D'Alessio, Sarah C. - royalgazette.com · 3 they were able to charge for CT and MRI services. When the current Government came into office, the situation was reviewed and several

1

D'Alessio, Sarah C.

From: Attride-Stirling, JenniferSent: Sunday, January 14, 2018 7:01 PMTo: Kennedy, Catherine L.Subject: RE: Draft statement: subsidy for MRI/CT services

canyoutactfullygiveannaaheadsupthatBHBislikelytobementionedinastatement?JAttrideStirling,PhDPermanentSecretary________________________________________From:Kennedy,CatherineL.Sent:Sunday,January14,20186:06PMTo:AttrideStirling,JenniferSubject:RE:Draftstatement:subsidyforMRI/CTservicesHelloPS,Yes,minewasthekitchensinkapproachRegards,CatherineFrom:AttrideStirling,JenniferSent:Sunday,January14,20186:01PMTo:Wilson,KimN.Cc:Kennedy,CatherineL.Subject:Re:Draftstatement:subsidyforMRI/CTservicesMinisterhereisadraftstatementforyourconsideration.YoucanseeCatherine'soriginalbelowbutthisoneisshorterDRAFTTheGovermenttookstepstomitigatetheimpactoffeereductionsbythepreviousGovernment.BoththeBrownDarrellClinic(BDC)andtheBermudaHospitalsBoard(BHB)werenegativelyaffectedbyadownwardadjustmenttothefeestheywereabletochargeforCTandMRIservices.WhenthecurrentGovernmentcameintooffice,thesituationwasreviewedandseveraloptionswereconsideredtomitigatethefinancialimpacttothetwoentities.Importantly,itwasdecidedtosupplementthetwoentitiesfromGovernmentfundsratherthanraisepeopleshealthcarepremiums.MakinghealthcaremoreaffordableisoneofthemostimportantGovernmentinitiatives.TheGovernmentregretstheimpendingclosureofCTservicesattheBrownDarrelClinicbutwishestoassurethepublicthataccesstoCTscanswillcontinuetobeavailableatBHB.Sentfromahandhelddevice.PleaseexcuseanytyposOriginalmessageFrom:"Kennedy,CatherineL."Date:14/01/20185:49pm(GMT04:00)

2

To:"AttrideStirling,Jennifer"Subject:Draftstatement:subsidyforMRI/CTservicesHelloPS,Pleaseseebelow:GovernmenthasrecentlygrantedfinancialsupplementstoboththeBrownDarrellClinic(BDC)andtheBermudaHospitalsBoard(BHB)inordertohelpensureCTandMRIservicesarereadilyavailabletothepublic.BothBDCandBHBwereaffectedunderthepreviousGovernmentbyadownwardadjustmenttotheidenticalfeestheywereabletochargeforCTandMRIservices.WhiletheBermudaHealthCouncilrecommendedmultiplehealthservicefeesbereduced,ultimatelyonlythosefeesrelatedtoMRIandCTserviceswereaffected.WhenthecurrentGovernmentcameintooffice,thesituationwasreviewedandseveraloptionswereconsideredtomitigatethefinanciallossesthetwoentitiesincurred.Thedecisionwasmadetoprovideapercentageofthedifferencebetweenwhatthetwoproviderswereabletochargepriortothedownwardadjustmentoffees,andwhattheyarecurrentlyallowedtocharge.TheamountallocatedisapercentageofthecostofeachCTscanperformedduringxperiodatbothentities;itisnotalumpsum.Importantly,itwasdecidedtosupplementthetwoentitiesfromGovernmentfundsratherthanraisepeopleshealthcarepremiums.MakinghealthcaremoreaffordableisoneofthemostimportantGovernmentinitiatives.TheGovernmentregretstheimpendingclosureofCTservicesattheBrownDarrelClinicbutwishestoassurethepublicthataccesstoCTscanswillbeavailablefromBHB.[Imageremovedbysender.Gvt.Logoemail(300).jpg]CatherineKennedyCommunicationsOfficerGovernmentofBermuda|DepartmentofCommunicationsGlobalHouse,GroundFloor|43ChurchStreet|Hamilton,BermudaHM12Extension:2104DirectTelephone:4412942780|[email protected]:4412925998

1

D'Alessio, Sarah C.

