Dear Colleagues

In today's Star there is a story announcing that Dr. Barry Rubin has agreed to chair an expert panel that will look at the OHIP reductions in self-referral fees for physicians, and that will develop recommendations to ensure high quality and timely access to diagnostic and imaging studies for patients in Ontario. In doing so, he is taking on a large challenge and opening himself up to potential criticism.

Self-referral occurs when a doctor bills OHIP both for a consultation and for performing a diagnostic or imaging test determined to be necessary by that consultation. The Ministry suggests that sometimes these tests are not necessary and has reduced the fee associated with these tests – these fees pay for a technologist to do the test and for the physician to interpret the test. One unintended consequence of this action however is that doctors practicing in large academic groups would have the payment for diagnostic or imaging tests impacted if another hospital doctor (who is an expert in performing the test) undertakes the examination. This would also decrease revenues received by the hospital for the technical elements involved in the test.

This unintended consequence would create a major disruption in our ability to do many necessary diagnostic and imaging studies for our patients. And because the Ontario Medical Association is currently not in active discussions with the Ministry of Health, this panel will give the Ministry the expertise it needs to understand this issue.

We talk a lot about having the right care, for the right patient, at the right time and in the right place. From what I understand, this is the focus of the expert panel and in selecting Barry to chair the panel, the government has someone who will use science and evidence-based medicine in formulating the panel's recommendations. It is my belief that physicians need to be engaged in these discussions and I applaud Barry for stepping forward and taking this on. It takes courage to step forward when others are stepping back but the premise of doing the right thing, at the right time, for the right patient in the right place is one that we all support.

Having spoken with Barry I know that the panel will also be looking at how clinics outside hospitals ensure that the appropriate quality standards are in place so that all parts of the system can rely on the images produced by clinics in the community. This is critical to anyone who uses images to make decisions about a patient's care.

Barry has my support in taking on this assignment and I look forward to the results of the panel's deliberations. ​

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