Video: Dr Ewart Brown On CT Scan Closure

There was legal action pending prior to the agreement for Government to pay a financial supplement for CT and MRI scans, Dr Ewart Brown has confirmed, adding that while the Government has “taken steps to help” they have “suffered staggering losses”.

Dr Ewart Brown — a former Premier who is the Executive Chairman of Bermuda Healthcare Services and Brown-Darrell Clinic — sat down with Bernews for a 80-minute live interview, on a wide range of topics, with the closure of Brown Darrell CT scan unit one of the matters discussed.

CT Scan Unit At Brown Darrell To Close On January 31

Dr Brown previously said that the CT Scan Unit at Brown-Darrell Clinic will close on January 31, 2018, with the company saying it is as a “result of severe reductions in payments by the Bermuda Health Council,” and a press conference was held last week by Dr Brown to address the matter.

Dr. Brown has previously said, “Few businesses could survive up to 87% cuts in revenue with only 2 weeks notice. No local or exempt company has ever been treated so harshly,” and the Health Council is “wreaking havoc on the provision of physician services to Bermudians.”

The Government recently confirmed they will be paying “financial supplements paid to CT and MRI providers to offset the drastic fee cuts of June 2017,” saying “if the level of services remained the same as last year, Brown Darrell and Bermuda Health Care Services would receive approximately $778,0000 and BHB $1.8 million.”

21-minute extract of the interview portion on the CT scan closure

Fees Reduced

Dr. Brown said, “In 2013, the then-CEO of the Health Council indicated that it was her intention to begin the reduction in healthcare costs by starting with diagnostic imaging. To this day, I don’t know why. I asked her why. She said, ‘Because you’re low-hanging fruit.’

“I thought that that was not very scientific, not very fair, not very just. I have been in support of health care cost reduction for all of my professional life. I have worked in California, Washington D.C., other places, where I’ve always lobbied for work for reduction in health care.

“And in our own practice we go a long way to try to see to it that people don’t spend unnecessarily. But to be singled out as an entity in the health care reduction exercise, to be singled out without any justification, to me is unfair.“

‘Extent Of The Slashing’

“We were not going to be surprised by a reduction. But when we saw the extent of this slashing, we knew then that there was a vendetta component to all of this. You just don’t cut a CT of the brain from $1400 or $1200 down to $275,” Dr Brown said.

“Now they claim that they used RVU methodology, which is relative value unit. I can tell you that that has been a total joke, because it was not RVU methodology.“

‘An OBA Government Initiative’

Saying the Health Council “boxed in the PLP Government,” Dr Brown said, “This was really an OBA Government initiative,” as at the time that the Health Council made this decision, the Council was “full of OBA candidates, political consultants to the Minister, ” and he “can’t say that there was any attempt to be objective.“

‘Was Court Action Pending’

Asked for clarification about the $778,000 fee, was it a grant or settlement, Dr. Brown said “they called it a grant,” and added that, “It was a settlement in the sense that there was court action pending.“

Asked if it was court action pending by him, Dr. Brown said yes, adding that “we agreed to withdraw that particular action.“

Dr. Brown said, “The court case was about this unfair targeting that we say we experienced from the Health Council.

“Real consultation would have put me across the table, at least once, from the people on the Health Council. The only time I’ve ever done that is when I asked for it. I asked for an appearance. That didn’t go far.

Dr. Brown expanded, “I can only say that the terms of the grant, what the Minister said, is absolutely accurate. But I liken it to my having my wallet stolen. And I say, ‘Jeremy, I know who stole my wallet.’ And you say, ‘How much did you have in it?’ And I say, ‘A hundred dollars.’ And you say, ‘Well here, here’s fifty.’ Well, thank you. You know I appreciate it, and thank you very much. However, I had credit cards. I still have fifty dollars that I’m out of.:

 ’Suffered Staggering Losses’

“The Government has definitely taken steps to help us some, but we suffered staggering losses since June 1,” Dr Brown said. “And our losses were so staggering that in spite of what the Government has done for us, and we do appreciate that, looking at the new numbers that the Government established, those numbers are still 40, 50, 60% below what it used to be prior to June 1. And we just can’t operate in a viable way.“

Asked about the $778,000, and if it was enough to keep the CT scans/clinic going, Dr. Brown said, “No. It was enough to help us out, but it was not enough to help us to keep going. In other words, back to the wallet analogy, what about the original theft?“

“$778,000 dollars sounds like a lot of money, and it is a lot of money. There are many people in Bermuda who look at that number and say, ‘Well, what does he want?’ Well, I want justice. I want justice.”

