Quebec will make some of private clinics’ illegal fees legal

Quebec will make some of private clinics’ illegal fees legal
0 17 juin 2015

Health Minister Gaétan Barrette plans to change the law to allow private medical clinics to bill patients certain “accessory” fees that are now illegal while setting limits on other charges, the Montreal Gazette has learned.

“We will soon table an amendment to Bill 20 that will set limits to what can be billed to a patient and what can’t,” Joanne Beauvais, Barrette’s press attaché, said in an email response to a query about the controversial accessory fees.

“This amendment will be studied when the (National Assembly) commission sits again in August.”

Barrette, she continued, “has always been” open to the concerns of some physicians in private practice who have argued that the current fee structure does not reflect today’s medical reality.

“What he was opposed to was the exaggeration in fees — $180 for eye drops?”

Beauvais would not say exactly what fees will be permitted under the new amendment or what will remain illegal. But Barrette’s openness to allowing certain fees follows pressure by the Quebec College of Physicians to modernize the list of accessory charges.

On Tuesday morning, the Association des cliniques médicales du Québec (ACMQ) held a news conference warning that some private clinics might close after July 7 — when an updated code of ethics for doctors comes into effect — because they will now have to produce detailed billings. Previously, some physicians — like gastroenterologists who perform colonoscopies — chose to disguise extra fees under the heading of “medication” in bills to some patients — something that the revised code of ethics would prohibit.

At present, the Quebec Health and Social Services Act stipulates that doctors who practise in the public system can bill patients only for “medication and anesthesia agents.” In addition, the provincial government did negotiate with the medical federations a list of other fees that are permitted, such as the use of liquid nitrogen to remove moles ($10) or the use of a topical anesthetic for a minor eye wound (also $10).

Over the years, however, many physicians in private practice started billing for many more items and services, sometimes prompting investigations by the provincial medicare board, the Régie de l’assurance maladie du Québec (RAMQ). In response to a sharp increase in complaints, the College of Physicians decided to revise its code of ethics, but at the same time it called upon Barrette to update and expand the list of accessory fees.

“We propose standardizing fees based on the actual cost of operation of clinics,” said Dr. François Loubert, co-president of the ACMQ.

He noted, for example, that gastroenterologists who set up a private clinic must buy all the medical equipment and pay for the salaries of nurses who assist them during a colonoscopy. The gastroenterologists bill RAMQ for the colonoscopy procedure, but those medicare billings don’t cover their true cost of operations.

Private clinics that offer colonoscopies usually charge patients a $600 accessory fee in addition to the gastroenterologist billing RAMQ for the procedure. Whether Barrette would permit such a fee or cap it to a certain level will only be known once he tables his amendment to Bill 20, his reform of the health system that focuses on access to care.

Critics have argued that the use of accessory fees is a form of two-tier medicine that lets patients with private insurance “jump the queue” in hospitals to get certain procedures done sooner at a private clinic.

Isabelle Girard, executive director of the ACMQ, denied that expanding the list of accessory fees undermines medicare.

“Our clinics are here to support the public system,” Girard said.

The ACMQ has already met with Barrette. “The association was aware we were going to intervene,” Beauvais said.

Quebec long ago allowed for one exception — for radiology clinics. They are permitted to bill patients for MRIs and other medical-imaging scans. Prior to being appointed health minister, Barrette and his wife ran a private radiology clinic.

Source : www.montrealgazette.com/news/local-news/quebec-to-update-list-of-medical-fees-doctors-can-charge-patients-in-private-clinics

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