MEDIREGI is a RAMQ medical billing agency founded in 1987 (www.mediregi.com), so we’ve seen our share of healthcare reforms. From the introduction of the GMFs in the early 2000s, to the creation of the CISSS and CIUSSS, to the abolishing of the “Agences Régionales”, and most recently the creation of Santé Québec under Bill 15, all of which have had varying degrees of impact on our healthcare system. Throughout all these changes, we’ve stayed silent and trusted that the “government knew best”, but with the adoption of Bill 2, we can no longer stay silent.
Bill 2 is as complex (Minister Dubé can’t explain it clearly when pushed about the specifics) as it is undemocratic (adopted at 04h00 AM under a special gag order provision? What kind of Soviet-era practice is this!?). Using buzzwords like “capitation”, “performance metrics”, “penalties for non-compliance”, the CAQ government is hoping to gain in political currency before the next election by attempting to look tough against doctors.
As a RAMQ medical billing agency (a medical billing agency is a company that deals exclusively with the administrative processes that pertain to doctors’ remuneration in the public healthcare system), we have intricate knowledge of the underbelly of the healthcare system, and this allows us to be uniquely well placed to understand what these buzzwords really mean, and more importantly, what they do not. I use the term buzzword because very few of the concepts brought forth in Bill 2 are new, as I will outline below, despite the government beating its chest about this “drastic reform” and how it will save the healthcare system. What these buzzwords actually mean:
- “Capitation” –> This means that a portion the family doctors’ salary will be contingent on how many patients are rostered (registered) to them under their care. If the doctors register more patients (and/or more complex patients), they will earn more. There is nothing new about this concept! Family doctors currently already have a significant portion of their remuneration tied directly to this criterion!
- “Performance” –> Doctors are already paid based on their performance! Doctors are currently paid via either a fee for service model, an hourly model, or a blended model (hourly base rate with added incentives per patient seen). In any of the 3 modalities, the higher the performance (the more patients/ hours worked), the higher the earnings! Again, there is nothing new here.
- “Penalties for non-compliance”: –>There are several significant restrictions that doctors currently need to comply with, or they will be faced with severe penalties (sometimes reaching 30% of their gross income). They have PREMs (they need a permit to practice in a given geographical area), they have AMPs (specific, less desirable tasks they need to do that are mandated by their local DTMF (formerly DRMGs)), they have a ceiling of revenues they cannot exceed (maximum amount of money they can earn before they are capped), the have a maximum amount of certain procedures they can perform in a given period of time (before they are capped), etc. All of these exist already – therefore imposing more penalties is not going to save the healthcare system.
Given that these buzzwords aren’t novel, and aren’t solving anything, it seems the only thing drastic about this reform is how it was adopted (in the middle of the night on a Friday?!) and how damaging it is (hundreds of doctors planning to leave the province to move to Ontario and abroad). Why adopt Bill 2 under a gag order at 04h00 am if the CAQ is convinced it is well founded and reasonable? Why not let the usual course of dialogue and discussion take place? What’s the rush (other than the imminent provincial election, of course)?
We’ve seen many instances of Minister Dubé showing how Bill 2 will cut certain costs – which is great, sure – but how will that money be used to improve the healthcare system? How exactly, specifically, does Bill 2 benefit Quebecers? What part of this reform will ensure shorter wait times at the ER? Or trim the growing list of patients waiting for a surgery? Or provide a family doctor for each Quebecer?
We all agree the healthcare system needs help – reorganization or reallocation of resources of some sort – but we need concrete, actionable solutions, based on collaborative expert opinions from both sides of the negotiating table, not unilateral, tunnel-minded executive decisions from a political party desperate for reelection.
If the CAQ government wants to be remembered as anything other than the administration who messed up the healthcare system beyond repair by causing a mass exodus of doctors, it needs to suspend Bill 2 immediately and return to negotiating in good faith with the FMOQ/FMSQ.
Otherwise, and I don’t mean to sound alarmist, but with current doctors leaving QC and with the appeal of working in the QC public system significantly reduced for future generations, I fear this very well could be the beginning of the end for our public healthcare system.
Patrick Busch, President of MEDIREGI BILLING SERVICES INC.