PLP: ‘OBA Must Drop Ill Thought Out Scheme’

October 8, 2014

[Updated with Minister's response] “The news that the Bermuda Medical Doctor’s Association [BMDA] opposes the OBA’s pre-certification scheme should come as no surprise to most Bermudians,” Opposition Leader Marc Bean said, adding that the “OBA must drop this ill thought out scheme.”

The Opposition Leader was speaking after the BMDA said they “note with some dismay the Request for Information published by the Ministry of Health,” adding they are “steadfast in its opposition of the implementation of pre-certification.”

The BMDA said pre-certification “can delay access to treatment” and “will add to the costs of the system – every person in Bermuda will pay for the implementation of pre-certification.”

Mr. Bean said, “The facts are that pre-certification has been discredited and dismissed as a viable tool to lower healthcare costs because it has proven to:

  1. 1] Delay patient access to needed medical treatment
  2. 2] Drive up medical costs.

“Doctors are concerned that their patients may find their conditions worsening or even losing their lives while a clerk second guesses their physician.

“Of particular concern in the Bermudian context is that with mounting job losses and stagnating wages, the Bermudians who can least afford it will be forced to pay more for the OBA’s pre-certification scheme through increased government expenses, increased expenses for insurance companies and increased expenses for medical practitioners
.
“On top of the risk that this Death by Delay system would create, the medical services targeted by the OBA to require pre-certification are all provided by Dr. Ewart Brown’s clinics.

“In some instances, BHCS and Brown -Darrell are the only providers of the diagnostic tests outside the hospital. In their apparent haste to target the business of a former PLP Leader and Premier of Bermuda, the OBA have attacked the entire medical fraternity and put patients potentially at risk.

“The OBA must drop this ill thought out scheme and embrace a true consultative approach with the stakeholders that approaches healthcare cost containment in an holistic manner, that will not compromise patient safety or compromise service delivery,” Mr. Bean concluded.

The Health Ministry has not yet responded to our request for comment, however we will update if able.

Update 6.24pm: The Minister of Health, Seniors and Environment Jeanne Atherden said, “I have to wonder if Mr. Bean read the Background and Policy Guidelines document that accompanied the Pre-Certification Request for Information [RFI]. If he had, it would be clear to him that the pre-certification proposal does not only target the facilities operated by Dr. Ewart Brown.”

“Paragraph 57 of the Guidelines clearly states that pre‐certification will be required for all out‐patient MRI, MRA, CT, CTA Scans, Pet, Nuclear Cardiology and Echocardiography tests ordered by non‐specialist providers.”

The Minister also said: “While Dr. Brown’s facilities provide some of these tests, the Hospital and facilities run by other physicians also provide these tests and will be subject to pre-certification.

“In addition, clinical laboratory tests which meet the criteria set out in the Guidelines will also be subject to pre-certification. In all cases the focus is on the physician who orders the test rather than the place where the test is performed, unless the physician is self referring.”

The Minister went on to say that her Ministry has issued a Request for Information, and once that information has been received, the responses will be reviewed and a decision will be made on whether or not to proceed to the Request for Proposals [RFP] stage.

If an RFP is issued, this is when the Ministry will begin to set out the conditions that the operator of the pre-certification system would have to comply with.

“This is where we would set time limits for pre-certification requests to be processed and define how they would be submitted to the operator,” said the Minister.

“Clearly our intent is not to delay treatment for patients or to endanger lives. Emergency and urgent care services are expressly excluded from pre‐certification [paragraph 59 of the Guidelines].”

Minister Atherden said that the objective of pre-certification is to reduce the amount of laboratory testing and to reduce the number of diagnostic imaging procedures that are done by all providers – private sector providers and the Hospital.

The Minister said, “If we can reduce the number of tests done, that will reduce the number of claims paid which will ultimately lead to lower insurance premiums. If claims go down, premiums go down, and everyone benefits.”

The Minister concluded: “I know that the private physicians still have concerns, and I understand those concerns. I want to assure the physicians that we are committed to finding ways of reducing utilization through self-policing, providing information to physicians on their utilization rates and through the use of clinical guidelines.

“However, if these efforts do not produce results, we will have to move forward with pre-certification.”

Share via email

Read More About

Category: All, News, Politics

Comments (21)

Trackback URL | Comments RSS Feed

  1. cucumbah says:

    Furthermore an insurance company does not have the right to tell you where you get your medicine or how much you pay.

  2. Triangle Drifter says:

    LOL LOL LOL LOL!!!! Well now the PLP, of all groups, should know a thing or two about ill thought out schemes.

  3. hmmm says:

    Do doctors get referral fees for things like scans????

    • Openyoureye says:

      No! Doctors do NOT make money off of lab test, scans nor medications.

      • Alicia says:

        They do if they own an interest in the facility doing the testing.

      • Alicia says:

        they do if they own an interest in the lab, diagnostic imaging facility or pharmacy

        • more than enough says:

          They also get paid for the in office referral.

    • Family Man says:

      Some doctors own the scanning equipment so they (might) send as many of their patients as they can get away with for as many scans as the insurance company will pay for.

    • Lol says:

      IF the Doctor owns the machine and the lab he makes money off of it!

  4. jt says:

    I agree that this needs a re-think.
    One of the best ways to help pay for our health care system is to increase the numbers of younger, mostly healthy contributers….and you know what that means. I wonder what the plp thinks about this?

  5. Stick to your style; this is waaaaaay out of your league :-(

  6. serengeti says:

    Bean is out of the loop. There is no “scheme”. The Ministry requested ideas, feedback and solutions.

    It’s the first time we’ve heard from Bean for weeks. He’s just trying to make sure his buddy DREB doesn’t take a hit in the pocket.

  7. marge says:

    OBA, To even think of pre certification is absolutely ridiculous !!!!

  8. PATI says:

    Give me some Ganga tea!

  9. eye in the sky says:

    any free ganga tea from this so called scheme?

  10. wtf says:

    Everyone receiving a pay check should be deducted 3-5% to go towards island health care to decrease rates across the board. You may hate it now but you wont when you have to pay for your own medicine etc.

    We as a people can NO LONGER expect govt to pay for this and that. The PLP thought govt could give out free beeze but now look at our debt.

    If you want solutions be prepared to pay up, the moneys gotta come from somewhere. Govt can no longer “borrow” money to look like a superstar infront of its people, its clear, WE as a country are BROKE!!!!

  11. Cookie Monster says:

    What percentage of doctors are members of the BMDA?

  12. Coffee says:

    Basically what this is , is a modern day shake down ! LOL … AND POORLY ORCHESTRATED !
    Stay silent Dr.Brown … Let your peers and patients do your bidding !

  13. JUNK YARD DOG says:

    Should Insurance companies offer a “SELECT CARE” Policy.

    One size fits all is not working because people are not all the same.
    Why should I pay the premium for air ambulance or surgery for example when that is not required ?

    That is to say
    Buy a policy specific policy to cover :-

    Medication
    Air Ambulance
    Surgery
    Electronic treatment
    Consultation
    Hotel expenses ETC.
    Or any crafted combination of procedures.

  14. JUNK YARD DOG says:

    @RAYMOND RAY
    I would be good if we all were aware as to whom you had in mind on October 8 .2014 at 1:13 pm. I Hope, not me as I appeared out of no where from the JUNK YARD at 7:57 pm

  15. more than enough says:

    Robbery.

Latest Tweets From ForeverBermuda.com