EXCLUSIVE: changes proposed to OHIP coverage

By Cynthia Mulligan, Cristina Howorun and Dilshad Burman

Big changes are being proposed to healthcare coverage in Ontario as the provincial government is looking to find half a billion dollars worth of savings from within OHIP, CityNews has learned.

Tests and procedures ranging from diabetes and pain management to colonoscopies are under review by an “appropriateness” working group made up of doctors from the Ontario Medical Association and government officials. The group is looking at latest and best practices to see what medical tests ordered by doctors are unnecessary, overused or inappropriate.

OHIP services have not been carefully examined in years as doctors did not have a contract with the province. A new contract was agreed upon in February and the working group to find savings is part of the agreement.

The deadline for the group to agree to reductions worth $100 million is May 1 and the next deadline to save an additional $360 million is Sep. 1.

Documents obtained by CityNews show that if an agreement is not reached by those dates, the issue will go to an arbitration panel which will determine where $460 million in savings will be found.

The documents estimate “as much as 30 per cent of medical services in Canada are unnecessary and inappropriate.” They also state that “there is evidence that less than 4 per cent of Ontario’s family doctors are responsible for ordering nearly 40 per cent of tests of low value.”

For example, the documents state that MRI’s for middle aged people’s knees have become “routine” and most patients “improve within a few weeks or months.” Therefore, these procedures could be reduced to save $2 million.

In total, 28 services are on the list for potential savings including sedation offered during colonoscopies which would save $16 million. According to the documents, anesthesiologist-assisted colonoscopies has increased five-fold over the past decade and the government has questions about the appropriateness of this usage.

Eric Thompson from Crohn’s and Colitis Canada says the proposal is not realistic.

“It is unthinkable to have a colonoscopy without sedation,” he says. “Its a very uncomfortable, invasive procedure, so its extremely critical that patients are very comfortable when they are having this procedure.”

He adds that not having sedation would discourage patients from choosing to have a colonoscopy.

“Any barrier to access would ensure that some patients would opt out of the procedure,” says Thompson. “Patients are going for colonoscopies to detect disease worsening, to see if they have any precancerous lesions, polyps … so its extremely critical that there’s no barrier to access for colonoscopies.”

Pain management medications are also under review, with a proposed reduction in peripheral nerve blocking shots to just 16 a year, to save $51 million. For some patients suffering from chronic pain, that number will not cover a single week’s medication.

“I get two [injections] in the lobes, two in the back of each side of my head. All together, from my shoulders, down my back and through to my knees, I get 24 injections [a week] just so I can work and live a life,” says Tibor Goscar, who was hit by a vehicle driven by an impaired driver in 2002.

Goscar was told he would never work again, but has been able to return to work with the assistance of the shots. He says cutting his annual supply to less than his weekly dosage would be debilitating.

“I won’t be able to work, I know that for a fact. I’m a professional chef. I find I’m struggling right now, just working on my feet 12, 15 hours a day — and to have no injections, I’ll have to go on disability,” he says.

The government says there has been a marked increase in the use of these shots between 2009 and 2015, but doctor Alan Shievitz says limiting access to pain medication will be counterproductive.

“We’re in an era right now where we are focused on reducing opioids and the use of pain medications for patients. This is one tool we have in our box to provide people with pain relief that’s an alternative to opioids,” he says. “If you remove this, I suspect you’re going to see patients requesting and requiring higher doses of opioids and going to get these opioids possibly from the streets, in places that they shouldn’t be. That’s dangerous and risking overdose.”

Other services being reviewed on the list include funding to remove certain polyps found during colonoscopies for a savings of $9.2 million and limiting psychotherapy to 24 hours a year for a savings of $13 million. Diabetes management, echocardiograms and tonsillectomies are also being examined.

While unnecessary tests clog up the health system and cost both time and money, the Ford government is also looking to cut costs. Healthcare is the largest expense in the provincial budget, coming in at close to $60 billion last year, which accounts for 42 per cent of all program spending.

NDP Leader Andrea Horwath agrees that services should be reviewed to ensure that they are necessary and delivering value for money, but she does not believe that is the true goal of this exercise.

“[The Ford government] have set a price tag, a monetary target on how much money to pull out of our OHIP funded services. That scares me to death,” she told CityNews.

Health Minister Christine Elliot said in a statement that she is “extremely encouraged by the progress that has been made” by the working group.

“We wouldn’t want to presuppose the outcomes of those discussions, but we know the focus will be on evidence and best practices, and how we can improve outcomes for patients…. we will continue to put the patient at the centre of the discussion.” she said.

April 6th Update: The Premier’s office tells CityNews proposed changes to sedation for colonoscopies are no longer under consideration

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