of patient care delivery. There is concern about the absence of clinical competency
behind a decision-making process that appears to be guided solely by a cost savings agenda. Urgent calls to the Minister of Health to arrange a meeting with him have failed to obtain a response other than the letter will be reviewed within “fifteen business days”. This out-of-touch response and a complete breakdown in communications between the government and Ontario physicians underlines how chaotic the situation has become. We are continuing to seek answers and will be reporting accordingly.

Technical fees have been reduced by 1.3%. The payment discount will be taken from monthly RA’s.

An article appeared in the Toronto Star this week making reference to the OAR’s letter to the Health Minister and the inequitable impact on DI. See the link to view the article.

The IHF Facility Schedule has not as of yet been uploaded to the MOH website. The link to the new October 1, 2015 OHIP SOB for hospital services is:

There is new language found under the professional component section of the ultrasound preamble (page F4 - see the shaded sections). It appears that in order to bill the reduced Professional fee, a radiologist does not need to be present unless it is believed having a physician present would be appropriate. The practicality of what that means or how that would be determined is ambiguous. The new preamble descriptor further reflects the problem of bureaucrats attempting to practice medicine via the creation of unclear rules that don’t respect physician involvement in patient care. There is now an ability to delegate the service to another physician (see note 2 of the preamble). Radiologists are cautioned to be careful about how they interpret this fee code language as the MOH has not offered any explanations. The OMA has not received any code interpretations from OHIP. We will be following up on this issue.

CAR President, Dr. Willie Miller has issued a supportive news release urging the Ontario Health Minister to reverse the radiology fee cuts to safeguard the interests of Ontario patients.

No information has been provided as to how or when the 1% threshold cut will be applied.

Discussions with the Ontario Association of Cardiologists regarding the interpretation No information has been provided as to how or when the 1% threshold cut will be applied. Discussions with the Ontario Association of Cardiologists regarding the interpretation of the new echocardiography rules indicate that there is significant confusion about how the rules should be interpreted as well as concern that some physicians, including radiologists, will be unable to provide echo services when the new rules are implemented. This has implications for radiologists who currently provide echo services. The OAR is pursuing this as it appears that this is an effort to inappropriately shut out qualified radiologists with cardio-thoracic training credentials, including in cardiac CT and MRI.

Unrelated to the unilateral October 1st cuts affecting radiologists, OHIP has been issuing letters to radiologists questioning the use of specific fee codes on both an individual practice basis or an across the board use of certain codes. This appears to be a deliberate effort to curtail the use of physician fees for the delivery of patient care services in the absence of any appropriate medical dialogue and feedback with Ontario radiologists. If you have received such a letter, advise the OAR as we are working on an appeal to the J149 ultrasound guidance code for vascular-related services. Other appeals or requests for clarification from OHIP need to be prepared by the OAR on behalf of our specialty to protect physicians from a one-sided interpretation of billing rules guided by a fiscal agenda versus the delivery of effective and safe patient care.