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An open letter to our patients

Dear Patient,

In health care and in life, process and words are important.

In recent days, New Brunswick’s doctors have seen many comments about our billing practices, work ethic, and appetite for change. We take such comments seriously. We talk straight in our offices and we’ll do so now.

New Brunswick’s doctors support billing accountability.

There have been some accusations that we are trying to protect people who are intentionally committing fraud by deliberately overbilling Medicare. Physicians are wholly supportive of efforts to find anyone who deliberately overbills Medicare. We also support actions taken to correct these problems. Any such cases undermine the trust that people have in doctors, a key to the success of the patient-doctor relationship.

Our position on this remains unchanged from a month ago, when we wrote the Department of Health and once again offered to help fix the billing system. That’s why we again wrote last week to invite the Minister to address this issue with doctors. Since then, he has repeatedly asserted that he believes that 99.9% of doctors are billing appropriately, which we appreciate.

New Brunswick’s doctors support audit processes.

We always have, and always will, support a strong Medicare audit process. This isn’t new. It has been in place for decades and was developed jointly with government. There are dispute resolution mechanisms in place. The audit process has served as an educational tool for both physicians and Medicare. Audits serve to both discover and resolve different interpretations of billing codes that were designed forty years ago in a 260-page fee schedule. It protects our Medicare system and the best use of limited health resources. Audit is helpful, and must be improved.

New Brunswick’s doctors have entered productivity data for years.

We’ve heard some comments about the work ethic of salaried doctors. There’s even talk of a “new system to help us figure out if they’re working”, called shadow-billing. Shadow-billing has also been around for years. Shadow-billing data are important because they show health services provided to sick New Brunswickers and help us figure out how to better care for them. The number of doctors entering these data was again noted in the Auditor General’s report – it stands at 96%.

New Brunswick’s doctors believe in consultation.

We are not in favour of reducing emergency services without any community consultation or discussion with caregivers. If it is truly felt by the government that closing a third of the province’s emergency rooms would indeed have little impact on patient care, we believe caregivers and patients have other views. That doesn’t mean we’re “obstructing change” – it means we’d like caregivers and patients to be consulted, and the impacts on care to be carefully examined.

Health care is about people working together with evidence.

That’s why we offered the opportunity to the Minister to address doctors with a transparent and honest conversation face-to-face, and we’re glad he accepted. We too want accountability, and we too want health system sustainability. We also want change in our system, which is why we wrote the Minister in early August with forty ideas on how to improve the quality and accessibility of the health system. We still await a thoughtful Health Plan from government that tackles the systemic issues New Brunswick faces.

We look forward to working together with government in months to come in this way – sitting down, addressing problems with each other first, and examining the evidence. As the Minister points out, everyone in health care must be accountable. We couldn’t agree more.

Robert Desjardins, MD
President, New Brunswick Medical Society