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Doctor says new clinic at risk in SHB freeze

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A doctor who wanted to run a walk-in urgent care centre in the heart of Hamilton has claimed a freeze on applications for new services will be “potentially catastrophic”.

JJ Soares said a moratorium on requests to provide treatment under the standard health benefit put his almost-completed clinic at risk.

Dr Soares added that he was shocked by an e-mail that notified healthcare professionals of the freeze but the health ministry insisted he had been told several times about the process that had to be followed to operate under SHB.

Jennifer Attride-Stirling, the health ministry permanent secretary, explained that opening a facility did not guarantee eligibility to have services covered and most clinics operated without SHB approval.

The Hamilton Medical Centre in 2016 announced its intention to offer blood testing and diagnostic imaging such as MRI and CT scans under one roof at a new location on Burnaby Street.

Dr Soares told The Royal Gazette that he hoped to open the five-floor clinic in the summer.

The Bermuda Health Council alerted providers last week to a bar on applications for new services under the basic healthcare package while talks on changes to the healthcare system and its financing were held.

Dr Soares claimed he was “blindsided” by the memo.

He said: “The moratorium will be potentially catastrophic to the feasibility of the new centre that is at this point approaching completion.”

He added: “There was no direct consultation with myself prior to this date about this move by the BHeC.

“The BHeC has known about my plans for over three years now.”

He said the unit would have a walk-in urgent-care clinic open every day from 8am until 10pm, as well as the island's only open MRI scanner, a CT scanner and facilities for X-ray, mammography, ultrasound and blood tests.

Dr Soares said the only service he thought would be covered by SHB — the basic package of benefits that must be included in every health insurance policy — was doctors' visits.

Standard health benefit includes hospital treatment as well as home medical services, non-hospital diagnostic imaging services and palliative, end-of-life home care.

Any SHB services that are outside of the hospital are offered by approved providers at a set rate.

Dr Soares said: “If we do not have SHB approval then no MRI, CT, ultrasound or X-ray scans will be covered under SHB.

“What this means is that insurers can decide whether they will pay our facility or not for these scans.”

He said lack of approval would mean HIP and FutureCare policyholders were unlikely to have diagnostic imaging covered at the centre.

Dr Soares added: “When a patient is seen in our urgent-care centre for an acute illness they should never have to worry whether or not their investigations will be paid for by their insurer.

“For this reason alone SHB approval is absolutely necessary.”

He claimed the freeze on applications would “severely restrict our ability to compete in the marketplace”.

Dr Soares added: “The viability of the whole project is therefore in jeopardy as a direct result of this moratorium.”

A letter from Dr Attride-Stirling to the practitioner dated last September referred to a number of talks over the previous four years.

She said she wanted to make sure he understood the distinction between opening up a scanning centre and securing approval to provide those services under SHB.

Dr Attride-Stirling wrote: “Significantly, and for clarity, the latter does not preclude the former.

“However, as you are aware, opening a facility does not automatically give entitlement to SHB eligibility.”

The permanent secretary said that “on various occasions” dating back to November 2014 the ministry and Dr Soares discussed SHB coverage and its restrictions.

She explained that at a meeting about the doctor's proposed scanning clinic in August 2016, she and the then health minister pointed out that to be covered by the scheme, the services and facility must be approved by the BHeC.

Dr Attride-Stirling said that correspondence from Dr Soares the following month did not suggest he wanted to become an SHB provider.

She claimed the BHeC had informed her of similar discussions with the practitioner “over the years”.

Dr Attride-Stirling said that most health facilities in Bermuda were not part of the scheme and those services were covered by insurers as supplemental benefits.

Dr Soares said yesterday that although conversations with the ministry and BHeC had included explanations about SHB approval, “they never indicated nor did I ever anticipate this sudden announcement of a moratorium being put in place”.

He added: “I have always anticipated applying for SHB approval. In fact I did send in an application only to be told that a moratorium was now in place.”

Ricky Brathwaite, the acting chief executive of the health council, said: “Once we complete discussions on the redesigned SHB package for 2020 and how much it should cost, we will lift the moratorium to accept applications for those newly defined service areas.

“New health services can still continue to be added through coverage from our local insurers, despite the moratorium on SHB.”

No consultation: JJ Soares
Construction work at the proposed urgent care and diagnostic imaging facility on Burnaby Street (Photograph by Fiona McWhirter).

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Published March 14, 2019 at 9:00 am (Updated March 14, 2019 at 8:08 am)

Doctor says new clinic at risk in SHB freeze

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