Opinion: Chris Famous On “Death By Delay”

April 14, 2014

[Opinion column written by Chris Famous] In December, the then Health Minister Patricia Gordon-Pamplin announced the OBA was looking to introduce pre-certification to the medical industry.

This means that our physicians will be required to get approval from a faceless person on the end of a 1-800 number before any medical diagnostic procedures can be performed.

The Why?

“I hear that certain doctors are being incentivized when diagnostic testing is done.” Minister Gordon-Pamplin- RG December 2nd, 2013. If there is proof of abuse by specific doctors then efforts should made to tighten controls and enforcement thereof.

Minister Gordon-Pamplin justified pre-certification as OBA’s attempt to contain health care costs. Last year, $50m was spent on diagnostic testing which equates to approximately 8% of healthcare expenditure. This is in comparison to hospital costs which amount to 44%. OBA projects that pre-certification will result in a saving of $6m, representing a mere 1% of the $679m in total costs.

However, OBA failed to factor in the costs of implementing this initiative. Costs include employing staff to manage the pre-certification process which will probably be passed on to the patient.

What is the real motivation to focus on such a small driver of health care costs? Is it linked to the recent Throne Speech announcement that OBA will implement controls on the importation of medical equipment by private health providers?

While OBA stated that this was to curtail health costs, they failed to reveal:-

  • some private medical facilities charge MRI’s at 80% of the cost of the hospital
  • the KEMH CT scan has occasionally been inoperable and patients were dependent on privately owned CT.

Recently, the Diagnostic Imaging fee schedule was released with cuts of more than 50% for certain scans. If this is allowed, the island’s only CT option outside KEMH will be shut down. The fee schedule has subsequently been abruptly withdrawn.

Health Risk
Pre-certification does not have the support of the Bermuda Medical Doctors’ Association [BMDA] who represents the Island’s physicians. BMDA views pre-certification as a safety risk to patients because:-

  • patients are forced to wait for permission to have necessary diagnostic testing i.e. “death by delay”
  • it directly interferes with patient care
  • who will be liable if a patient dies or health status worsens as a result of a refusal to grant permission for diagnostic testing?

OBA Collaboration?
“I don’t make decisions or look at information in isolation……I consult with people who are in the field.” Minister Gordon-Pamplin – RG December 2nd, 2013

“This decision was taken in the complete absence of consultation with physicians, and as such puts the safety and care of our patients at risk.” Dr Sherratt-Wyer – RG January 14th, 2014

A Bermuda Health Council [BHeC] spokesperson confirmed that they were instructed last year by Cabinet to implement pre-certification. RG January 14th, 2014.

The BHeC oversees local healthcare and has been given the mandate by Government to develop pre-certification procedures. Local doctors have expressed concerns that the BHeC lacks physician input and that it has evolved to be a body that tends to make “pencil and paper” decisions without understanding the human impact of their decisions.

Seems fairly obvious the Medical Fraternity were not consulted before hand.

The questions that Bermudians have to now ask themselves are as follows;

  • A. Do you trust your Doctor with your health?
  • B. Do you trust the OBA with your health?
  • C. Death by Delay?

-Chris Famous

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Category: All, Politics

Comments (27)

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  1. claudio says:

    Other countries such as Bahamas use this and it is not an issue. Please provide examples in which this ‘death by delay’ has occurred.

    If you can’t come up with solutions to reduce healthcare costs.. do try to use the scaremongering tactic. Shows that you prefer to play politics instead of dealing with the real issue.

    Again I ask.. what can we do to reduce healthcare costs?

  2. On the other hand we are inundated and rife with up coding……easily seen in audit….the more lucrative and or expensive tests done far more often than lesser costing tests.Hospital admitted to asking staff to meat a quota of tests required….that in and of itself is fraud!

  3. Evie says:

    What is the real reason for this THINGS that make u say mmmmmh

  4. Unbelievable says:

    I’m sorry dude but you REALLY are paranoid. No wonder you sit behind pen-names like Mazumbo, Steve Biko and Coffee.

  5. Muhammad Goldberg says:

    On this issue Mr Famous has a justified complaint. Pre certification has failed miserably in every jurisdiction it has been implemented in. Why is government forcing this on our health care system with no consultation with medical professionals, and against public warnings from medical professionals?
    There must be more to this story…what is motivating the Government’s decision to pursue this? Who will benefit from it?

    • claudio says:

      Please provide examples and articles in jurisdictions where this has failed?

    • Terminator says:

      You are misinformed about the implementation of precertification–which is merely one tool in the larger issue of utilization management. Utilization management in one form or another is in place in most jurisdictions, and has been successful in reducing healthcare costs. Bermuda is about two decades behind the rest of the world in doing this. Unless you can provide clear examples of where it has “failed miserably,” I suggest you spend more time researching the facts and less time making inaccurate comments.

  6. Real Talk (original) says:

    Another band-aid solution which does precious little to address the real reason for rising health care costs, namely, an increase in certain preventable diseases such as diabetes, and more importantly, unregulated health care which allows for exhorbitant health fees.

    A recent 10 minute visit to a doctor to remove wax build-up in my child’s ears resulted in an almost $300 COPAY, meaning the true cost of the visit was likely nearer to at least $500.

    Nationalize our health system.

