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Observers see pros and cons to revealing how much OHIP pays out to doctors.

VINCE TALOTTA / TORONTO STAR Order this photo

Brian Beamish, Ontario's acting information and privacy commissioner, says decisions from the commission have traditionally treated billing details "as the personal information of physicians and exempt from disclosure. However, there is a growing trend toward greater transparency, particularly in the area of government expenditures.”

Nineteen physicians billed Ontario’s publicly funded health insurance plan more than $2 million each in 2012-13.

But you can’t know who they are.

Revealing their names would be an unjustified invasion of privacy, according to the health ministry’s privacy office, which denied that part of a freedom-of-information request from the Star.

But the release of physician-identified billing records in the United States earlier this year has reignited a decades-old debate about public disclosure of such information in Ontario.

Even the province’s acting information and privacy commissioner has indicated the time may have come to rethink keeping the data under wraps.

Proponents of disclosure say:

Manitoba and British Columbia make physician-identified billings public, and Ontario publishes a list of all public servants earning more than $100,000. Why the special treatment for Ontario doctors?

Disclosure might help bring much-needed accountability from physicians in an era of fiscal constraint.

It could focus attention on the need to rationalize how doctors get paid. Technology has contributed to some specialists earning much more than others.

Opponents of disclosure say:

There could be unintended consequences. Doctors working long hours, providing much-needed services, may pull back to stay out of the headlines.

It could lead to confusion. People might mistake billings for income.

Disclosure won’t provide important information — for example, how many hours doctors work and whether they are doing a good job.

The province pays physicians $11 billion annually, most of it in fee-for-service payments through the Ontario Health Insurance Plan (OHIP).

Supporters of disclosure say the public should be given more information on how those tax dollars are spent.

“We are in a world of increased transparency in the expenditure of public funds. The public has a right to know how their dollars are spent and to judge whether they believe they are getting appropriate value,” said former deputy health minister Graham Scott.

THE TOP 100 OHIP billers took in a combined $191 million in 2012-13, according to data gleaned from the Star’s FOI request.

Ophthalmologists were the biggest billers, followed by diagnostic radiologists and then cardiologists, according to information provided.

The Star asked in its request for details on the specialties of each of the 100 top billers, but this information was kept secret for 22 physicians, with personal privacy cited as the reason.

Those 22 include the six top billers. The highest biller alone claimed more than $6 million, while the second and third highest billers each claimed more than $4 million.

The Star asked the province’s acting information and privacy commissioner, Brian Beamish, why the release of physician-identified billings would be considered an unjustified invasion of personal privacy.

He issued the following statement:

“Decisions from the (Information and Privacy Commission) have traditionally treated this information as the personal information of physicians and exempt from disclosure. However, there is a growing trend toward greater transparency, particularly in the area of government expenditures.”

Beamish indicated it might be worth re-examining whether the public interest in such information trumps personal privacy.

He pointed out that in 2010 his office ordered the release of salaries of the chief and deputy chief of the York Regional Police force. The York Regional Police Association had sought the information but the force refused to release it, maintaining the salaries were “personal information.” The association successfully appealed, arguing there was a “compelling public interest” in disclosure.

The Star is appealing the decision by the health ministry to deny that portion of the FOI request related to physician identities.

“An appeal for your particular request regarding the identification of OHIP billings by individual physicians would provide a good opportunity to take a fresh look at this issue,” Beamish wrote.

MICHAEL DECTER, another former deputy minister of health, has long supported the idea of disclosing physician-identified billings and says it was an issue when he worked at Queen’s Park 20 years ago.

“It’s public money; there ought to be public disclosure. I don’t know why we exempt Ontario doctors from what applies to everyone else in the public sector,” Decter argues.

He was referring to Ontario’s so-called Sunshine List, the list of public servants with salaries of more than $100,000, which is released every spring. Most doctors are not on the list, and that’s because they are not salaried employees. Doctors who bill OHIP are considered independent contractors.

