Tuesday, July 28, 2015


Of all the "optimization measures" that Quebec is imposing, the most controversial is compelling doctors to stop ordering tests that the government is now considering "unnecessary" in the context of fiscal austerity. 

The Quebec government is ordering hospitals and other health facilities to slash $150 million from their budgets for medical tests, imaging scans and procedures to patients that it has judged are not "pertinent to care," the Montreal Gazette has learned.
In total, the Health Department is aiming to chop $583 million in spending through so-called optimization measures. And in a bizarre twist, the government has decided that it won't provide hospitals funding for next year's leap year day, Feb. 29, which will fall on a Monday, saving it $64 million.
It's up to hospitals to cover the shortfall on that day out of their own already diminished budgets.
One of the biggest cutbacks will take place at the McGill University Health Centre, which last year was forced to cut $50 million from its operating budget. It must now reduce its spending by an extra $21 million.
Of all the "optimization measures," the most controversial is compelling doctors to stop ordering tests that the government is now considering "unnecessary" in the context of fiscal austerity. Patient-rights advocates and managers in the health system are warning that this sets a dangerous precedent, opening the door to ageism and the prospect of clinicians no longer performing tests for people above a certain age.
Reducing the number of tests in the public system could also result in an increase in the number of tests in private clinics. Health Minister Gaétan Barrette has said he plans to propose legislation in August that would permit private clinics to start charging patients fees for some tests and procedures that would otherwise be covered under medicare in the public system.
Paul Brunet, president of the Conseil pour la protection des malades, expressed concern about the potential unintended consequences of the government's cost-cutting measures.
"Oh yeah, certainly patient care will suffer," Brunet said. "Long-term care facilities are going to take most of the hit. We know that."
Some institutions, however, have signalled to the government that they won't cut the number of medical tests.
"At this stage, it's out of the question to re-evaluate the pertinence of medical tests for patients," said Joëlle Lachapelle, a spokesperson for the Centre hospitalier de l'université de Montreal.
(A standard complete blood count test, for example, costs a hospital $5.77, while a private clinic will charge more than $60 for it. Private insurance would cover most, if not all, of the latter fee.)
The CHUM must cut $15.4 million in its 2015-2016 budget, and of that sum, $11.3 million is supposed to come from an optimization measure called "pertinence of care and physical health services."
Lachapelle said the CHUM will focus on reducing overtime rather than cutting the number of tests and procedures.
Joanne Beauvais, Barrette's press attaché, denied that the government is pressuring hospitals to cut patient care.
"We are not cutting funding for care, but implementing measures to help clinical professionals provide better care by foregoing tests and procedures that are expensive and shown not to result in either improved recovery or better diagnostics," Beauvais responded in an email.
"We expect the progress we will be making over the next year to yield recurrent savings of $150 million."
The $583 million in "optimization" savings breaks down as follows:
  • Cutting $220 million in payroll costs by abolishing 1,300 management positions.
  • Avoiding "unnecessary" (Beauvais's word) tests and procedures, saving $150 million.
  • Not funding leap year day: $64 million.
  • Persuading hospitals to team up in buying goods and services to save $35 million.
  • Additional "compressions" that are unspecified: $114 million.
The CHUM will have to cut through attrition 15 managers out of 337. The MUHC, in contrast, will have to cut more than 100 managers out of 459. A cloud of fear and anxiety has descended over the managerial ranks at both the CHUM and MUHC.
Ian Popple, a spokesperson for the MUHC, said the reduction in the number of managers will be carried out over three years.
"Part of the reduction will be done by attrition as managers leave or retire," he explained. "Other reductions will have to occur by transforming some manager positions into professional-level positions (that pay less) in order to meet the ministry target. We are looking at every option, but there remains a shortfall that is requiring ongoing work to address."
Beauvais dismissed the notion that the government is actually making cuts:
"These are not cuts. Quebec cannot afford the kind of growth rate in health-care spending we experienced over the past decades, and the system is clearly able to do more with less. The best-performing teams in the network prove it. Since the health-care budget keeps growing, those measures are not cuts. They are a strong inducement to everyone in the system to improve their game."
Quebec has budgeted $32.8 billion this fiscal year on health care, an increase of 1.4 per cent, but less than the 5-per-cent annual hikes of previous years.

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