Bill 68 | Opposition fears transfer of doctors’ burden to other professions

The Quebec government wants to reduce the burden of long insurance forms that doctors have to fill out. While this is generally applauded, elected officials and the Association of Psychologists fear that this administrative task will be transferred to other health care providers.

Parliamentarians heard from several organizations on Tuesday, including the Collège des médecins du Québec (CMQ) and the Fédération des médecins spécialistes du Québec (FMSQ), as part of special consultations on Bill 68, aimed primarily at reducing the administrative burden on physicians.

The bill essentially aims to prohibit insurers from requiring a medical service to obtain reimbursement in certain contexts, including professional services provided by psychologists, occupational therapists and physiotherapists. “It seems extremely important to us to allow reimbursement without requiring a medical certificate,” said Labour Minister Jean Boulet.

He cited as an example that employers will no longer be able to require a medical certificate for sexual violence, common illnesses such as gastroenteritis and for caregivers who have to take time off work.

Mr. Boulet also wants people who need technical aids (canes, crutches, etc.) to no longer need medical papers for reimbursement.

Québec solidaire’s health spokesperson, Vincent Marissal, stressed that if the bill discharges the responsibility for the forms from doctors, “it is possible that insurance companies will not give in so easily and will simply transfer the responsibility to other professionals.”

The president of the Association of Psychologists of Quebec, Gaëtan Roussy, fears this scenario. He would not want insurance applications to end up on the desks of psychologists who are already unable to meet the growing demand for their services from the population.

Minister Boulet wanted to be reassuring. “We don’t want there to be a pushback like [présentement] in some cases. Insurers are pushing work that is within the expertise of a psychologist into a doctor’s office. This is not helpful, because it places a burden on them that is often outside their area of ​​expertise and it hinders access for other people who really need clinical work.”

FMOQ sifts expectations on released appointments

According to the Fédération des médecins omnipraticiens du Québec (FMOQ), reducing the burden of insurance forms on doctors will not significantly increase the number of appointments offered. It will mainly be useful for reducing the workload of doctors and using “the time slot in a much more relevant and optimal way.”

“There is paperwork that is done in the office and there is also paperwork that is done in [heures supplémentaires] evenings and weekends outside the office. So, there is a portion that will be available for additional leeway, but there is a portion that will not be available for concrete gains in terms of accessibility to patients, but which will have a significant effect on the work overload of physicians when they do this work in the evenings and on weekends,” said the president of the FMOQ, D^r Marc-Andre Amyot.

Mr. Boulet clarified that increasing the number of appointments was not the objective of this bill, but that the government estimated that all of the measures would potentially free up 600,000 “appointments with no added value” per year.

The D^r Amyot also spoke about the problem of patients who do not show up for their medical appointments. “We absolutely must work with the ministry to stop this scourge. Last year, 162,000 appointments were reported to us,” he said.

According to him, patients have difficulty cancelling their appointments via the Frontline Access Desk (GAP) or the Rendez-vous santé Québec (RVSQ). “We need to work together to improve the cancellation mechanism,” argues D^r Amyot.

No impact for half of the specialties

The FMSQ supports the bill, but finds that “it doesn’t go far enough, we’re only scratching the surface.” The president, D^r Vincent Oliva said that the measures in Bill 68 will have little or no impact on nearly half of the 35 associations of specialist physicians that he represents.

“The bill is not an end in itself,” assured Minister Boulet. He recalled that his government has already reduced the administrative burden in the context of work accidents and occupational diseases with the Commission des normes, de l’équité, de la santé et de la sécurité du travail (CNESST).

With Bill 68, the government also wants to remove the obligation to see a doctor at predetermined frequencies and leave the determination of frequencies to the professional who has taken charge of the patient.

Forms too long

All the health professionals who spoke to elected officials in the morning about their reality highlighted the aberration of the long forms from private insurance companies, but also from the public network, including the Régie de l’assurance maladie du Québec (RAMQ), the CNESST and Retraite Québec.

The CMQ wants Quebec to remove the requirement to obtain a doctor’s prescription to access services insured by the RAMQ when an assessment by another health professional has been completed. Along with the FMSQ, the CMQ deplores the fact that this takes away valuable time from doctors with their patients when other professionals have already demonstrated the need for care.

The D^r Alain Naud, a family doctor for 39 years, denounces that “everything must go through the doctor”. This is the case, for example, of a podiatrist who determines that his patient needs a foot prosthesis.

Currently, for an audiologist who prescribes a hearing aid, the RAMQ requires that the prescription be made by an otolaryngology physician. “In my opinion, there is an abuse in such situations,” comments the president of the CMQ, D^r Mauril Gaudreault.

He said the College has long advocated for more latitude for health professionals. “For us, once a competent professional has assessed a person, identified the care, service or equipment that is required, it is superfluous to systematically go and get a doctor’s prescription. This is a measure from another era. It is unnecessarily cumbersome. We really do not see the added value for the network and for the population,” he said.

He says there are many examples of a doctor’s prescription being requested when the patient has been assessed by another professional. “It doesn’t make sense to operate like that, to ask a professional to sign something for a patient they haven’t even seen.”

On the other hand, the CMQ and the FMSQ would like a multi-party committee to be formed to study the relevance of the forms. Its mandate would be to shorten forms, merge them and, in some cases, abolish them. “It’s to make the doctor’s job easier, but it’s much more than that. […] To ensure that the patient’s journey does not become an obstacle course,” comments D^r Gaudreault. The Association of Psychologists said it was available to participate in the committee.

Bill 68 would involve amending two laws: the Act to promote access to family medicine and specialized medicine services and the Act respecting labour standards.

On Wednesday, parliamentarians will hear from the Canadian Medical Association and the Canadian Life and Health Insurance Association.

The Canadian Press’ health content is funded through a partnership with the Canadian Medical Association. Editorial choices are solely the responsibility of The Canadian Press.