"Ontario loses fight, reveals MDs' billings"

[Guest Ian Wong]

Here's an interesting article published in today's Globe and Mail, regarding the access of Ontario physician billings to the general public. This article is in reference to the highest-billing GP in Ontario, who billed $550,000, paid for in large part by performing over 2000 abortions in that year. Ethics about abortion aside, I've got to say that I'm staggered by the number of abortion procedures this one doctor managed to provide...

 

Ian

UBC, Med 4

 

www.globeandmail.com/serv...emp/1/1/1/

 

Ontario loses fight, reveals MDs' billings

Figures released after long court battle show doctor at top of list charged $552,695

 

By LISA PRIEST

 

Monday, January 20, 2003 – Page A12

 

The top-billing general practitioner in Toronto in fiscal 1998-99 charged primarily for abortion-related procedures -- a secret the province fought almost three years to keep.

 

Documents obtained under the Freedom of Information and Protection of Privacy Act after a lengthy court battle reveal that the physician, who billed $552,695 in fiscal 1998-99, did 2,280 abortions in that time period.

 

At the reimbursement rate in the Ontario Health Insurance Plan, the family physician, who was not identified, would have billed a total of $242,882 to terminate pregnancies in that year.

 

Ontario's quest to keep that information -- and the amounts individual physicians charge to the health-care system -- secret means the public has no way of knowing where their tax dollars are going.

 

Only two provinces -- British Columbia and Manitoba -- publish doctors' billings to the public purse by name.

 

Though Saskatchewan doesn't identify its doctors' billings by name, it does publish average amounts by specialty.

 

Saskatchewan also itemizes figures on how many procedures are performed and what they cost medicare for any given year.

 

While no one advocates publishing the names of doctors who perform abortions for fear that they will be targets of violence, some do question why Ontario has failed to make public general physician billings by name.

 

"If we're willing as a society to say how much an official who runs a publicly traded company is making, then why not somebody being paid with tax dollars?" asked Michael Decter, chairman of the Canadian Institute for Health Information.

 

In this case, Ontario went to two courts trying to prevent publication of the top 10 most frequently billed procedures that the highest-billing Toronto family physician or general practitioner had made for that given year.

 

This April 3, 2000, request for the figures followed earlier information that revealed that some general practitioners and family physicians were billing double and almost triple the average $185,400 billed during the fiscal 1998-99 period.

 

But during an Court of Appeal hearing in November, Elaine Atkinson, a lawyer representing the province's attorney-general, told the judges that "this is not about whether the ministry gets to hold back a record.

 

"This is a physician's personal information."

 

Ms. Atkinson told the court that the information The Globe and Mail was seeking was inflammatory.

 

She also said that the doctor may be only one of a very small group of physicians in Toronto doing the procedure -- what she referred to as a "small cell count." She provided no evidence of that.

 

Mr. Justice David Doherty of the Ontario Court of Appeal said he had a look at the information and it "doesn't identify anything."

 

Peter Jacobsen, the lawyer representing The Globe, told the judges that "there is absolutely no evidence here of any harm. . . .

 

"There is great concern about a case where the attorney-general puts forward no evidence and continues to appeal the matter."

 

The Court of Appeal judges upheld the decision of the Information and Privacy Commissioner to order disclosure of the record. It was released after the Ontario government decided not to seek leave to appeal to the Supreme Court of Canada.

 

As it turned out, the physician who performed the large number of abortions is not typical of most high-billing general practitioners.

 

A study published by the Institute for Clinical Evaluative Sciences in Ontario, a government-funded body that tracks health-care services, found that 81 per cent of high-billing general practitioners billed an average of $400,000 and had 16,000 patient visits a year.

 

However, only three of 219 high-billing general practitioners were primarily providing abortion services, according to the study, published in 1998.

 

In this case, the doctor performed 2,180 abortions before or at 16 weeks gestation, a procedure for which medicare pays $103.40. The doctor performed 100 other abortions, done after 16 weeks gestation, for which the rate is $174.70.

 

The remaining amount -- $309,813 -- includes billings for general assessments, visits to nursing homes, diagnostic ultrasounds and well-baby care, among other services. The figures do not take into account the cost of running a doctor's practice, which can be substantial.

 

"It's a bit surprising to me," said Dr. Henry Morgentaler, whose Toronto clinic does about 9,000 abortions a year. He said about 40,000 to 45,000 are performed each year in Ontario.

 

"I don't know anybody doing that. But if he [or she] has patients who trust him and he does a good job, then I don't see anything wrong with that," he said.

 

Costs in the amount of $23,226 were awarded to The Globe and Mail.

[Guest Unknown </username> <dateline>1118448240</dateline> <title>Unknown</title> <pagetext>(This]

(This post is missing and can not be restored)</pagetext>

</post>

<post>

<thread>N</thread>

<threadtitle>"Ontario loses fight, reveals MDs' billings"</threadtitle>

<threadviews>0</threadviews>

<threadsticky>0</threadsticky>

<poll></poll>

<username>

 

Unknown

 

 

</username>

<dateline>1118448240</dateline>

<title>Unknown</title>

<pagetext>(This post is missing and can not be restored)

[Guest Unknown </username> <dateline>1118448240</dateline> <title>Unknown</title> <pagetext>(This]

(This post is missing and can not be restored)</pagetext>

</post>

<post>

<thread>N</thread>

<threadtitle>"Ontario loses fight, reveals MDs' billings"</threadtitle>

<threadviews>0</threadviews>

<threadsticky>0</threadsticky>

<poll></poll>

<username>

 

Unknown

 

 

</username>

<dateline>1118448240</dateline>

<title>Unknown</title>

<pagetext>(This post is missing and can not be restored)