Auditor General of Québec's Report : A Misleading Analysis According to the FMSQ
Montreal, December 4, 2015 – When the Auditor General's report was tabled this past November 27th, the Fédération des médecins spécialistes du Québec (FMSQ) published its preliminary response, since it had not had the opportunity to read and analyze it. The results of the audit of physicians' remuneration, contained mainly in volume 2, have given rise to public comments as excessive as they are deplorable. The FMSQ intends to set the record straight.
"We respect the institution represented by the Auditor General of Québec (AG) and it is not our intention to attack the individual. However, this report leads to unfounded conclusions or even to completely false ones," indicated the President of the FMSQ, Dr Diane Francœur.
Exceeding the Remuneration Budget
To begin, it is false to state that the budget for the remuneration of medical specialists was overspent by $384 million between 2010 and 2015. The amount by which the budget was exceeded was in reality $64.6 million, or 0.005% of the total expenses incurred during this period. The explanation is due to the fact that, during this interval, a portion of the projected increases were not paid. This created a one-off savings of $319.4 million. "This amount was never disbursed; rather it was included with the other amounts that were deferred to the years 2018 to 2021," clarified Dr Francœur.
Underestimating the Evolution of Medical Practice
It is true that there was a $384 million shortfall in estimates to take into account the evolution of medical practice. This is attributable to the Conseil du trésor which authorizes the remuneration budget. Calculating the amounts to be budgeted must include a previously established percentage, a margin of manoeuvre, so as to be able to remunerate physicians who enter into active practice, to absorb the growing demand for health care and services, and to pay for the implementation of new programs, like medically-assisted procreation. "More physicians, more medical services provided to patients : that's what the evolution of medical practice means. We had previously told the government that their estimate was not sufficient, that 2% was not enough. What the report does not say is that this underestimate still represents direct services and care for the population," emphasized the President of the FMSQ.
Savings Resulting from the Re-Averaging Agreement
It is wrong to let it be understood that the re-averaging protocols signed in the fall of 2014 did not result in a tangible and meaningful contribution on the part of physicians. This deferral of projected remuneration increases for physicians was aimed at allowing the government to reduce the extent of the budget deficit for the year 2014-2015 and allow it to reach a balanced budget during the year 2015-2016. The reason for the agreement was to spread out the increases that had already been granted, not to make them disappear !
Remember that this re-averaging agreement between the government and medical specialists gave rise to a one-off savings of $725 million for the year 2014-2015, and another one of $499 million for the year 2015- 2016, which add up to $1,225 million for the two years specifically chosen by the government. "We learned, in a recent economic update, that the budgetary deficit was $1.1 billion rather than $2.3 billion for 2014- 2015. Don't try to tell us that the concession agreed to by physicians did not contribute to this," emphasized Dr Francœur.
Remember also that the FMSQ waived payment of the amounts projected for the eight year, i.e. a total of $350 million, as mentioned in fact by the Auditor General. "To say that physicians pocketed an additional $400 million, as repeated by the official opposition, is pure demagoguery and demonstrates a clear intention to discredit physicians who are pronounced guilty by association," said the President.
To clearly understand the situation, it is important to separate the measures implemented by general practitioners from those put in place by medical specialists. Yet, several pages of the report deal with measures by general practitioners, while only two paragraphs concern specialists. No distinction is made and this amalgamation maintains confusion.
It is wrong to write that the incentive measures do not improve access to services. "The Auditor General mentions that the 17 measures we implemented were examined in detail by members of her team. And yet, they never took the time to meet with the FMSQ to discuss the matter. Contrary to what is affirmed, targets and indicators do exist for many of these measures, while in other cases none are required. Our measures were put in place to improve the quality and accessibility of our care and, in spite of what is stated, they have well and truly produced results. Services were improved and this improvement monitored," added the President.
A Better Control
Finally, chapter 3 of the AG's report deals with the remuneration of physicians and its control. To begin with, the FMSQ recognizes the importance and legitimacy of performing controls and does subscribe to the need for a close audit. The complexity of coding medical acts and the rules that apply to this process are the framework in great part that sets the Régie de l'assurance maladie du Québec's (RAMQ) terms of payment. "We are at the complete disposal of the government to continue to actively cooperate with the RAMQ, the Ministère de la Santé et des Services sociaux (MSSS) and the Conseil du trésor to improve the processes by which they analyze and control our members' billing. We are convinced there is always a better way. On this point, we agree with the Auditor General," declared President Francœur.
"Last week was particularly destabilizing for Quebeckers as a whole and, specifically, for physicians who do not deserve to be treated this way, neither in public nor in the National Assembly. On the one hand, there were public expressions of gratitude to one of the individuals found guilty of plotting to commit fraud, breach of trust, corruption and intimidation associated with the granting of public contracts, because of his contribution to and courage when faced with the Charbonneau Commission. On the other hand, based on the Auditor General's report, several people accused physicians of being thieves and of defrauding the public healthcare system. We physicians do not deserve to be dragged through the mud. I heartily deplore all of the false and groundless accusations as well as the motives imputed to us," concluded Dr Francœur.
The Fédération des médecins spécialistes du Québec represents more than 10,000 medical specialists certified in one of 59 recognized medical specialties.