From: Attride-Stirling, JenniferSent: Sunday, January 14, 2018 7:52 PMTo: Kennedy, Catherine L.; Wilson, Kim N.Subject: RE: CT Statement

Yes.PleasereleasefromtheMinisterJAttrideStirling,PhDPermanentSecretary________________________________________From:Kennedy,CatherineL.Sent:Sunday,January14,20187:44PMTo:AttrideStirling,Jennifer;Wilson,KimN.Subject:RE:CTStatementGoodevening,Isthefollowingnowapprovedforrelease?AndisitfromtheMinisterofHealthorMinistryofHealth?Regards,Catherine________________________________________From:AttrideStirling,JenniferSent:January14,20187:17PMTo:Wilson,KimN.Cc:Kennedy,CatherineL.Subject:RE:CTStatementAminortweak,Catherine.PleasecheckfortyposREVISEDDRAFTThenewGovernmenttookstepstomitigatetheimpactofsignificantfeereductionsbythepreviousGovernment.TheBrownDarrellClinic(BDC),BermudaHealthCareServices(BHCS)andtheBermudaHospitalsBoard(BHB)werenegativelyaffectedbythereductioninfeestheywereabletochargeforCTandMRIservices.WhenthecurrentGovernmentcameintooffice,thesituationwasreviewedandseveraloptionswereconsideredtomitigatetheadverseimpactcausedbytheformergovernmentsratereductions.Afterreview,itwasdecidedtosupplementthefeesforMRIandCTservicesperformedatallentitiesfromGovernmentfundsratherthanraiseresidentshealthinsurancepremiumsmidyear.TheGovernmentiscurrentlyreviewingallhealthcarefeesandwillimplementanewfeeschedulein2018.MakinghealthcaremoreaffordablewillcontinuetobeoneofthemostimportantGovernmentinitiatives.TheGovernmentregretstheimpendingendofCTservicesattheBrownDarrellClinicbutwishestoassurethepublicthataccesstoCTscanswillcontinuetobeavailableatBHB.JAttrideStirling,PhDPermanentSecretary________________________________________

2

From:Wilson,KimN.Sent:Sunday,January14,20187:04PMTo:AttrideStirling,JenniferCc:Kennedy,CatherineL.Subject:Fwd:CTStatementSeebelowpleasedoublecheckforpunctuationandspacingTheHon.KimN.Wilson,JP,MPMinisterofHealthGovernmentofBermudaBeginforwardedmessage:From:PremierDavidBurtDate:14January2018at6:59:39PMGMT4To:"Wilson,KimN."Subject:RE:CTStatementThenewGovernmenttookstepstomitigatetheimpactofsignificantfeereductionsbythepreviousGovernment.TheBrownDarrellClinic(BDC),BermudaHealthCareServices(BHCS)andtheBermudaHospitalsBoard(BHB)werenegativelyaffectedbythereductioninfeestheywereabletochargeforCT&MRIservices.WhenthecurrentGovernmentcameintooffice,thesituationwasreviewedandseveraloptionswereconsideredtomitigatetheadverseimpactcausedbytheformergovernmentsratereductions.Afterreview,itwasdecidedtosupplementthefeesforMRI&CTservicesperformedatallentitiesfromGovernmentfundsratherthanraiseresidentshealthinsurancepremiumsmidyear.TheGovernmentiscurrentlyreviewingallhealthcarefeesandwillimplementanewfeescheduleonApril1,2018.MakinghealthcaremoreaffordablewillcontinuetobeoneofthemostimportantGovernmentinitiatives.TheGovernmentregretstheimpendingendofCTservicesattheBrownDarrelClinicbutwishestoassurethepublicthataccesstoCTscanswillcontinuetobeavailableatBHB.From:Wilson,KimN.Sent:Sunday,January14,20186:05PMTo:PremierDavidBurtSubject:Fwd:CTStatementSeebelowTheHon.KimN.Wilson,JP,MPMinisterofHealthGovernmentofBermudaBeginforwardedmessage:From:"AttrideStirling,Jennifer"Date:14January2018at6:01:43PMGMT4To:"Wilson,KimN."Subject:CTStatementMinisterhereisacleandraftstatementforyourconsiderationDRAFTTheGovermenttookstepstomitigatetheimpactoffeereductionsbythepreviousGovernment.BoththeBrownDarrellClinic(BDC)andtheBermudaHospitalsBoard(BHB)werenegativelyaffectedbyadownwardadjustmenttothefees

