Earlier this week the OMA President released information about how fee cuts and increases would be implemented across the medical profession. Our specialty and others were not permitted to communicate what was occurring behind the scenes about the Medical Services Payment Committee (joint OMA-MOH fee setting committee) due to an OMA non-disclosure agreement (NDA) that we were forced to sign.
From the outset, we felt that this was an exercise gamed against technology-based medicine, including all radiologists. The OMA has failed to explain on what authority it has determined that a small number of sections are red-circled (do not qualify for any funding increase to existing fee codes) and could be further punished financially using the MSPC process in an unprecedented manner.
OMA Misleads Radiologists & Other Specialists
The recent OMA communication misleads radiologists, as it did with several other red circled specialties, in which it is claimed that the OAR/DI Section did not provide input to the MSPC. Our Section made clear numerous times that it did not agree with the OMA’s proposal to decrease some fees so that others could be increased. In addition, see our letter to the OMA President and MSPC dated August 5th. We received no response. Nothing further was communicated to DI until late October (see MSPC Process Facts below).
The purpose of the August 5, 2019 DI letter to the OMA and MSPC was two-fold.
- To obtain on-call premiums funding to recognise that radiologists are one of the busiest specialties providing services in an after-hour setting (DI was the only specialty to provide hard data from PACS, that were province-wide).
- To obtain funding for many new unpaid DI and IR procedures (e.g. stroke therapy). In late 2017 radiologists identified about 100 new fee services not included in the OHIP Schedule. This issue was communicated to the OMA several times including in the negotiation and arbitration phases. They were repeatedly ignored by the OMA.
MSPC Process Facts
- No contact from the OMA/MSPC occurred until Thursday, October 24th afternoon when red circled sections received an urgent OMA email (with no agenda or materials) to be on a teleconference the same day (4 -5 hours after an OMA email was received) or the next day (Friday at 6pm knowing many could not make that time)
- Many specialist leaders were away/on call and unable to attend this last-minute effort by the OMA/MSPC to say they consulted red circled sections
- OMA said there were 6 options (including no funding impact on red circled sections) but it became clear they had already decided on what they wanted as an approach
- The approach taken by the MSPC was that Sections that did have new money to allocate could suggest which fees (e.g. lumbar puncture) they wanted to increase; if these fees were ‘shared’ with red circled Sections (i.e. were disallowed any new funds), then the red circled Sections had to sacrifice some of their other fees to be cut so that the net impact would be zero dollars
- DI’s view was that this was unacceptable as it would mean that some individual radiologists would still see an overall decrease; and the DI Section felt that this violated the spirit of the Kaplan decision
- The DI Section also strongly believes that there is an inherent danger in allowing one Section to be able to force another Section to decrease some of its codes (and a dangerous precedent to be set for future negotiations)
- Thus, each red circled section was told to identify their own fee code reductions to accommodate the financial impact that benefitted certain shared fee codes; 3 of the red circled specialties had multi-million-dollar hits
- The unilateral reduction applied to red circled sections was termed a “net neutral solution” by MSPC/OMA in order to meet the needs of funded sections
- Repeated requests by DI and other affected sections to exclude red-circled specialties were ignored; our alternate recommendation of offsetting the decrease with supplemental funding was rejected by the OMA
- The 2019 MSPC process had no resemblance to the 2008 MSPC activity when every OMA section received some amount of funding (DI used our 2009-10 funding for a 10% increase to IR, mammo, and abdominal/pelvic ultrasound codes)
- The 2019-20 MSPC process can only be described as hasty, contrived, and poorly handled by the OMA’s MSPC; this direction was manufactured to further punish unfunded sections outside of the purview of the Kaplan arbitration decision
- MSPC leadership and direction characterized the OMA’s old guard approach: no discussion, no transparency, isolating and trampling the rights of minority sections
- The OMA has returned to its past practice of creating a crisis of mistrust and a breach of its promise to fix the OMA after the 2016 tPSA mess it created
- The OAR, along with all other affected OSA specialties, refused to be complicit to agreeing to our own fee code cuts in contravention to the Kaplan arbitration decision so that the OMA could mitigate its failure to affected minority members
- The OSA, with strong OAR input, engaged a law firm to send a letter put the OMA on notice that this decision was in contravention of the Kaplan arbitration report.
- Discussions at the OSA are ongoing considering the legal options available to specialists that continue to be marginalised by the OMA
Bottom Line on the OMA’s MSPC Decision
- The needs of Ontario patients were completely overlooked by the OMA MSPC process
- The OMA’s funding priorities have lost sight of using new funding for those areas of medicine that deliver innovative patient care driven by new procedures and various technologies that provide measurable value to patients in a modern health care system
- The OMA has once again failed many specialists, including radiologists
- The unilateral cuts to red circled sections create a troubling precedent for further OMA mischief through side activities not anticipated or condoned by the Kaplan arbitration process
- The OMA MSPC process is in shambles requiring new leadership and an entirely new process with no financial impact to any Ontario doctor
- The OMA that created the 2016 tPSA meltdown is fundamentally behaving the same way
- Since 2017, 2 separate OMA relativity committees have been constituted, the first of which has been disbanded
- Any of their recommendations that recognized reasonable specialty issues were buried
- CANDI has been roundly denounced as inaccurate, and yet remains the official relativity model still in use by the OMA
- A new FAIR relativity model is being created which it is believed likewise has very little chance of success
- The untrustworthy MSPC process and OMA approach to trample minority sections signals extreme danger for all specialists as we head towards the next negotiation