Doctors don’t want to be held accountable, claims insider
Physicians fighting a law requiring second decisions for high-cost procedures are merely opposing the introduction of accountability for doctors, according to insiders on Government's bid to introduce pre-certification.
The Royal Gazette understands that pre-certification is intended to impose supervision onto a largely unregulated market for expensive diagnostic testing.
Although Government has kept silent on the issue, sources familiar with the debate said the Bermuda Health Council had been tasked by Government with developing a system for pre-certification in the face of escalating healthcare costs.
Rather than insurers declining claims on unnecessary procedures, pre-certification would be aimed at letting patients know in advance whether they would end up paying for themselves.
Bermuda's healthcare system was branded “a perfect storm” — second only to the US for rising costs.
“The reason why some physicians are fighting back on this is this is going to bring accountability into the system,” the source said.
“For years and years, they've been free to do what they like.”
According to a Bermuda Health Council spokesperson, Bermuda spent over $58 million on diagnostic tests in the fiscal year ending 2012.
Local authorities have examined the Caymanian medical system, finding a similar number of physicians and diagnostic facilities — but up to three times fewer MRIs being ordered.
Claim costs were said to be higher for Bermuda even though its demographics are roughly the same as the Cayman Islands.
Bermuda's physicians run their own labs and diagnostics, even though in other jurisdictions this is considered a conflict of interests, the source said.
The pre-certification model proposed for Bermuda was said to be initially planned solely for diagnostic treatments like MRIs, C-scans and some lab work.
It would not apply to emergency procedures, however.
Tests would be expected to be approved in 24 hours or less, and would be expected to get approved if they fell within clinical guidelines.
Those regulations would be “universal guidelines” for all physicians, whether private or hospital-based.
And an appeals procedure would allow a doctor whose request was turned down to go back and give a more detailed explanation, including family history and extenuating circumstances.
Health Minister Trevor Moniz warned MPs on Friday that while the Bermuda Hospitals Board was engaged in cost controls, “if the wider healthcare system remains essentially unregulated, then Bermuda as a country is unlikely to see the benefit”.
In his Budget brief, the Minister also said private doctors control “a large portion” of the Island's utilisation.
“GPs and specialists in private offices are essentially unregulated,” Mr Moniz said.
“They do the best they can to provide the best services, but in a system that is not coordinated, duplication is common and there are no agreed guidelines to assist them with regards to the most appropriate testing.”