3

theywereabletochargeforCTandMRIservices.WhenthecurrentGovernmentcameintooffice,thesituationwasreviewedandseveraloptionswereconsideredtomitigatethefinancialimpacttothetwoentities.Importantly,itwasdecidedtosupplementthetwoentitiesfromGovernmentfundsratherthanraisepeopleshealthcarepremiums.MakinghealthcaremoreaffordableisoneofthemostimportantGovernmentinitiatives.TheGovernmentregretstheimpendingclosureofCTservicesattheBrownDarrelClinicbutwishestoassurethepublicthataccesstoCTscanswillcontinuetobeavailableatBHB.Sentfromahandhelddevice.Pleaseexcuseanytypos

1

D'Alessio, Sarah C.

From: Attride-Stirling, JenniferSent: Sunday, January 14, 2018 10:39 PMTo: Alicia Stovell-Washington; curtis. dickinson; Wedderburn, Tawanna V.; Symonds,

VenettaSubject: Fwd: MEDIA STATEMENT:CT/MRI scans

Good day all I'm sure you've heard this issue hitti g the media. FYI Below is the statement we released earlier. Sent from a handheld device. Please excuse any typos -------- Original message -------- Begin forwarded message:

From: Department of Communications Date: 14 January 2018 at 8:53:53 PM GMT-4 Subject: MEDIA STATEMENT:CT/MRI scans

Good evening, members of the media, Please see below a statement from the Minister of Health, the Hon. Kim Wilson, JP, MP regarding the impending closure of the CT scanner at the Brown-Darrell Clinic: The new Government took steps to mitigate the impact of significant fee reductions by the previous Government. The Brown-Darrell Clinic (BDC), Bermuda Health Care Services (BHCS) and the Bermuda Hospitals Board (BHB) were negatively affected by the reduction in fees they were able to charge for CT and MRI services. When the current Government came into office, the situation was reviewed and several options were considered to mitigate the adverse impact caused by the former governments rate reductions. After review, it was decided to supplement the fees for MRI and CT services performed at all entities from Government funds rather than raise residents health insurance premiums mid-year. The Government is currently reviewing all health care fees and will implement a new fee schedule in 2018. Making health care more affordable will continue to be one of the most important Government initiatives. The Government regrets the impending end of CT services at the Brown-Darrell Clinic but wishes to assure the public that access to CT scans will continue to be available at BHB.

ENDS Contact: Catherine Kennedy Email: [email protected]

1

D'Alessio, Sarah C.

From: Attride-Stirling, JenniferSent: Monday, January 15, 2018 9:55 AMTo: Kim N. Wilson ([email protected])Subject: Fact sheet

DRAFT.Letmeknowifthisworks GovernmenthasrecentlygrantedfinancialsupplementstoboththeBrownDarrellClinic(BDC)andtheBermuda

HospitalsBoard(BHB)inordertohelpensureCTandMRIservicesarereadilyavailabletothepublic. BothBDCandBHBwereaffectedunderthepreviousGovernmentbyadownwardadjustmenttothefeestheywere

abletochargeforCTandMRIservices. WhenthecurrentGovernmentcameintooffice,thesituationwasreviewedandseveraloptionswereconsideredto

mitigatethefinanciallossesthetwoentitiesincurred. RevertingtothepreJune2017alldiagnosticimagingfeeswouldhaveledtoanincreaseof$23.03tomonthlyhealth

insurancepremiums,andto$8.6millionadditionalcosttoGovernment.Thiswasnotanacceptableoption.o INFOONLY.MANAGECAREFULLY:RevertingtothepreJune2017foronlyMRI&CTfeeswouldhaveledto

anincreaseof$18.53tomonthlyhealthinsurancepremiums. Severaloptionswereconsideredanditwasdecidedtoadoptthefeesthathadbeenoriginallyrecommendedbased

onthestandardizedrelativevaluemethodology,ratherthanreverttothepreviouslyhighfees.o INFOONLY.MANAGECAREFULLY:BasedonafeeschedulewhichrecommendedthatallBHBfeesbeset

withacostneutralrelativevaluemethod,theprojecteddifference(loss)inrevenuetoeachfacilityisforMRIandCTwas: BHB:$1,863,305.00 BrownDarrellandBermudaHealthCareService:$778,107.08

o ThedifferencerepresenttherevenuethesefacilitieswouldhaveearnediftheBHBfeeshadallbesetin2017usingtherelativevalue,costneutralmethod,ratherthatdecreasingtheratestothecommunityfees.