    • WillSee says:

      I had my right ear checked and was issued a prescription for a $50 copay plus a smaller amount
      for the drops.
      Find a new doctor!

    • Build a Better Bermuda says:

      Wow, $300 copay for 10 minutes, my physicals cost less than that and take longer. I can see how you think the doctors are responsible for for our increased healthcare costs. My advice, get a new doctor, cause your current one is ripping you off… also report that doctor, cause it sounds like there is a grounds for fraud. Q-tips daily would have been cheaper

  7. Archie says:

    This is a quite misinformed article, I have some experience in this field.
    First of all it is not a question of death by delay – that has been pedaled by a few people and is simply alarmist.
    It already takes weeks for people to be scheduled for an appointment – this will not make it any slower. Those responsible for Ok-ing the treatment also have to make a decision within 24 hours.
    Any emergency procedures are not subject to this – their procedures go ahead and are reviewed afterwards.
    As it stands right now, there is little or no regulation of doctors – who are free to carry out as many procedures like this as they wish, with no regard to the patient or driving up costs in the long-run. There should be no fear of the type of regulation that already exists in other countries and why is it that a profession as key to people’s health has no regulation? That alone should cause an outcry.
    Do you know that in terms of GDP, health care costs contributed more in 2012 than tourism?
    Do you know that if this goes unchecked, insurance will continue to rise? Do you want to be able to afford to retire in Bermuda?
    For once, take the politics out of it Mr Famouss and just look at the impact spiraling health care costs will have.
    Pre-certification is not the end of the matter – it is starting the process towards controlling costs.

    • 32n64w says:

      Is there an actual point to Mr. Famous’ remarks or is this just more of the same rambling of incoherent, unrelated, selective and incomplete “facts” in an attempt to make a point that yet again misses the reasonability mark?

      Repeating out of context and unrelated observations in the hope of reconstituting them into an illogical summary is not the sign of a “writer” who prides himself on the truth … unless fiction is your genre.

  8. Keepin' it Real...4Real! says:

    The Global Wheels keep on turning…hang on

  9. hmmm says:

    What a weak attempt to bash the OBA !

    • hmmm says:

      If there is huge demand placed on scanning equipment from uneccessary and multiple scheduled appointments, then there is a waiting list. When there is a waiting list, there is delay.

      You could so easily say Death by delay to that.

  10. verbal kint says:

    What about the statement by Ms. Pamplin-Gordon that doctors were “incentivized” to prescribe testing?

  11. Creme Brulee says:

    A lot of what we are dealing with here has to do with medicine becoming more and more monetized since the early 1990s, and especially the return to Bermuda of a few aggressive American trained doctors who are clearly very interested in the bottom line. Though not necessarily a bad thing in that the consumer can get treatments very early on (which for example is why American cancer survival rates are far better than most other wealthy countries, especially the UK), this model does drive costs through the roof and this does eventually have to be addressed – as the Americans have with their health group pools, etc, all designed to reign in the excesses. It would appear that in our muddled way, we are beginning to address this too – I do think Government should butt out as much as possible and leave it up to the marketplace of individual insurance companies.

    In the meantime, perhaps Government health policy should focus more aggressively on models of preventive medicine (diet, exercise, etc) which in the long term will do the most to control costs.

  12. Jokes for Days says:

    Seriously… death by delays? This is the same kind of scaremongering misinformation the Republicans tried to do with Obamacare’s alleged “Death Panels”

    Ironic that a PLP advocate in Bermuda is using the same tactics as the US Republican party…

    • LOL (original TM*) says:

      No other party in Bermuda mirrors the Republicans as the PLP do, thats a fact Jack.


  13. Terminator says:

    Mr. Famous, as usual, is inaccurate, alarmist and his info is about four months out of date. Mr. Moniz is the Health Minister. A symposium for physicians was held in February (all the sessions can be seen by the public on BHB YouTube) and the issue of precertification was on the agenda. That meeting started the dialog between physicians and the Ministry, which continues. A BHeC working group has been established to ensure input from stakeholders, including physicians. Have you been hiding under a rock, CF?

    • Lauren Bell says:

      Symposium was held in February but Bermuda Health Council confirmed that they were advised by Cabinet to implement pre-certification last year. In fact, in January, the BHeC stated that they would be releasing a public document outlining their proposed changes. Thus what triggered the outcry from the Bermuda Medical Doctors’ Association and their head, Joanna Sherratt-Wyer

  14. Terry says:

    Mr. Famouss is being used an attack dog like another who frequents this page.

    I respect him but Chris please let it go. Your well established and have concerns but like I told you sometime ago don’t be used because your up front and vocal.

    I would suggest to just shut up, move on and be a beacon that people will trust.

    Your heart is in the right place but don’t let others lead your heart.

    Bless up.

  15. Mike Hind says:

    C. Isn’t a question.

  16. Terry says:

    More a choice with the alternative being ‘C’.

  17. Comment is Free says:

    As many others have said, Mr Famous is alarmist and ignoring the problem, which is the unnecessary use of expensive diagnostic testing. Pre-clearance simply means that a second medical opinion is required before a routine test. Where does Mr Famous get the idea that this will be received from an anonymous 1-800 call recipient?

  18. Coffee says:

    Would this be a issue if the Doctors and service providers who have the equipment had their businesses on Point Finger Road ?