BHC Modernizes MDCO Fee Schedule
The Bermuda Health Council [BHC] has updated the Medical and Dental Charges Order [MDCO] “to align with global standards and methodologies,” with the updated order to come into effect tomorrow [Oct 1].
A spokesperson said, “The Bermuda Health Council has modernized the way doctors and dentists are paid for acute care provided in inpatient settings locally, updating the Medical and Dental Charges Order to align with global standards and methodologies. The modernized Order will come into effect on 1st October 2025, and fees will be published on the Health Council website.
“This modernization follows the same structured methodology the Health Council has used to update other regulated fees across the health system, an approach that has helped stabilize healthcare costs over time. The Council also recognizes that insurance premiums have continued to outpace the actual cost of healthcare and is actively collecting and analyzing data to better understand the drivers of this gap, mitigate unnecessary increases, and strengthen accountability throughout the system.
“The updated system works by starting with the U.S. Centers for Medicare and Medicaid Services [CMS] values and applying a Bermuda-specific adjustment to reflect the higher cost of providing care locally. It has also been benchmarked for reasonability against Optum’s 50th percentile charge benchmarks — a recognized reference for local physicians and insurers. Both the international values and the Bermuda adjustment will be updated twice a year to ensure fees remain transparent, predictable, and up to date.
“As part of this modernization, a new code has been included in the MDCO to create more structure for emergency and complex care coverage. This ensures that specialists responding to urgent, life-threatening situations are supported within the regulated system, giving patients greater confidence that critical care will be delivered without delay.
“These actions affect members of our community in very direct ways:
- No surprise bills: families cannot be charged extra or balance-billed beyond the legislated amount.
- Stronger protection in emergencies: critical services like maternity, surgery, and emergency care are properly supported, reducing the risk of delays when time matters most.
- Accountability in the system: aligning regulated fees with global standards and updating them regularly ensures costs are transparent and do not go unchecked.
“The Ministry of Health, as the lead for Bermuda’s Universal Health Coverage [UHC] reforms, expressed strong support for the Health Council’s actions. This reform is part of a broader modernization agenda that includes:
- Establishing a systematic and strategic set of core benefits so every resident has access to essential health services.
- Placing greater emphasis on mental health to improve access to counseling, treatment, and prevention services.
- Clarifying regulated services and funding mechanisms to reduce unnecessary balance billing.
Minister of Health Kim Wilson said, “This modernization ensures that Bermuda’s regulated fee structures reflect international best practice and support our core goal of affordability under UHC. The Health Council’s update protects patients from unexpected charges, unauthorized balance billing, makes the cost of care more predictable, and strengthens access to essential services.
“Together with reforms such as those to core benefits, mental health care, and our local workforce, these changes build a healthcare system that puts our communities first.”
Dr. Ricky Brathwaite, CEO of the Bermuda Health Council, said, “Our role as regulator is to make sure the foundations of the health system are strong, transparent, and accountable. By modernizing the MDCO, we are aligning with global best practice while protecting patients from surprise costs and unnecessary delays in care.
“We are also making the system more transparent by publishing all regulated fees on the Health Council’s website, so the public can see exactly what is covered. This work also complements our ongoing efforts to enhance innovation across the health system — from digital platforms and data transparency to new ways of delivering care. Together, these steps help stabilize healthcare costs, close the gap between premiums and actual care, and prepare the environment for UHC.
“Every resident deserves access to affordable, high-quality, and forward-looking care, and this work brings us another step closer to that goal.”
The spokesperson said, “Timeline:
- 1970 – Bermuda Hospitals Board Act establishes authority to set hospital-related fees.
- 1999 – Medical and Dental Charges Order [MDCO] enacted [April 1], formalizing fee schedules.
- 2000s–2010s – Bermuda uses Ingenix/UCR methodology [based on insurer claims data]. Internationally criticized as opaque and undervaluing services.
- 2011 – Ingenix rebranded as Optum, which pivots toward CMS-based RVUs. Bermuda, however, continues using the old Ingenix methodology.
- 2015–2018 – The Health Council begins formally advising that Bermuda should abandon the Ingenix approach and shift to the CMS RBRVS system.
- 2018 – MDCO 2018 is introduced [July 1] but still uses the outdated Ingenix-style methodology, despite the concerns.
- 2015–2025 – Over a 10-year advocacy period, there is a continued push for reform.
- 2025 – Bermuda finally adopts the CMS-based methodology + Bermuda-specific conversion factor. Marks the first true methodological shift in how medical and dental charges are calculated in Bermuda.
