Canadian Docs - Yes or No Only -- Have you ever been asked to reduce your costs regarding diagnostics or patient treatment?

Dear Docs:

I know many of you are afraid to get into things like this, but I have heard two different sides from you in confidential conversations. I would like to know if you have ever been asked to cut your costs regarding diagnostics or patient treatment.

There is no need to go into explanation unless you wish to. I would just like a yes or no.

While it will be easy to say no, I am interested in finding out how many will have the nerve to admit they have indeed HAVE been asked.

Love this one! Somehow I

Love this one! Somehow I knew no doctor would dare reply!

My question would be, asked

My question would be, asked by who? Having done billing for multiple doctors, there are set fees paid by the health care of the province. I'm not sure how a doctor would cut costs in that scenario?

By anyone in the health

By anyone in the health system. This question is directed to doctors, not to billing agents.

In 28 years of practice in

In 28 years of practice in canada i have never been asked to do this

We discuss costs 'all the time' and the pressure to save money comes from collegial interaction.
There is no 'comptroller' assigned to help save the system money. Once a year, a printout is generated that shows your 'cost per patient' and compared to other docs in your category ( emergencr, surgery, gi, etc) and you have feedback if you are expensive compared to others.

I have never been challenged for this, probably because my cost per patient is low. I have colleagues who have had to explain their costs to an 'administrator' but nothing has ever been done about it.

As an insider, the biggest waste of money (from a docs point of view) is unnecessary surgery. Pointless surgery, surgery when even 10 years ago it would have been recognized as innappropriate.

Length of hospital stay and choice of drugs and tests get discussed. Whether we should take out a 90 year olld gallbladder or fix the hernia does not get discussed. No one seems to call the surgeons on this EVER. Even a first year medical student can see this is going to be a major problem cost wise.

My mom is a doctor and she

My mom is a doctor and she told me that she's been asked of the said topic. Shes a beauty expert that specializes on botox and facial rejuvenation. She has been serving clients for 8 years and have been asked several times is she's willing to reduce the costs of her treatments. Want to know her answer?

It would make sense for

It would make sense for unnecessary surgeries, but I thought it was interesting that you said you would have feedback if you're expensive compared to others. I do know of one doctor who was asked to reduce his costs by 25%, and was very surprised because that doctor was more reluctant than most to give diagnostic tests.

So if they give the feedback to the guy who is most expensive, that lowers the treatment bar all over I guess, because the next time the second highest guy will get the feedback, and the next time the third highest and so on until finally they are refusing treatment to the majority of patients (I would think).

I would like to know her

I would like to know her answer, but hope you won't state it without her permission. She may be able to be identified by that answer and may not want to be for protection.

Rtrp9 wrote: I would like to

Rtrp9 wrote:

I would like to know her answer, but hope you won't state it without her permission. She may be able to be identified by that answer and may not want to be for protection.

Don't hold your breath. BettieSpradlin is a spammer. Her comment is a promotion for a Fort Worth, TX doctor specializing in aesthetic medicine.

Since the provincial

Since the provincial government asked all hospitals to cut the fat, and blood tests done at the hospital OPD are covered by Medicare, we (the members of the Department of Family Medicine) asked the director of the Biochemistry lab (she's an MD & PhD) at our hospital to review with us the indications and costs of various blood tests - for example: PSA and 25-vitamin D levels. Notice I said it was we who asked for the talk, not the hospital. There were no restrictions put on the number of tests we could order; just a better sense of our responsibility - responsibility to society, without diminishing responsibility to our patients

Twain wrote: Since the

Twain wrote:

Since the provincial government asked all hospitals to cut the fat, and blood tests done at the hospital OPD are covered by Medicare, we (the members of the Department of Family Medicine) asked the director of the Biochemistry lab (she's an MD & PhD) at our hospital to review with us the indications and costs of various blood tests - for example: PSA and 25-vitamin D levels. Notice I said it was we who asked for the talk, not the hospital. There were no restrictions put on the number of tests we could order; just a better sense of our responsibility - responsibility to society, without diminishing responsibility to our patients

Actually I think that's a great idea. Not only should doctors know the costs, but also patients. It's when doctors are encouraged to REDUCE costs by being told that they are ordering more tests or more expensive ones than others that worries me, because each year the next highest will be told to reduce his costs and then the next highest and so on until finally everyone is too scared to test for anything. Also I think that intimates many doctors, especially the less confident and more newly trained, so they cut back too much. It's likely to be especially unfair to those who have chronically ill patients or higher numbers of patients requiring more expensive tests.

At one time when I asked if a drug could be increased because the tumour wasn't shrinking, the only answer given was, "no, because it would cost the government too much money." The training doctor appeared as shocked as I was. I was so horrified over that answer that I actually repeated it. "You mean you think it would be better to let the tumour grow, which could cost me for life, than to shrink it now because of government costs?" I asked. He didn't answer because I think he had let that fly inadvertently out of frustration and wished he hadn't.

What was most upsetting was that this type of answer and behaviour was being taught to trainees by specialists. I then sent the doctor a letter asking if there was any other reason for the denial other than for that statement. He never did answer it of course, but was of course angry I had sent it. Obviously there was another answer that should have been given instead.

Clearly I met more than a handful of Alberta doctors who appeared very angry with the system but dared not say it, and yes, there have been news articles before claiming that doctors and especially Canadian scientists, were very upset about being silenced. This has been brought up by them on numerous occasions.

I think doctors often just got so frustrated they sometimes just inadvertently let things fly. When anger is suppressed it comes out in other ways.

Rtrp9 wrote: Clearly I met

Rtrp9 wrote:

Clearly I met more than a handful of Alberta doctors who appeared very angry with the system but dared not say it, and yes, there have been news articles before claiming that doctors and especially Canadian scientists, were very upset about being silenced. This has been brought up by them on numerous occasions.

Suppression of Canadian (and American) scientists working in Canada has nothing to do with the medical system or the Alberta government. That is the federal government which is intent on silencing news stemming climate change science. That was followed by an edict to librarians whose compensation was in part federally funded to not speak on matters of Canadian history (while it is being rewritten). More recently, there is an effort by the federal government to stem medical (and actually, all) research which does not directly lead to innovation.

MicOnTheNorthShore][quote=Rtr

MicOnTheNorthShore][quote=Rtrp9 wrote:

Suppression of Canadian (and American) scientists working in Canada has nothing to do with the medical system or the Alberta government. That is the federal government which is intent on silencing news stemming climate change science.

That's right. That's why I didn't say it did.

The management of chronic

The management of chronic pain in Ontario is currently under attack by the provincial government. Specifically:

1. In April of 2012, fees for managing treatment refractory chronic pain patients were dramatically reduced by 30 %, courtesy of the" honourable " Deb Matthews.

In addition to the reduced funding, there have been significant and invasive quality assurance measures instituted by the college, which have been extremely costly for the remaining pain clinics that have remained open in the province.

2. As a result of the above, a significant number of outpatient chronic pain clinics have closed their doors.

3. Over the past few years a number of hospital-based chronic pain clinics have closed, citing lack of financial resources. As a result, the community-based clinics have had to manage an increased patient load ( with no assistance from the government ). Rather, clinics are trying to manage despite the barriers the province has established.

Managing these patients is a time-consuming and challenging endeavour. Although it can be satisfying, it can also be very frustrating ( more so due to the above ). Considering the aging population and the prevalence of chronic non-malignant pain, Ms. Matthews has demonstrated a distinct lack of foresight in planning for the future care of Ontario. I have a hard time seeing physicians going into this field, given the current state of affairs.

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