A Government move to bring in “pre-certification” — requiring doctors to get a second opinion when ordering diagnostic tests — has been poorly received across the Island’s medical community.

However, according to the Bermuda Medical Doctors’ Association (BMDA), the Ministry of Health won’t put the measures in place without a broad consultation with physicians, clients and insurers.

One irate physician, requesting not to be named as the matter is still under discussion, told The Royal Gazette: “We don’t know why it’s so urgent, considering that these tests are only about eight percent of healthcare expenditure. Compare that with the hospital, which is 44 percent in terms of overall costs.”

The measures were under consideration by former Health Minister Patricia Gordon-Pamplin, who told The Royal Gazette that she hoped to see the measures in place next year.

Pre-certification was introduced as part of a raft of measures aimed at cooling the Island’s rampant healthcare spending.

However, with a new Minister put in place last week — former Public Works Minister Trevor Moniz, who is now in charge of Health and the Environment — Government has yet to clarify what form of second opinion will be expected of local physicians.

Meanwhile, the BMDA has “significant concerns” over pre-certification, according to the group’s president, Joanna Sherratt-Wyer.

She said the association was “acutely aware of the need to control healthcare costs”, but echoed physicians’ claims that the initiative “does not address the main contributors to high health costs in Bermuda”.

“There are safety and administrative concerns associated with pre-certification, which has significant potential to put patient safety in danger,” Dr Sherratt-Wyer added.

More than 60 doctors met with the former Minister earlier this month, she said, reporting them “pleased with her assurance” that pre-certification would not be imposed without “appropriate consultation with all the stakeholder groups — patients, physicians and all insurance companies among these”.

“The BMDA feels that the safety and quality of patient care is of paramount importance, and if we put this first, cost savings will follow. This must be done by incorporating guidelines and standards to ensure quality care, and by evaluating Bermuda’s healthcare system as a whole. The Spending and Government Expenditure (SAGE) Commission recommended a further investigation into the costs of healthcare, and we fully endorse the need for this.”

The association looked forward to meeting with the new Minister to discuss plans to rein in healthcare costs, she said.

The Bermuda Health Council (BHeC) called diagnostic testing — which covers procedures ranging from ultrasound to particularly high-cost technology such as MRI and CT scanning — an are of “shared concerns across the community” when it comes to overuse, a spokeswoman said.

The council, which oversees local healthcare, has been tasked by Government with developing pre-certification to control “utilisation of diagnostic testing procedures under the Standard Hospital Benefit, in order to control health costs”, she said.

“The intent is to apply the process to certain diagnostic laboratory tests and imaging, where utilisation and total costs have been escalating at an unsustainable pace.”

She stressed that Government hadn’t yet determined the exact procedures that would have to be vetted by another physician.

Nor would the Ministry respond to repeated requests for details.

The BHeC spokeswoman said the council was still meeting with stakeholders, to take in their views before making any “necessary adjustments to the initiative”.

Although Bermuda spent more than $50 million on local diagnostic testing last year, representing seven percent of total spending, it added up to 34 percent of Standard Benefit claims, she said — and represented a rise of 25 percent over 2011’s figures.

“This initiative aims to introduce robust utilisation management mechanisms to secure cost-containment.”

And Bermuda Hospitals Board (BHB) also defended pre-certification as a tool which “nearly always helps the system to be more cost-effective” — even if health plans and physicians’ offices incurred some extra administrative costs.

A spokeswoman called diagnostic testing “a critical part of a physician’s investigative toolkit”, adding: “This will not change.”

Many other countries use pre-certification to match the clinical circumstances of patience with “best-evidence guidelines”, she said.

“BHB has had to act ahead of any national legislation because there is a great pressure for the hospital to focus diagnostic activity on tests that are clinically required. People may feel that any test they go for is clinically required — but we know in Bermuda many people have tests that are not supported by clinical evidence.”

Despite the strong emotional appeal of diagnostic tests for people who felt it was “better to be safe than sorry”, she said inappropriate testing squandered time and money, as well as exposing patients to unnecessary radiation and exotic chemicals.

“We already have the evidence that people in Bermuda have far more tests than individuals in other developed countries,” she said. “And yet there is no evidence that this over-testing contributes to better healthcare outcomes for Bermuda. Testing too often provides a false sense of security. While it might feel hard to resist when you are worried, it is unlikely to get you better faster.”

She also cautioned that in other jurisdictions, pre-certification required “collaboration and cooperation”, but hadn’t had a negative outcome on patient survival.

BHB is currently seeking to rein in utilisation, she continued — but if only BHB were regulated, “we will see business diverted privately”, and insurance premiums would continue to soar.

“Denial of coverage for appropriate test ordering is quite rare, but ordering of inappropriate or duplicative testing generally drops significantly when pre-certification is implemented.”