CBC Investigates

B.C. eye doctors demand province halt plans to reduce cataract fees

B.C. eye doctors are taking the province to court to stop a reduction in fees they can charge for cataract surgery.

Ophthalmologists, now among highest paid doctors in the province, say they would be the worst paid in Canada

In cataract surgery, the clouded lens is removed and replaced with an artificial lens to restore clearer vision. (CBC)

British Columbia's eye doctors are taking the Medical Services Commission and the Ministry of Health to court to stop the province from trying to reduce the fees ophthalmologists are paid for cataract surgery.  

The doctors allege in court documents filed at the end of September the province is reducing the amount paid for cataract surgery and lens implants from $425 to $350 effective Oct. 1

They argue that the decision is "unreasonable," and  "lacks justification, transparency and intelligibility"  because "no final and binding written agreement has been reached" and they say the ministry failed to consult health authorities as required.  

Dr. William H. Johnston, a Nanaimo ophthalmologist and co-president of the British Columbia Society of Eye Physicians and Surgeons, has filed an affidavit in support of the petition.

The reduction comes after the ministry already reduced fees from $533 to $425 in 2012, he says in the affidavit, adding it will cause hardship for the eye specialists as they deal with higher overhead costs and for patients as waiting lists grow.

The court action aims to stop the implementation of the fee reduction. 

The Ministry of Health has not yet filed a statement of defence but in an email to CBC a spokesperson said that the fee reduction took effect Oct 1.

Cataracts are described as a clouding of the lens and can occur as people age. (Shutterstock)

Cataracts are described as "a clouding of the lens" inside the eye and occur frequently as people age.

In cataract surgery, the clouded lens is removed and replaced  with an artificial lens to restore clearer vision. 

The ministry has been trying to decrease the fees for several years, arguing that the surgical time required has been much reduced as technology improves and doctors can do many more surgeries in a day. 

The doctors say their own data shows it takes almost 40 minutes of time on average to perform the surgery including pre- and post-operation procedures.

28 surgeries in a day

But in a 2011 report, the province says some doctors were performing as many as 28 cataract surgeries in a day then, up from 16 in 1995.

The affidavit says there has been no new technology since the last reduction in 2012 and that more patients are choosing customized lens implants that require more time. 

It also says overhead costs including staff, equipment and continuing education eat up about 45-50 per cent of the fee and there are almost 22,000 people wait-listed in B.C. for one, or often two, cataract surgeries.

There are almost 22,000 British Columbians on the wait-list for cataract surgery. (Shutterstock)

'Chilling effect' of lower fees

The documents lay out the back and forth between the ministry, the Doctors of B.C., the umbrella organization for the profession and the society as they discussed and disagreed over the fee reductions saying it "would likely have a chilling effect on the availability of the cataract procedures."

They also say the proposed combined fee of $350 would be well below the lowest fee paid in Canada and below the reduction proposed and dropped by the ministry in 2012. 

The current $425 fee includes $336 for cataract extraction and $88 for the lens implantation.

Top earners

The Medical Services Plan (MSP) Bluebook, available online, shows that the top 10 highest grossing physicians — of more than 10,000 medical practitioners in the province — are all ophthalmologists, billing between $2.2 million and $3.6 million last year.

Ministry of Health documents attached to the court filing show the province is seeking to level the disparity between surgical specialities, arguing that "productivity gains in cataract surgery have accrued to the provider" while taxpayers are paying more.

Eye doctors warn, that with the fee change, waiting lists will grow as more doctors refuse to take on complicated cases. (CBC)

Johnston's affidavit however says the fee reduction will cause "irreparable harm" as there will be fewer surgeons willing to perform cataract surgeries in B.C., there will be less frequent replacement of expensive equipment, refusal by ophthalmologists to take on complex cases that might take longer than 39.5 minutes and patients will risk blindness as waiting lists for surgery grow.

None of the assertions have been tested in court.

With files from Jason Proctor 

Read more from CBC British Columbia

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