Expensive Business & Place

He also pointed out the high expenses of the business, saying, “This machine, to get the Brown Darrell CT up and running cost in excess of $3 million. We pay more than $40,000 a year for our maintenance of the machine. It’s an expensive business. And when you hear the hospital claiming that it is expensive to run a hospital, it is also expensive to run these services outside the hospital.“

Asked if he feels the fees for MRI’s and CT scans have been very high, Dr. Brown replied, “I accept that the CT prices have been consistent with the relative value in Bermuda. This is Bermuda, where a loaf of bread costs twice as much as it does in New York. Or more.

“Bermuda is an expensive place. In fact, some people said it’s one of the more expensive places in the world. So the CT reimbursements, I think, have been consistent with the cost of living in Bermuda. The MRI prices, same thing.”

‘If Excessive Scans, Check The Hospital’

Dr. Brown also said, “If too many scans are being done, I think first you should go to the hospital. The hospital does twenty some thousand scans a year, and we do about a thousand. A little over a thousand CT scans a year. So if there are excessive scans being done, I’d suggest that the first place to check would be the hospital.“

Asked about a perception some may have he is fighting lower healthcare costs, Dr. Brown said, “I am not fighting lower healthcare costs. I am fighting the lowering of healthcare costs on us, and us alone. Yes, the hospital was cut back. But then it was compensated for by increasing fees for the operating room. So we already know that including the hospital in the cut was what I call a cosmetic cover.“

“We don’t want to close,” Dr Brown said. “That’s a strictly economic decision. It’s not a political decision or emotional decision. It’s economic.“

Health Ministry Confirm ‘Matter Settled Via Legal Counsel’

We asked the Ministry of Health for clarification on the legal and fee aspects following this interview, and a spokesperson said, “The Ministry can confirm that a letter before action was received in relation to the fee levels. However, as the matter was settled via legal counsel, details about the particulars of the action will not be provided.”

The Ministry confirmed the “letter before action is dated 3rd October 2017,” and when asked if the Government was advised by counsel/AG to settle before it reached court, the Ministry said no.

“On reviewing the history and background the Government determined that the fee levels set by the previous Government had been excessively low. The fees could not be reversed as that would have resulted in premium increases mid-year,” the spokesperson said.

“Instead, the Government determined that to avoid premium increases, it would award a special financial grant to the three facilities affected to mitigate the impact of the low fees for MRI and CT; namely, the Brown Darrell Clinic, Bermuda Health Care Services and the Bermuda Hospital Board.”

‘Agreed On The Condition That The Letter Before Action Would Be Withdrawn’

When asked about Dr Brown comments suggesting the Government settled this case without going to court by providing the $778,000, the Ministry said, “As stated above, the Government decided that, to avoid premium increases mid-year, a special financial grant would be provided. This was agreed on the condition that the letter before action would be withdrawn.

“The $778,000 figure is an estimate based on the 2016/17 utilisation. If the same number of MRI and CT procedures were done this year, the total payment would be of that amount. However, the amount being paid is based on actual claims for procedures performed, so the final figure will not be known until the end of the fiscal year.”

When asked is this a one-off payment or were terms agreed whereby there would be follow-up payments, a spokesperson said, “Per above, terms were agreed.”

Asked who decided the payment and on what the amount based on, a spokesperson told Bernews, “The Cabinet considered all options, and decided on the payment and method to be applied, based on the relative value method to determine the fee levels.”

When asked have other medical practices threatened legal/are threatening legal action over the levels of consultation, the Ministry said, “One other practice joined Dr Brown in the letter before action. There were no grounds to that claim.”

When asked if a review of fees is on-going, a spokesperson said, “Yes. The BHB fee schedule is being revised to apply a rational, transparent relative value method to all fees.”

The text above represents only a small portion of the discussion, so for full context of the please watch the 21-minute video above, which was extracted from the full 80-minute interview.

Dr Brown discussed a range of topics including Zane DeSilva’s resignation from Cabinet, the Commission of Inquiry, the police investigation, gaming, the America’s Cup, politics in general, same sex marriage and more; you can watch the full video here, an extract on the Lahey lawsuit here, and we will post additional excerpts/transcripts/responses as able.

#BermudaBusiness #BrownDarrellCTScanClose #DrEwartBrown #Health

Category: All, Business, News, Politics, Videos