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Explanations still needed over Brown payout

Clinics row: Dr Ewart Brown and a CT Unit at Brown-Darrell clinic, Smiths (Photograph by Akil Simmons)

Dear Sir,

With all of the “he said/she said” accusations and statements flying around regarding the Bermuda Health Council’s reduced imaging fee rates and the former Minister of Health, Jeanne Atherden who was instrumental in their implementation, I have been frustrated at the lack of clarity by the sitting government to set the record straight.

The public sit on the sidelines, having watched this poor and acrimonious display of political showmanship, and are continually kept in the dark as to the facts. Thus, we are left to speculate.

For those who need it, a little background on the subject:

Ms Atherden, former Opposition leader, and health minister in 2017, specifically asked the BHeC to look at whether the fees being charged at the King Edward VII Memorial Hospital for outpatient imaging scans were appropriate.

She believed they had “gotten out of whack” over the years and were much higher than they needed to be.

She received and accepted the BHeC’s technical advice and recommended this to One Bermuda Alliance-led Cabinet, which resulted in the new, reduced fee structure being implemented in June 2017.

Then in comes our new government, along with an angry private-sector, imaging-service provider who threatens to sue over the new fees, and the obligatory “war of words” between the Government, the Opposition and Ewart Brown ensues. (It should be noted that Dr Brown chose voluntarily, as a provider of Standard Health Benefit services, to tie his fees to the BHeC’s fee schedule).

David Burt, the Premier, and present health minister Kim Wilson have said the fee cuts were imposed only to negatively target Dr Brown, with the Premier describing them as an “economic vendetta” and Ms Wilson calling them “economic sanctions”.

Mr Burt further claimed the OBA Cabinet disregarded the advice of the Bermuda Health Council and seems to use this to justify the $1.2 million government compensation payout to Dr Brown, who had subsequently closed his diagnostic clinic. Finally, as of November 1, new, increased imaging fees have gone into effect.

The only way for us, the voting public, to have clarity on the matter is for the BHeC to release the technical advice that was originally given to Ms Atherden and which she claims she followed.

It is all very simple, really. While requests for the information have been made, the BHeC refuses or, possibly, is “not allowed” to provide it.

I thought I would look a little further into what information exactly is publicly available on this subject.

I came across a BHeC press release, from its website, dated January 12, 2018 — some six months after the reduced fees were implemented — which defended its position on the original fee changes. I quote from the BHeC statement:

“The health council’s recommendations are based on a resource-based relative value scale methodology. This is the same methodology as that used by the Centres of Medicare and Medicaid for determining reimbursement rates in the USA. It is a robust and transparent methodology for determining the rates that can reasonably be charged by private sector providers for medical services.

“The switch to the RBRVS methodology has been the subject of considerable and lengthy consultation and discussion with stakeholders since 2013.

“The health council has always been conscious of the impact of this methodology. For this reason, it was only implemented in 2015 after a two-year consultation process.

“Further, the health council adopted a staggered approach to its implementation. The new methodology was applied to ultrasound and X-ray imaging service rates in 2015, but to MRI and CT services in 2017.

“We regret the decision, announced this weekend, that the Brown-Darrell clinic will stop providing CT scan services at the end of January 2018.

“It is, however, incorrect for the Brown-Darrell clinic to suggest that it has been targeted. The health council adopts the same approach to all service providers.

“The health council is confident that, despite this announcement, there is and will continue to be reasonable provision for CT scan services in Bermuda.”

This statement from the BHeC seems to imply that its recommendations were indeed followed by Ms Atherden and, furthermore, it claims specifically that Dr Brown was not, in any way, targeted by the June 2017 fee reductions.

Three things come to mind:

1, Why did this government write a cheque for $1.2 million in compensation “damages” to a private-sector service provider who voluntarily chose to tie his fee schedule with the BHeC fee structure?

2, When can we see a public apology to Jeanne Atherden from David Burt and Kim Wilson?

3, Are we to presume the Bermuda Health Council has done some “recalculating” of its original technical advice to justify these new rate increases?