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http://www.canada.com/national/nationalpost/news/toronto/story.html?id=266ba8b2-8a33-476c-9008-7f5458c4bd04

Could some Canadian up on the local optometry gossip tell me the low down on what this conflict is over? I thought optometrists were happy about going to private coverage because they could raise their rates?

I'm sure most of them are VERY happy to be going private pay for patients aged 20-64 after 16 years without an increase in their reimburments. However, you can bet that collecting only $39.15/ exam for children and the elderly is fustrating when the private pay fee ranges from $80-120. From the sounds of the article that some Ontario OD's are threatening to stop seeing patients still covered by the provincial health insurance unless the province listens to them by either increasing the schedule of fees or deinsuring everyone.

I think it'd be a poor idea for some ODs to stop treating/taking OHIP patients. Kids generally have parents that also need optometry services, and many elderly probably get taken by their kids to the clinics.

If some ODs stop treating those under 16, will any parent make two trips to see two different optometrists? Probably not, they'll take the whole family to the OD that'll take OHIP as payment.

It would also make ODs look very greedy by asking everyone to be deinsured by the government. Before people could blame the faceless Ministry of Health, but now they'd only have their friendly OD to blame for having to pay out-of-pocket for their kids/themselves.

I think it'd be a poor idea for some ODs to stop treating/taking OHIP patients. Kids generally have parents that also need optometry services, and many elderly probably get taken by their kids to the clinics.

If some ODs stop treating those under 16, will any parent make two trips to see two different optometrists? Probably not, they'll take the whole family to the OD that'll take OHIP as payment.

It would also make ODs look very greedy by asking everyone to be deinsured by the government. Before people could blame the faceless Ministry of Health, but now they'd only have their friendly OD to blame for having to pay out-of-pocket for their kids/themselves.

Tell me this then .... what do you consider part of a routine exam? What if the governement pays you $40 for an "eye exam" ... and then you suspect glaucoma and want to do maybe fields. Would you expect to be reimbursed for that test? Imagine the uproar MDs would make if they couldn't bill for each service they provided. Is your dentist going to give you free x-rays? So now what if the governement told you that (a) they won't pay for VFs, but (b) you can't charge the patient or bill the goverment ... then what? That's the main issue with Ontario ... the governement still wants us to do every conceivable test free of charge.

Although the ontario association's stance might anger some .... the other option is to send every single glaucoma suspect to an ophtho for fields (where coincidentally the governement would then pay) ... Imagine how ridiculous the backlog for VFs would be ... and then to waste an ophthos time do read the field when you could have done the same?

Sometimes political action is the only way to make people see a more efficient way of allocation resouces.

PS: Trust me when I say ODs don't get rich off of doing fields.

hmm...

is this why ODs are struggling here in some states in the u.s.a too?

very insightful.

[QUOTE=canuck_OD]Tell me this then .... what do you consider part of a routine exam? What if the governement pays you $40 for an "eye exam" ... and then you suspect glaucoma and want to do maybe fields. Would you expect to be reimbursed for that test? Imagine the uproar MDs would make if they couldn't bill for each service they provided. Is your dentist going to give you free x-rays? So now what if the governement told you that (a) they won't pay for VFs, but (b) you can't charge the patient or bill the goverment ... then what? That's the main issue with Ontario ... the governement still wants us to do every conceivable test free of charge.
[QUOTE]
Is this still a problem in Ontario? When I talked to my OD about 8 months ago he menioned this problem, but when I worked for another OD over the summer I believe he was able to bill OHIP for seniors and collect directly from uncovered patients for VF's.

[QUOTE=canuck_OD]Tell me this then .... what do you consider part of a routine exam? What if the governement pays you $40 for an "eye exam" ... and then you suspect glaucoma and want to do maybe fields. Would you expect to be reimbursed for that test? Imagine the uproar MDs would make if they couldn't bill for each service they provided. Is your dentist going to give you free x-rays? So now what if the governement told you that (a) they won't pay for VFs, but (b) you can't charge the patient or bill the goverment ... then what? That's the main issue with Ontario ... the governement still wants us to do every conceivable test free of charge.
[QUOTE]
Is this still a problem in Ontario? When I talked to my OD about 8 months ago he menioned this problem, but when I worked for another OD over the summer I believe he was able to bill OHIP for seniors and collect directly from uncovered patients for VF's.

This type of problem is. That's why ontario ODs are contemplating wirhtdrawing their services from OHIP. Why should we expect to provide a service for free when another group can bill for it. So either make it a level playing field by allowing us to bill for additional tests, or allow it to be covered. But it's not realistic to expect ODs to provide top level care with new equipment (VFs, GDx or HRT's, Pachs, Topos etc) if there's no possible way to recoup any of those costs.

On another note I saw a patient today who was being monitored by an ophtho as a glaucoma suspect. There was a positive family history ... but otherwise everything (and I mean everything) was normal. The ophtho convinced this man to pay $150 every 6 months for the HRT-II. I'll let you decide whether or not you would have ordered this. (PS: for the past 2 years his HRT results were normal ..... )

Many US insurances pay less than 40 per eye exam (ie. Medicaid, Humana)

Many US insurances pay less than 40 per eye exam (ie. Medicaid, Humana)The difference is we can bill for additional testing such as VF's, gonioscopy, scanning laser, etc for glaucoma patients. Not being from Canada I am no expert, but from what I can tell the issue is that OD's will not be reimbursed for ancillary testing, and furthermore, cannot bill the patient. I don't blame them for being upset, and I don't think it's greedy to want to be paid for services performed.

