(December 10, 2015)<\/p>\n
By: Ashley Csanady, Canadian Politics<\/p>\n
A Toronto woman is upset with a letter she received from her doctor asking for an annual fee. Such practices are allowed but she feels the missive wasn’t clear it was for optional services.<\/em><\/p>\n A Toronto woman was incensed after receiving a letter from her doctor asking for an annual $150 fee.<\/p>\n The letter from Wellpoint Family Practice cites recent cuts to doctors fees, the clinic\u2019s after-hours service and quality of care in appealing for the fee.<\/p>\n \u201cThis year, more than ever, I\u2019m asking each and every one of you to pay the annual fee so that I can continue to provide the level of service you come to expect,\u201d the missive from Dr. Nandini Sathi at Wellpoint states. \u201cThe fee is good value and avoids the delays that occur when we must request payments from you for individual services.\u201d<\/p>\n These sorts of \u201cblock fee\u201d requests are increasingly normal in Ontario and permitted under the law, so long as they cover things such as doctor\u2019s notes and insurance forms not covered by the Ontario Health Insurance Program.<\/p>\n But the tone of this particular letter has the patient and health care advocates scratching their heads.<\/p>\n The patient \u2014 who asked that her name be withheld for fear of reprisal from her physician \u2014 called the letter \u201cunexpected and slightly galling.\u201d<\/p>\n The 20-something said she only goes to the doctor maybe once a year so she didn\u2019t understand why she was being asked to pay so much.<\/p>\n \u201cI kinda felt like she doesn\u2019t care about being a good doctor\u2026 and just wants money,\u201d the woman said. She pointed to a section of the letter that mentions the sorts of things she expects from a family doctor, such as delivering babies, as odd.<\/p>\n The letter itself makes a strong case for the fee to maintain service but also notes that if patients don\u2019t pay the fee, they can\u2019t expect email communication with their doctors or prescriptions to be renewed over the phone \u2014 the types of service for which family practices are allowed to charge.<\/p>\n Wellpoint says the plea is well within the College of Physicians and Surgeons of Ontario\u2019s guidelines on block fee requests. This isn\u2019t the first year they\u2019ve distributed the letter and they say it\u2019s meant to be a convenient way for regular patients to pay for services all at once. The fee remains optional and Wellpoint works with patients who can\u2019t afford services \u2014 even those they always charge for \u2014 to make sure they get proper access.<\/p>\n \u201cIn no way does this affect the patient care in any way,\u201d said Enza Costa, a manager in the clinic. (Dr. Sathi was out of the country at the time of writing). She said they never refuse services or give preferential treatment based on the fee.<\/p>\n Judy Plotkin, a vice-president with the health clinic, said the letter is \u201cpretty clear\u201d it\u2019s just an opt-in request. She said when viewed in conjunction with an accompanying pamphlet, it\u2019s obvious the block fee is a choice. And, in the end, she said it\u2019s always about patient care and ensuring their needs are met.<\/p>\n That newsletter also details the sorts of services for which the clinic charges: a $30 fee for a non-OHIP referral, such as massage therapy; a $25 fee for immunization records; $30 for a telephone consultation with nurses. It also notes what the annual fee doesn\u2019t cover: third-party physicals for immigration; employment or other needs; transfer of records; a physician consultation by telephone instead of in person; and legal or insurance forms.<\/p>\n Some doctors do perform some of those services without charging a fee, but it depends on the office.<\/p>\n \u201cPhysicians in Ontario are permitted to charge a block fee \u2014 a fee for a predetermined set of uninsured services during a predetermined period of time,\u201d said Dr. Mike Toth, president of the Ontario Medical Association in an email. He also stressed that the fees must be voluntary.<\/p>\n Health Minister Eric Hoskins, also a medical doctor, said physicians are small business owners and must have the freedom to charge for non-OHIP covered services. That said, and without commenting on a specific letter, he said patients need to understand it\u2019s a choice, not a requirement for care. He noted that even after the slight fee decreases that took effect Oct. 1, Ontario doctors are some of the best paid in the country, billing an average of $368,000 a year.<\/p>\n Physician fees were cut twice this year by 2.65 per cent in February and 1.3 per cent in October as part of an effort to hold government spending increases on doctor pay to 1.25 per cent. Hoskins said the cuts were based on a report from former chief justice Warren Winkler, who was trying to broker a conciliation between the Ontario Medical Association, which represents doctors, and the province.<\/p>\n The province spends about $13 billion a year in doctor pay, both through fees and in other areas such as funding for clinics and family health teams. That means, in a province with a budget of just over $130 billion each year, about 10 cents of every dollar spent by Ontario goes to a doctor.<\/p>\n \u201cIts an option that is by law available to them,\u201d Hoskins said. \u201cIt needs to be explicit that it is voluntary and that there is no added advantage\u2026 if they do subscribe to the block fees it needs to be neutral and it can only be compensate for non-OHIP insured services.\u201d<\/p>\n \u201cNo one has to pay a block fee,\u201d said Kathryn Clarke, senior communications coordinator with the College of Physicians and Surgeons of Ontario. She said a policy outlines expectations for doctors to ensure their requests are clear. She said they still receive complaints \u201cperiodically\u201d but couldn\u2019t comment on the substance of this precise letter.<\/p>\n \u201cThe intent of the policy is to establish it\u2019s meant to be an offer. It\u2019s an option that patients are given and they\u2019re not supposed to be mislead or forced into signing it,\u201d she said.<\/p>\n But for Natalie Mehra with the Ontario Health Coalition, which has long lobbied against any sorts of fees in health care as something that undermines OHIP, the Wellpoint letter doesn\u2019t pass that test.<\/p>\n \u201cThis letter goes much further than any block fee letter I\u2019ve seen to date,\u201d Mehra said, adding it\u2019s quite vague about it being a request. She said all the language about hours of service and concerns about cuts implies the fee is connected to care.<\/p>\n \u201cI think including the word \u2018delay\u2019 in that sentence is very manipulative.<\/p>\n \u201cWe get complaints fairly often from patients who have received letters from their family doctors asking for block fees and patients are often confused, even when the letters are more clear than this one that the fees are optional. Patients feel that they will get substandard care or they will be forced to wait longer if they don\u2019t pay the fees,\u201d she said. \u201cThe fees are really problematic. They really create the perception there\u2019s two tiers of care.\u201d<\/p>\n It\u2019s unclear how many doctors in the province ask for block fees with these sorts of mass letters, but Hoskins said it\u2019s a minority.<\/p>\n NDP health critic France G\u00e9linas said concerned patients should consider talking to the regulatory body, the College of Physicians and Surgeons of Ontario, if they feel pressured into paying such a fee.<\/p>\n \u201cIf the letter in any way shape or form implies the care will be different if they don\u2019t pay those blocks fees, they have a reason to complain to the CPSO,\u201d said said. \u201cIt\u2019s not the intention of the doctor, it\u2019s how it is interpreted by the people who get the letter, how it was communicated to them, how it was received.\u201d<\/p>\n Some doctors are turning to these fees just to make ends meet, said Tory health critic Jeff Yurek. He said the fee cuts imposed on doctors took hundreds of millions dollars out of the system.<\/p>\n \u201cI honestly think this is playing out from the cuts that took effect October first,\u201d Yurek said of the anecdotal increase in such letters. \u201cI think they\u2019re forced to. They\u2019re small businesses themselves and they need to make ends meet.\u201d<\/p>\n