Ministry Seeks Feedback On Pre-Certification

September 23, 2014

The Ministry of Health, Seniors and Environment said they are “seeking information and creative ideas for solutions to implement, manage and operate a system to provide pre-certification of diagnostic medical testing for Bermuda’s healthcare system.”

A spokesperson said, “The Ministry is seeking industry experts to submit RFI responses that will assist with assessing the most advantageous and cost effective solution. The information gathered by this RFI will help determine the optimal approach to procuring a new solution.

“Information will be gathered from different interested companies and will be used to evaluate the sourcing process with an official open RFP. The information submitted will be evaluated by the Ministry in conjunction with the Office of Project Management & Procurement.

“The information submitted will be evaluated based on the potential vendor’s experience in the area of pre-certification and the ability to meet requirements.

“Potential vendors will demonstrate successful experience in establishing and managing a pre-certification system in a sophisticated jurisdiction. The system must involve physicians, public and private insurers and providers of medical testing services.

“Interested parties that require any additional information may contact Mr. James Shubert, Business Analyst, Health Insurance Department at [441]295-9210 or jkshubert@gov.bm for further details.”

Full details and tender documents may be obtained at gov.bm or from the Health Insurance Department’s reception desk on the second floor of Sophia House, 48 Church Street, Hamilton during regular business hours from Monday to Friday.

Completed submissions must be returned [via email to jkshubert@gov.bm] no later than 5 pm on 31st October, 2014. Late submissions will not be considered.

“Bermuda has a higher rate of utilization of advanced imaging equipment than most OECD countries,” explained the Minister of Health, Seniors and Environment Jeanne Atherden. “Some procedures present risk to patients and their use should be minimized.

“Increased use of medical imaging has led to concerns globally about the impact of cumulative radiation exposure on individuals and public health. In addition, the utilization increases have had a significant impact on the cost of healthcare in Bermuda.

“As a result, we are seeking a centralized utilization management agency, contracted by the Health Insurance Department [HID], which will pre‐certify all eligible diagnostic imaging and clinical laboratory procedures. Public and private payers will be required to adhere to HID’s pre‐approvals for their insurance plans.

The Minister added, “Pre-certification will promote the delivery of quality healthcare in a cost effective manner, improve standardization in the ordering of diagnostic tests, and reduce unnecessary utilization of and duplication in diagnostic testing [both medical imaging and clinical laboratory tests].”

The statement from Government concluded by saying, “Pre‐certification is planned to apply to select medical imaging procedures [e.g. MRI, CT scans, Echocardiography, etc.]; and to specific clinical laboratory test orders and orders with a cumulative value above $300. Orders by specialists and diagnostic testing for emergencies will not have to be pre‐certified. Self‐referrals will be subject to pre‐certification.”

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Comments (14)

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  1. Coffee says:

    The winds are gathering to shut down or make it extremely difficult for a certain Dr/Businessman to operate in his own country
    …. Again !

    • frank says:

      this is aimed at one medical center headed up by a black Bermudian
      it is time to rise up

      • Double Standards says:

        Didn’t realize that it would only affect one doctors operations (sarcasm).

        Yeah let’s rise up against each and every attempt to reduce healthcare costs!

        Then after lets complain about how much we pay in insurance premiums and lay blame at the physicians that charge so much and the Government isn’t doing anything about it.

        That will help. Most definitely.

      • Creamy says:

        So an attempt to control spiralling healthcare costs gets met with a threat of violence.
        Nice.

      • Family Man says:

        That doctor’s staff should rise up and join the BIU.

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

        you do know, that with every uprising comes the down fallen…are YOU prepared to be one of the FALLEN or are you waiting to step on the backs of those to reap the benefits?…again!

    • Keepin' it Real!...4Real! says:

      its amazing how you came to that conclusion…i read the article and came out with the more stringent regulations put in place for YOUR safety as a patient by every place that provides these types of services…oh well, stupid is as stupid does…take a break on the coffee for a while, it’s clouding your brain activity…oh and by the way, if your mate doesn’t measure up to the required standards, then HELL yeah shut him down…

      ps. ummm… you know it’s useless trying to fight against corporate medical services…right? from big pharma thru the insurance co. right along down to your dr….all i can say is that you are biting at the wrong end of the rope.

  2. Rhonda says:

    I predict after the first non black Bermudian, dies from a delay in care, with pockets deep enough to fight the structural 400 year old system, the narrative on this will change.

    • Declan Harrison says:

      Hey, Rhonda. The 1950s are calling. They want their image back.

  3. Rhonda says:

    Is this another way of saying we can’t have poor people getting quality care. Let them eat cake. Those who can financially afford to bypass this will. My Dr orders a CAT scan another Dr will say no. Then what happens.

  4. Rhonda says:

    Physicians have spoken out against a pre-certification system for Bermuda, which they warn could prove costly and time-consuming.

    Local physicians are “overwhelmingly” opposed to a health plan imposed by Government to rein in unnecessary and expensive diagnostic testing.

    The initiative, known as pre-certification, will force doctors to consult with insurance companies or other third party to obtain permission for tests on their patients

    • serengeti says:

      And next year when insurance premiums go up you will be wringing your hands, complaining that the government didn’t try to reduce healthcare costs.

    • Double D says:

      Of course physicians will protest. It will affect their bottom lines!

  5. movin says:

    This is scary! To pre-certify for medical assessment is unethical at best. Not to mention delays can cause an escalation in many diseases like cancer. If you want to curtail medical costs start with review of high doctors charges and education for obese people in Bermuda. Medical care is so sub standard locally and now diagnostic tests will be curtailed….frightening.