It’s an issue that predictably rears it head during any labour impasse between a government and physicians. Provincial governments calling for physicians to disclose their billings, in an attempt to characterize them as overpaid and greedy in the eyes of the public. The media often joins the action, looking for a juicy story. Members of the public will often chime in, asking where their health care dollars are being spent.
In Ontario, Minister of Health Eric Hoskins has raised the issue, offering to potentially exchange public disclosure of physician billings for the binding arbitration process that physicians are seeking. Putting aside the fact that physicians should be entitled to a fair dispute mechanism without having to make these concessions, I wondered whether there is a solution to be found (assuming that Dr. Hoskins is genuine in his offer).
Let me start by stating unequivocally that simply providing a list of total yearly billings sorted by physician should be a complete non-starter. That type of list, like the Blue Book provided in BC, gives us virtually no useful information. Doctor X made $250,000 in 2015. So what? That tells us nothing about what volume and type of service Doctor X provided. It’s a shaming exercise, and nothing more.
The argument often made in favour of disclosure of physicians billings is that it would provide a degree of accountability in the system that is currently lacking. However, providing only a total billing figure by physician does not provide enough detail to make any form of meaningful analysis.
Here’s what I would propose.
An online database where any citizen can search for any physician (search by name, specialty, billing number, or location), and view a itemized listing of what fee codes were billed by each physician by date. This database would not include any dollar amounts, either by code, date, or totals, again because these totals can be inflammatory without providing any value. The OHIP schedule of benefits is a separate document available to view for anyone, which lists the dollar amount for each fee code. The details in that document is where a debate can be had as to the relative appropriateness of each fee amount. The online database I am proposing should be solely focused on outlining what services physicians are claiming through OHIP, for full disclosure.
(An important exclusion to this disclosure would be fee codes involving abortion and medical aid in dying, in order to maintain the confidentiality and safety of the physicians involved).
I want to know how many patients Doctor X saw on Date Z, and what they were seen for. That is the information that we need to identify outliers. Was the volume and frequency of billing reasonable? How much the physician made should be of secondary importance, and can be debated fee code by fee code as a profession, but not by looking at a physician’s total billings. If an investigative journalist wants to data mine to determine what total amount each physician billed for a given time frame, they can certainly do so, but ethically they should be expected to describe the details of the thousands of services provided by the physicians to earn their billings.
I would also propose a database where patients can search, by their health card number, for what services were billed in their name, by fee code, date, and physician involved. There would need to be some additional security measures to ensure that only the patient themselves can access their billing history, as certain billing codes can easily disclose elements of their medical history. The current process for patients to access this information can take weeks, and is quite tedious, discouraging patients from inquiring about any questions about OHIP claims made in their name.
At this point, anyone proposing simply listing total yearly billings by physician is either doing for political gain, or through ignorance of the inadequacies of such a system. Many physicians are indeed open to system of disclosure of billings, but only under a carefully thought-out methodology that provides accountability without inappropriately vilifying hard-working physicians.