Abolition of income related to certain meetings, reduction of premiums for surgeries on obese people … The cleaning undertaken in the remuneration of medical specialists is progressing this year, but the most difficult concessions remain to be made.
“If it continues like this, it’s very positive for the future. The director of the Institute for the relevance of medical acts (IPAM), Jean-François Foisy, is satisfied. After a disappointing first year, the work of his organization has made it possible, since January, to tap 97 million in the remuneration of doctors by cutting bonuses and superfluous or excessive codes.
The Federation of Specialist Physicians of Quebec (FMSQ) has, among other things, agreed to reduce the remuneration received by department heads of hospitals when they attend certain meetings. This cut alone will make it possible to recover 13.7 million per year.
The same goes for the income granted to doctors who participate in certain training courses. After reducing the number of paid half-days in February, IPAM decided to abolish them, freeing up 16.8 million more.
Recall that in the election campaign, the team of François Legault had promised to seek 1 billion per year in the salaries of medical specialists. A year later, the government and the Federation of Specialist Physicians of Quebec (FMSQ) instead agreed to draw 1.6 billion over four years in compensation, including 450 million in “relevance”. Instead of directly cutting wages, they have agreed to eliminate unnecessary acts and bonuses to which they have access.
To decide where to cut, IPAM works on the basis of proposals from the FMSQ, the Ministry of Health, but also suggestions from doctors, explains Mr. Foisy, a former CEO of the Integrated Health and Services Center. (CISSS) of the Laurentians (2015-2019).
“Now it’s the fun : we have doctors who write to us to tell us about their own specialty. At the start, we had a lot of them, but they all knew what to do in the neighbour’s specialty, ”he smirks.
Since January, no less than 63 codes and bonuses have been modified or abolished. This system stems from the fact that doctors are not employees and are paid on a fee-for-service basis. Over the years, more than 12,000 of these codes have been included in their agreement with the government to define the remuneration specific to each act in each specialty.
Among other things, the code list shows that surgeons receive a supplement when the person they are operating on is overweight. “Obesity makes any operation more complex and longer. The risk of complications is higher, ”explains the president of the Quebec Surgical Association, Mario Viens.
By tightening the criteria on this subject (the bonus will only be offered to the most obese patients), the IPAM was able to subtract a little more than $ 700,000 per year from the remuneration.
The anesthetists also agreed to put aside the attendance bonuses for which they had dragged the FMSQ to court last February. These premiums, costing $ 23 million a year, gave anesthesiologists 29% revenue increases when they worked between 7 a.m. and 8 a.m.
At the FMSQ, it is indicated that “the lawsuit is currently suspended”, that the Federation “has initiated out-of-court discussions with the Association des anesthesistes du Québec” and that they are “confident to reach an agreement”.
A majority for surgery
To achieve the targets set out in the agreement with the Legault government, IPAM had to subtract 70 million from compensation last year, as much this year, and 100 million in 2022-2023. Since these savings are recurring, this should free up cumulative funds of $ 450 million over three years.
This money will be almost entirely reinvested in the reduction of waiting lists for surgery created by the pandemic (400 out of 450 million). To catch up, the government has decided to delegate 14% of the total number of surgeries to private clinics. A bill of 800 million that doctors’ money will half pay off.
“We will have to make sure that these projects come true,” warns Mr. Foisy. We don’t write a blank check. “
In the last economic update, the Minister of Finance, Eric Girard, indicated that he intended to draw from this money 35 million this year, and 365 million more within two years.
Last year, IPAM was only able to recover 6 million in doctors’ codes. However, the work carried out since January has enabled it to seek 97.2 million of the 140 million it needs by the end of the fiscal year.
And it is not over, assures the director of IPAM, who is convinced of being able to reach the target of 140 million soon. “We have around 40 million dollars in analytical measurements which should yield results by the end of the year. “
However, the most arduous efforts remain to be made. Once the most obvious savings have already been made, the FMSQ will have to cut for 100 million codes and bonuses next year (30 million more than this year). “The closer you go towards the end, the harder it is.” Currently, there is no one who is happy, but we have in front of us people who understand. “