Businessman Preferred Over Certified Radiologist in Operating Diagnostic Imaging Equipment and Delivering Service to Third Party Payers
December 3, 2010
The National Post on Wednesday, November 16, 2010 ran an interesting feature article on the issue of third party purchasing of diagnostic imaging which is performed in our public hospitals, more specifically, imaging such as MRI and Cat Scans and Third Parties.
Medical and diagnostic services which are requested by Third Parties (such as ones employer, the manager of a sports team, and the like), are not insured services under OHIP and it is completely legal to charge for those services and does not breach either the letter or the spirit of the Canada Health Act or our Ontario Health Insurance Act. The legal rules, however, both for the provision of these non-insured third party services to residents of the Province are strict and complex. However, for some considerable time these services have been provided in our public hospitals around the Province and have been paid for to independent businesses who partner with the hospital to provide these third party services on hospital premises, sometimes on hospital equipment, and who share the revenue generated by the provision for payment of these services between the hospital and the business. As the National Post report indicated, the various hospital spokes people who explained how this is accomplished in our government-sponsored system, indicate that the diagnostic testing is made available “outside of regular patient hours”. If, however, medically necessary health service is a 24-7 affair, it is difficult to reconcile how a publicly-funded facility can be made available for third party diagnostic imaging in public hospitals when we still have waiting lists for first party medically necessary imaging.
There is absolutely a need and a place for third parties to refer individuals for this type of diagnostic imaging and to elect to pay for that service. It is, however, of concern that instead of utilizing the legally licensed and therefore regularly inspected facilities of our certified radiologists who own and operate their own diagnostic imaging clinics pursuant to legislative oversight on safety and quality, the Ministry prefer to permit private enterprise to equip and staff diagnostic imaging facilities inside our public hospitals to provide MRI and Cat Scans for third party referrals.
Currently, the legislation we have, while it permits the services to be provided and to be paid for outside the public purse, it prohibits a radiologist from interpreting an MRI or a Cat Scan that is performed anywhere other than in a public hospital setting. It is for this reason that private business have partnered with public hospitals to provide the services. Once the service is provided on hospital premises any radiologist can then be given the scans to interpret and report. The time is overdue to change the regulations and allow our Radiologists to interpret Cat Scans and MRIs performed in their own clinics for non-OHIP patients.