(The list does include some salaried physicians, for example those working in community health centres.)

Andrew Francis Wallace/Toronto Star

Former deputy health minister Michael Decter says there "ought to be public disclosure" with respect to physician billings.

The Sunshine List was introduced in 1996 by the Mike Harris government, with the intent of making public servants more accountable to taxpayers.

But as Decter points out, in one respect, it backfired. Thanks to the availability of peer comparisons, salaries of hospital executives and some other public servants jumped after the list came out.

Decter says physician-identified billing disclosure would hardly be a panacea for what ails the health system, but it could help draw early attention to problems with fees being out of line.

He points out that Manitoba has been releasing physician-identified billings since 1996 and British Columbia since 1971.

ROGER MARTIN, former dean of the University of Toronto’s Rotman School of Management, says disclosure of billings could help with reforming the health system.

“Transparency in the name of punishment or shaming wouldn’t be useful. But if the purpose for posting physician (earnings) is to educate the public and help make the case why greater reforms and leadership are required from our physicians, as we call for in our report, then it would be a positive step,” he said in an email.

Martin, now chair of the Institute for Competitiveness and Prosperity, released a report earlier this year showing that physician wages jumped a whopping 51 per cent between 2002 and 2012, making Ontario doctors the best-paid in the country, with earnings (before overhead costs) averaging $375,000.

But the investment didn’t buy much-needed reforms, and the report says Ontario’s health system continues to underperform compared with other developed jurisdictions worldwide on factors such as wait times and access.

Chris Nicholls

Roger Martin is the former dean of the University of Toronto's Rotman School of Management.

THE PROVINCIAL GOVERNMENT is currently in contract negotiations with the Ontario Medical Association, which bargains on behalf of the province’s 28,600 physicians.

There is a media blackout on the talks, but multiple sources have told the Star the province is pushing harder than ever for more accountability from doctors.

Scott, who chaired the province’s negotiating team during the last round of contract talks, in 2012, said transparency and accountability go hand in hand.

“It is hard to justify confidentiality with regard to the expenditure of public funds. It is also hard to have accountability where there is no transparency. I believe doctors, like all others supported by the public, should accept that their income be made public and if necessary be prepared to defend it,” says Scott, who today wears many hats, including chair of the Institute for Research in Public Policy.

More accountability would mean, for example, that physicians would be required to meet performance targets and work in teams with other health professionals, he says. Patients would get quick appointments with family doctors, and sizable inequities in payments to various specialty groups would shrink.

Physicians known as “cognitive specialists” get paid much less than those known as “procedural specialists.”

The cognitive group includes psychiatrists, internists and geriatricians. They primarily deal with diagnosing and managing chronic and complex medical conditions.

The proceduralists include ophthalmologists, cardiologists and surgeons. They do identifiable procedures, reliant on technology-intensive expertise.

Disparities between what the two groups are paid have grown over time, driven largely by advances in technology that allow procedures to be done much faster. OHIP fees have not proportionately changed.

The oft-cited example is cataract surgery. A procedure that once took a couple of hours and required a multi-day hospital stay can now be done in 15 minutes on an outpatient basis.

Warning that the future of medicare is at stake, Scott says it’s essential to have transparency and accountability from all corners of the health system.

“The public remain strongly supportive of medicare, but they are aware that there is a sustainability challenge,” Scott says, referring to the fact the province last year spent $51 billion on health care, or 42 per cent of the provincial budget.

“In that context, they should have all the facts, not just about hospitals, hospital administrators, drug costs, etc., but also the payments to doctors and about the inequities in payments among highly skilled physicians,” he adds.

more: http://www.thestar.com/life/health_wellness/2014/12/06/billings_by_ontario_doctors_are_secret_should_they_be.html?app=noRedirect

Source: http://www.thestar.com/life/health_wellness/2014/12/06/billings_by_ontario_doctors_are_secret_should_they_be.html?app=noRedirect