Factions form in Quebec ultrasound reimbursement dispute

Ultrasound centers in Ontario just got a little busier, owing to an ongoing reimbursement dispute between Quebecer private imaging clinics and the Quebec public health insurance agency (RAMQ).

Last July, RAMQ pledged to cover out-of-pocket costs for ultrasounds in private clinics, intending to reduce long waits for ultrasounds in public hospitals. However, the late December start date came and went without a compensation agreement between the public health agency and area radiologists, leading some imaging clinics to close their doors and force patients to seek exams in neighboring Ontario.  

Martin Lacasse, owner of Ecosphere Imaging in Gatineau, Quebec, canceled 50 ultrasound appointments, saying he needs more information on RAMQ reimbursement.

"We're not a public enterprise, we're private, so therefore I have some risk,” he told CBC News. “When I take risks, I assess them and make the best decision on what I have in my hand.”

Quebec Health Minister Gaetan Barrette described the closures as radiologists “taking patients hostage” to increase their leverage in the ongoing negotiations.

On the other hand, the Quebec Association of Radiologists has criticized the process by which RAMQ promised to cover the ultrasounds, characterizing the negotiation as rushed. According to association president Vincent Oliva, MD, many Quebecer radiologists are in favor of ultrasounds being covered by RAMQ, but believe it should be a gradual change, rather than instantly covering all ultrasounds.

“It’s a bit of a shock to the system and it’s not clear that all the private clinics will be able to meet the demand, said Oliva. “If we have an avalanche of requests, we will be completely overwhelmed."

The two sides are deadlocked over a $30 gap—Barrette has offered $70 per ultrasound, while radiologists are requesting $100 per ultrasound.

“We will always pay the price to cover costs—I’m not asking anyone to work for a loss,” Barrette said.

This fight isn’t simply between providers and payors, however. The Council for the Protection of Patients is adding it’s voice to the fracas, saying they plan to introduce a class-action lawsuit against imaging centers who’ve closed, alleging that imaging practices can’t refuse care when compensation is on the way following resolution of the dispute.