Three years after its creation, the Institute for the relevance of medical acts (IPAM) has recovered more than a billion dollars in the remuneration of medical specialists, by sorting out unnecessary acts and bonuses. However, reinvestments are slow to materialize.
“People had doubts about IPAM, but it has to be said that it gave interesting results. The downside in that is that the implementation is long. We would like it to be faster, ”observes the president of the Federation of Medical Specialists of Quebec (FMSQ), Vincent Oliva.
According to our information, only $82.5 million has so far been reinvested in the network out of the $1.064 billion that has been recovered.
Remember that the Institute for the relevance of medical acts was created following a compromise between the Legault government and medical specialists.
When she was in opposition, the CAQ had promised to cut a billion a year in their remuneration. However, after the 2018 election, doctors and the Treasury Board (then led by Christian Dubé) had instead agreed to recover 1.6 billion in four years, by dipping into compensation indirectly.
“The idea was to eliminate medical activities that are not very useful for the patient”, summarizes the Dr Olive. Instead of reducing wages, we were going to clean up bonuses and the thousands of codes associated with fee-for-service. Thus, for three years, representatives of doctors and the government have agreed, for example, to reduce the bonuses granted to anesthesiologists who agree to work early in the morning or even to eliminate superfluous check-ups in pediatrics. Internists will not be able to bill certain annual examinations more than once. And so on, for a total of 114 cuts or adjustments.
Rain of techno projects, tenuous impacts in surgery
IPAM, the doctors and the Ministry of Health then agreed on 47 “projects” in which the money will be reinvested. All aim to improve access to specialized medicine, as provided for in the 2019 agreement.
The biggest project aims to reduce the wait for surgery. In the last budget, $400 million was earmarked for this purpose. However, its impact is limited due to the shortage of manpower, laments the Dr Olive.
“It is certain that the projects [de réinvestissement] that require human resources in the field are in a queue,” he notes.
According to the FMSQ, only a “small part” of the 400 million has been invested, and this, mainly in “planning” work.
During this time, IPAM multiplies projects of a technological nature. Thus, of the 47 projects funded, 18 relate directly or indirectly to digital or telehealth, for a total of $134 million.
Among these, a vast project of 51 million dollars allowing pathologists to digitize the glass slides of their microscopes in all OPTILAB laboratories.
The FMSQ is also pinning a lot of hope on a project to “optimize” the window through which requests for appointments in specialized medicine pass (the “service request dispatch centres”, known as “CRDS” in the jargon).
With six million a year, doctors think they can harmonize the 14 CRDS in Quebec. “There are duplicates in there, patients who need to be redirected…” mentioned the president of the FMSQ.
They also want to create an “integrated electronic medical record” for medical specialists who have an office practice. No less than 18 million dollars are allocated to it in the first year.
The fax still persists
Surprising fact: one of the telehealth projects aims in particular to facilitate the use of fax machines. Funded at a cost of 4.6 million, the future “digital health services support center” must, among other things, allow doctors to receive and “send an email and its attachments by fax”. IPAM calls this “cloud faxing” or even “web faxing”.
Questioned on this subject, its director, Jean-François Foisy, retorts that it will be necessary to wait “several years” before banning the faxes from the network. We must therefore find, he says, transitional solutions.
Otherwise, isn’t the development of all these new technological tools likely to come into conflict with the government’s desire to standardize IT services in the network?
Mr. Foisy replies that when a techno project is selected, the IPAM makes sure with the person in charge of information technologies of the ministry “that it will be able to be integrated afterwards in the digital health file”.
“That’s a good question,” replies Mr. Oliva. “But you just have to be aware that we have fallen behind enormously in technology in Quebec in recent years. It reflects that. The technology projects “are chosen jointly with the Ministry” of Health, he adds. “And the ministry is responsible for implementation. »
IPAM has until December 2023 to achieve the target of $1.6 billion in savings set out in the agreement with the government.