PLP: ‘OBA Must Drop Ill Thought Out Scheme’

[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
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“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.”

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