Toavoidpremiumincreases,theGovernmentdecidedtosupplementthetwoentitiesfromGovernmentfundsratherthanraisepeopleshealthcarepremiums.

o Theamountsbeingpaidarebasedonadjudicatedclaimsforservicesreceivedbypatients. MakinghealthcaremoreaffordableisoneofthemostimportantGovernmentinitiatives.

1

D'Alessio, Sarah C.

From: Attride-Stirling, JenniferSent: Wednesday, January 17, 2018 11:14 AMTo: Kennedy, Catherine L.Cc: Kim N. Wilson ([email protected])Subject: RE: CT Press ReleaseAttachments: CT & MRI Fact Sheet 180117.pdf

CatherineherestherevisedstatementandanewFactSheet(sendthisnotthepreviousversion):The Government has issued the attached fact sheet which factually sets out the rationale for the financial supplements paid to CT and MRI providers to offset the drastic fee cuts of June 2017. From:Kennedy,CatherineL.Sent:Wednesday,January17,201810:55AMTo:AttrideStirling,JenniferSubject:RE:CTPressRelease Noted and standing by.

Catherine

Get Outlook for Android

On Wed, Jan 17, 2018 at 10:51 AM -0400, "Attride-Stirling, Jennifer" wrote:

Dontsendyetplease.ImwaitingforthePremiersapproval Wewontsendtherecording. JAttrideStirling,PhD PermanentSecretary MinistryofHealth From:Kennedy,CatherineL.Sent:Wednesday,January17,201810:49AMTo:AttrideStirling,JenniferSubject:RE:CTPressRelease PS, shall I send the release to you first for approval or just use the paragraph and attachment you provided.

I also recorded the Minister reading our original statement. Would you like me to send that too?

Regards, Catherine


2

On Wed, Jan 17, 2018 at 10:46 AM -0400, "Attride-Stirling, Jennifer" wrote:

Catherineholdthereleaseamoment.ThePremierisreviewingfirst. JAttrideStirling,PhD PermanentSecretary MinistryofHealth From:AttrideStirling,JenniferSent:Wednesday,January17,201810:28AMTo:Kennedy,CatherineL.Cc:KimN.Wilson([email protected])Subject:CTPressRelease HiCatherine ThePremieraskedMinisterWilsontoissueapressreleasewiththeattachedfactsheet.Iproposethereleasemayreadalongtheselines.IunderstanditisinanticipationofapressconferenceDrBrownisholdingtodayattheBrownDarrellClinic: The Government has issued the attached fact sheet regarding financial supplements paid to CT and MRI providers to offset the drastic fee cuts of June 2017.

1

D'Alessio, Sarah C.

From: Attride-Stirling, JenniferSent: Wednesday, January 17, 2018 1:02 PMTo: Wilson, Aderonke B.Cc: Kennedy, Catherine L.Subject: FW: MEDIA CT statements

Importance: High

AderonkethesupplementstatementbelowcangoassoonasCatherinesendstothemediaFrom:AttrideStirling,JenniferSent:Wednesday,January17,201812:54PMTo:Kennedy,CatherineL.Cc:KimN.Wilson([email protected]);Wilson,AderonkeB.Subject:MEDIACTstatementsImportance:HighCatherinetheMinisterwilldoavoiceofthisstatementandbelowistheapprovedsupplementtoallmediaVOICESTATEMENTThesupplementswerepaidfromtheGovernment'sfundssothatpeople'spremiumsdidnotgoup.Atthispointwehaveanestimateofthelikelyexpenditurebutnotthefinalfigureforthefiscalyear.Ifthenumberoftestperformedremainedthesameaslastyear,theBrownDarrellClinicandBermudaHealthCareServiceswouldreceiveapproximately$778thousandandBHB$1.8million.SUPPLEMENTFORALLMEDIA:Theactualpaymentswillbebasedonservicesprovided,thereforetheexactamountsfortheperiodofoperationwillnotbeknownuntiltheendofthefiscalyear.Ifthelevelofservicesremainedthesameaslastyear,BrownDarrellandBermudaHealthCareServiceswouldreceiveapproximately$778thousandandBHB$1.8million.Bermudacurrentlyhas3CTscanners,placingusabovetheOECDaverage,andamongthehighestintheworldforCTscansperperson.

