Ontario needs 'predictable and sustainable physician budget,' health minister says

A "predictable and sustainable" budget for compensating the Ontario's doctors must be reached in their next agreement with the province, the health minister said Tuesday. Meanwhile, the provincial government and the Ontario Medical Association continue their war of words over a new contract that is two years overdue.

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During the contract impasse, the two sides have been debating issues ranging from the current fee schedule to whether a new deal should be reached via binding arbitration.

On Tuesday, Health Minister Eric Hoskins said that over the last four years, the provincial government has overspent the doctor's billing line in its budget by $750 million.

"We need a predictable and sustainable physician budget going forward, one that we agree on through agreement with the OMA, so we are able to predict what those costs will be year from year and have money to invest in those other important issues like home care, mental health care or hospitals," Hoskins told CBC's Metro Morning on Tuesday.

Hoskins repeated comments he made during a news conference on Friday, when he said he was open to mediation and arbitration to get the job done.

Hoskins later told reporters Tuesday that he is "willing to begin negotiations immediately."

The head of the OMA, Dr. Mike Toth, also appeared on Metro Morning Tuesday. He said he "would be happy to meet today."

But in an email to CBC News Tuesday evening, Hoskins's office said "the OMA has indicated that they are not available to meet this week."

"We remain hopeful that the OMA will accept our offer and resume formal negotiations on a new agreement that includes a predictable budget, allows us to invest in other areas of the health-care system and that addresses the inequities faced by many of our front-line physicians," the email stated.

"‎We remain prepared to discuss their request for mediation/arbitration within the context of formal negotiations."

Hoskins also denied Tuesday that he was pitting doctors against each other, or the public against the province's physicians, when he released some sky-high OHIP billing figures at that Friday news conference.

Hoskins told reporters then that more than 500 doctors had billed OHIP $1 million last year, while one physician alone billed more than $6 million.

On Tuesday, Hoskins said he was merely trying to ensure that residents and physicians "have an understanding of some of the challenges before us and some of the opportunities for us, as well, to find savings and reach an agreement."

Hoskins told Metro Morning that he wants "nothing more" than to reach an agreement with the province's 30,000 doctors. But he accused the OMA of walking away from negotiations a year ago, just as the province agreed to look at the organization's request for binding arbitration.

"For more than one year I have been increasingly desperate to get the OMA back to the table and they have refused at every moment," he said.

'Looking to pit doctor against doctor'

Toth said he is heartened by the signals from Hoskins that binding arbitration, which he believes is the best way for the two sides to reach an agreement, is on the table.

However, asked why he thought Hoskins released the doctors' billing figures last week, he said it was likely a response to the fact that the two sides have been at an impasse for so long.

"And I think that, of course, he is looking to pit doctor against doctor, and we think that that's unacceptable," Toth told Metro Morning.

He said the OMA and the government need to work together to identify problems in the system that may have led to some of the high billings.

"Doctors bill OHIP for the services that they provide," Toth said. "We need to understand that and as the minister pointed out, not that they did anything wrong or that it was fraudulent, but they had billed so presumably they provided the services that were needed to their patients."

The compensation of doctors is not the main issue of concern, Toth said.

But if there are problems that need to be addressed, he said, it can only happen within the framework of an agreement, which will put the two sides on a level playing field.

"We realize we work in a system where the government is the payer and we need to be accountable to our patients but also to the system," Toth said.

"We know we need to have an agreement with the government so we can look at these problems and work to solve them."

'Willing to begin negotiations'

Hoskins repeated what he said Friday: that he's not alleging that doctors with high billings did anything wrong or that there has been fraudulent activity.

But he told Metro Morning, "the schedule of benefits isn't keeping up with technological change and advances."

There are 7,300 fee codes through which doctors are compensated, Hoskins said, and some need to be changed. The government put forward proposals to change 80 of those codes to find some cost savings, but the OMA didn't respond, he said.​