Government has kept quiet on plans to curtail high-cost diagnostic imaging — but the hospital has defended itself against claims by local physicians that it has been the main culprit for spiralling healthcare costs.

Pre-certification, which requires doctors to get a second opinion, is aimed at cutting down on the frivolous use of procedures such as MRIs and CT scans.

The imaging tests cost thousands of dollars and come with their own health risks: CT scans deliver significant doses of radiation.

A Health Ministry spokeswoman said Government was working in tandem with the Bermuda Health Council to realise “a public information paper on the rationale and workings of pre-certification”.

“The focus will be on diagnostic testing, which includes medical imaging and clinical labs, and the intent is that before such procedures can be carried out, they would have to be preapproved by an authorised entity, based on standardised medical guidelines,” she said, adding that more information would be released “in due course”.

Details on how the scheme would be implemented in Bermuda, such as whether pre-certification would take place by phone or online, have yet to be revealed.

Pre-certification is common in the US managed healthcare system — and similar procedures are employed under the UK’s National Health Service — as the soaring cost of healthcare leads to rising insurance premiums.

Bermuda’s healthcare system is second only to the US for year-on-year increases that were branded “unsustainable” by Government three years ago.

Physicians have attacked Government’s rationale for introducing the system to the Island.

Pre-certification has been denounced as an onerous extra expense that will put patients at risk — and doctors who spoke anonymously with The Royal Gazette maintained that unnecessary testing was more the fault of the hospital than the local medical community.

However, according to the Bermuda Hospitals Board (BHB), close to 60 percent of the MRIs and CT scans carried out on the Island come from the community itself.

Bermuda residents receive more of the tests than fellow Organisation for Economic Cooperation and Development (OECD) states, MRI exams in particular — and conservative estimates show overuse costing our healthcare system well over $4 million annually.

A BHB spokeswoman said the hospital was mandated under law to offer “essential equipment”, which hospital-based doctors used in the community’s best interests.

“BHB does not receive additional revenue for tests performed on in-patients or emergency patients who are ultimately admitted to hospital, as all hospital services are covered under a fixed ‘diagnostic related group charge’ for their inpatient care,” she added.

“BHB also provides services to outpatients who are referred to the hospital for tests by community physicians. These referrals often include diagnostic imaging or laboratory tests. BHB performs these tests and bills the patients’ insurers accordingly.”

She acknowledged that the hospital has come under fire in the debate over the Island’s increasingly precarious healthcare system.

“Blame is frequently assigned to BHB for running up health costs when the reality is that a substantial portion of BHB’s annual revenues arise from community physicians referring patients for outpatient diagnostic imaging and laboratory work,” she said.

According to a December 2012 survey of MRI and CT tests performed at BHB, 56 percent of the tests were “on behalf of community physicians”.

A further 28 percent were ordered by BHB emergency physicians, and 16 percent by other BHB physicians.

“If we assume all tests ordered by community physicians are medically necessary and appropriate, they would be a cost to the health system regardless of whether they are performed at the hospital or another diagnostic centre,” the spokeswoman added.

And Bermuda’s high usage of both tests was established by the same survey.

Collectively, local doctors order 138 CT exams per 1,000 residents to be performed at BHB — compared to the OECD average of 131.

Seventy-nine MRI exams per 1,000 residents are performed at BHB compared to the OECD average of 46.

“Using this data and the price per test, the cost of Bermuda’s excess utilisation can be extrapolated as $4.2 million per annum,” she said. “It is key to note that these figures exclude MRI and CT tests performed at other local diagnostic facilities and tests performed overseas, so the potential overspend is likely understated.”

Any initiative to manage healthcare would have to consider both BHB and community physicians in order to rein in medically unnecessary testing and costs, she said.