Tell me this then .... what do you consider part of a routine exam? What if the governement pays you $40 for an "eye exam" ... and then you suspect glaucoma and want to do maybe fields. Would you expect to be reimbursed for that test? Imagine the uproar MDs would make if they couldn't bill for each service they provided. Is your dentist going to give you free x-rays? So now what if the governement told you that (a) they won't pay for VFs, but (b) you can't charge the patient or bill the goverment ... then what? That's the main issue with Ontario ... the governement still wants us to do every conceivable test free of charge.

Although the ontario association's stance might anger some .... the other option is to send every single glaucoma suspect to an ophtho for fields (where coincidentally the governement would then pay) ... Imagine how ridiculous the backlog for VFs would be ... and then to waste an ophthos time do read the field when you could have done the same?

Sometimes political action is the only way to make people see a more efficient way of allocation resouces.

PS: Trust me when I say ODs don't get rich off of doing fields.



After doing a bit of research and talking with od friends north of the border, I'll have to agree with your comments. It sounds like the hands of od's in ontario are tied and this health minister up there seems like a hard-ass that isn't going to budge.

A lot of the problems have to do...once again with economics and health care cost containment. Canadians pay income taxes, b/c they have a subset of expectations and part of the subset includes a social healthcare system. If you cut too many health services the public domain may complain and some parties may lose votes. Thus many political parties are opposed to cutting services, but want to contain cost via no increase in fees or jacking od's for doing more test for free. In addition to the inverse triangle demographic dynamics of baby boomers/the north american population, politicians are even faced with a more daunting tasking of containing healthcare cost....it almost seem impossible.

In the end who wins? the politicians. The od's lose, b/c they are not being properly compensated for their services. The pt's lose b/c they put up with potential substandard (may od's say they can't even buy the lastest equipment due to the low fees) of care or timely delays in testing via 'un-necessary' referrals.

I think it is necessary for politicians to revert back to the core basics of the Health Canada Act and cut many services offered these days. It's just unrealistic to expect the gov't to pay for all these services....Thus, the system needs to break into a two tier system, but revolts may not help those north of the border achieve their goals.

Most old british colonies have broken into two tier health care systems. The one tier system is just a good ideology.

ucbsowarrior

ps. In my profession they have what is called...fee for service...NOT free for service :thumbdown

Thus, the system needs to break into a two tier system, but revolts may not help those north of the border achieve their goals.



NO. A two tier system is not the answer. The tests that the ODs are not being paid for are covered by the health system but ODs are not allowed to be paid for them. I believe this is a problem because optometry in Canada is just now moving away from a solely refractive profession to lobbying for pharmaceuticals, etc. Give it time. If you aren't Canadian I don't think you can understand the importance and the pride Canadians place on the health care system up there.

NO. A two tier system is not the answer. The tests that the ODs are not being paid for are covered by the health system but ODs are not allowed to be paid for them. I believe this is a problem because optometry in Canada is just now moving away from a solely refractive profession to lobbying for pharmaceuticals, etc. Give it time. If you aren't Canadian I don't think you can understand the importance and the pride Canadians place on the health care system up there.It appears to me that if the Canadian health system would simply pay providers equally for the same tests, it might save money. It makes no sense to pay for an eye exam by an OD, and then pay for the consult by the OMD and then pay for the additional tests performed. You could cut out that consult fee if they would just pay the OD's for the tests performed. I agree with xmattODx - pay the OD's the same way they pay the OMD's (as long as the OD is only treating within his/her scope of practice).

i agree with ben completely! :thumbup:

NO. A two tier system is not the answer. The tests that the ODs are not being paid for are covered by the health system but ODs are not allowed to be paid for them. I believe this is a problem because optometry in Canada is just now moving away from a solely refractive profession to lobbying for pharmaceuticals, etc. Give it time. If you aren't Canadian I don't think you can understand the importance and the pride Canadians place on the health care system up there.


It's good to hear that ods up in Canada are expanding their scope. That's always a good thing and I believe that most ods are trained to beyond what they can practice in their state or province. It is often the laws that hold us back to practicing at the our highest levels. As to the two tier system of healthcare in Canada. It still really depends on the demographics, economics and the budget of the governments. If all these things don't align in favor of public health, than the system will eventually break into a two tier system. do i think it's a bad thing....it doesn't really matter what i think....it's all economics and bad public policy. do i agree with a two tier system - not really, but i'm not trying to state what i like and dislike and why. i'm merely observing what has happened in all of the other old british colonies - they all broke into two tier system - and all for the same reasons - there wasn't enough cash in the bank to support the system.

Canadians should have a lot of pride and honor in their public healthcare system, but as i've state it's economics and public policy that make the big decisions in society.

you all remember that show....pimp my ride....all those peps had crap-mobiles, and only cash could convert them to something that was even worth looking at. it's the same with healthcare...sad but true.

before i go, i would like to thank all those who have added to this topic...it's been great!@