1

D'Alessio, Sarah C.

From: Attride-Stirling, JenniferSent: Wednesday, January 17, 2018 1:05 PMTo: Kennedy, Catherine L.Subject: RE: MEDIA CT statements

Yourproposedwordingisgreat.PleasebccmeagainFrom:AttrideStirling,JenniferSent:Wednesday,January17,20181:03PMTo:Kennedy,CatherineL.Cc:Wilson,KimN.;Wilson,AderonkeB.Subject:RE:MEDIACTstatements ShejustsentitFrom:Kennedy,CatherineL.Sent:Wednesday,January17,20181:02PMTo:AttrideStirling,JenniferCc:Wilson,KimN.;Wilson,AderonkeB.Subject:Re:MEDIACTstatements Thanks, PS,

I'll wait for the voice clip, shall I? I think the optics of three separate statements is unfavorable.

My plan is to say: based on a number of queries, please see here a supplementary statement from the Government and voice clip from the Minister of Health, the Hon. Kim Wilson, JP, MP.

KR, Catherine


From: Attride-Stirling, Jennifer Sent: Wednesday, January 17, 12:54 PM Subject: MEDIA CT statements To: Kennedy, Catherine L. Cc: Wilson, Kim N., Wilson, Aderonke B.

Catherine the Minister will do a voice of this statement and below is the approved supplement to all media VOICE STATEMENT The supplements were paid from the Government's funds so that people's premiums did not go up. At this point we have an estimate of the likely expenditure but not the final figure for the fiscal year. If the number of test performed remained the same as last year, the Brown Darrell Clinic and Bermuda Health Care Services would receive approximately $778 thousand and BHB $1.8 million. SUPPLEMENT FOR ALL MEDIA:

2

The actual payments will be based on services provided, therefore the exact amounts for the period of operation will not be known until the end of the fiscal year. If the level of services remained the same as last year, Brown Darrell and Bermuda Health Care Services would receive approximately $778 thousand and BHB $1.8 million. Bermuda currently has 3 CT scanners, placing us above the OECD average, and among the highest in the world for CT scans per person.

1

D'Alessio, Sarah C.

From: Attride-Stirling, JenniferSent: Wednesday, January 17, 2018 3:02 PMTo: Kennedy, Catherine L.Subject: RE: Re: MEDIA QUERY: fact sheet on financial supplement, CT/MRI scanners

Referhimtopage10oftheactuarialreporthttp://www.bhec.bm/wpcontent/uploads/2017/07/ActuarialReview2016ForPublic1.pdfFrom:Kennedy,CatherineL.Sent:Wednesday,January17,20182:33PMTo:AttrideStirling,JenniferSubject:Fwd:Re:MEDIAQUERY:factsheetonfinancialsupplement,CT/MRIscanners PS, please see the additional question here.

Regards, Catherine


---------- Forwarded message ---------- From: "Ayo Johnson" Date: Wed, Jan 17, 2018 at 2:27 PM -0400 Subject: Re: MEDIA RELEASE: fact sheet on financial supplement, CT/MRI scanners To: "Kennedy, Catherine L."

Thanks. Can you add to the questions an explanation of why insurance premiums would have gone up by $23 if the reimbursements have not been adjusted? a

On 17 Jan 2018, at 11:54 AM, Kennedy, Catherine L. wrote: Good day Ayo,

I've sent your query on.

Thanks, Catherine


On Wed, Jan 17, 2018 at 11:52 AM -0400, "Ayo Johnson" wrote:

2

Morning Catherine: Question: Can you provide a breakdown of the amounts paid to the BHCS, BDC and BHB? Also, what will be the situation/fees going forward? Will the government continue to pay these supplements? Does the ministry consider that the country will be adequately served if Dr Browns services are discontinued? What will be the impact of the recently announced closing of diagnostic services by Brown-Darrell? Ayo

On 17 Jan 2018, at 11:38 AM, Department of Communications wrote:

Good day members of the media, The Government has issued the attached fact sheet which factually sets out the rationale for the financial supplements paid to CT and MRI providers to offset the drastic fee cuts of June 2017. Please see the attachment. _________________________________________ Contact:Communications Officer Catherine Kennedy [email protected] 294 2780

**********************************************************************

This email and its attachments ("email") contains confidential information intended solely for the recipient. Unless you are the recipient, this email cannot be used, copied, stored, printed or disclosed either partially or in its entirety. All copies should be deleted if you have received this email in error. No liability is accepted for damage due to the opening of this email. It is your responsibility to take appropriate precautions to safeguard your computer systems and networks.

**********************************************************************

**********************************************************************


1

D'Alessio, Sarah C.

From: Attride-Stirling, JenniferSent: Friday, January 19, 2018 10:23 AMTo: 'Andrew Simons'Subject: RE: Additional questions on the supplemental fees paid for MRI and CT services in

excess of the diagnostic imaging fee schedule?

thanksFrom:AndrewSimons[mailto: Sent:Friday,January19,201810:21AMTo:AttrideStirling,JenniferSubject:Re:AdditionalquestionsonthesupplementalfeespaidforMRIandCTservicesinexcessofthediagnosticimagingfeeschedule? Certainly. My mailing address is: Andrew Simons

Bermuda Thanks, Andrew On Fri, Jan 19, 2018 at 10:02 AM, Attride-Stirling, Jennifer wrote:

Andrewwewillprovidetheresponsesbyemailshortly,butcanIhaveamailingaddressfortheformalresponse,please?

JAttrideStirling,PhD

PermanentSecretary

MinistryofHealth

From:AttrideStirling,JenniferSent:Wednesday,January17,20188:06PMTo:'AndrewSimons' Cc:[email protected];JeanneAtherden;KimN.Wilson([email protected])Subject:RE:AdditionalquestionsonthesupplementalfeespaidforMRIandCTservicesinexcessofthediagnosticimagingfeeschedule?

2

DearAndrew,Senator

Itakenoteofyourquestionsand,asusualforaqueryofthisnature,willrespondviatheMinisterinduecourse.Pleasegiveusamomenttoprepareaformalresponse.

Jennifer

JAttrideStirling,PhD

PermanentSecretary

GovernmentofBermuda|MinistryofHealth

ContinentalBuilding|25ChurchStreet|HamiltonHM12

P.O.BoxHM380|HamiltonHMBX,Bermuda

MinistryTelephone:4412784900|Email:[email protected]

From:AndrewSimons[mailto Sent:Wednesday,January17,20183:02PMTo:AttrideStirling,JenniferCc:[email protected];JeanneAtherdenSubject:AdditionalquestionsonthesupplementalfeespaidforMRIandCTservicesinexcessofthediagnosticimagingfeeschedule?

Dear Dr. Attride-Stirling,

I write as the opposition spokesperson for health in the Senate.

I have just seen the _CT and MRI Fees Fact Sheet_ published by DCI. Could you provide further details, specifically:

1. For each affected CPT code:

3

o CPT code short description

o 2016-2017 DI fee

o 2017-2018 DI fee

o New supplemented fee ("Technical Recommended Fee")

2. When did this arrangement start?

3. How much has been paid thusfar to:

o Bermuda Hospitals Board o Brown-Darrell Clinic o Bermuda Health Care Services

4. What is the estimated total cost to taxpayers of these supplemental fees to the end of March 31, 2018?

5. Where in Government will the funding for the special payments come from?

o If money was paid from funds managed by the Health Insurance Department, were those payments approved by the Health Insurance Committee?

o Can you provide the minutes from those meetings?

6. What is the legal mechanism by which funds have been paid to a community provider?

7. Could you clarify whether claims paid by private insurers will be supplemented by government funds or just those paid by public plans?

8. The recent press release implies that the "technical recommended fee" is "what these facilities would have earned if all BHB fees had been set using the recommended fees (relative value, cost-neutral method)". Why are BHB fees referenced as the technical recommended fee for the community providers (Brown-Darrell Clinic and Bermuda Health Care Services)?

9. Is there a mechanism by which other diagnostic imaging providers (or SHB approved providers) can appeal the approved reimbursement rates and seek government support?

Regards,

Senator Andrew Simons

--

mobile:

**********************************************************************

4


**********************************************************************

-- mobile:

1

D'Alessio, Sarah C.

From: Attride-Stirling, JenniferSent: Saturday, January 20, 2018 10:38 AMTo: Wedderburn, Tawanna V.; Brathwaite, Ricky C.Subject: Fwd: Additional questions on the supplemental fees paid for MRI and CT services in

excess of the diagnostic imaging fee schedule?Attachments: 180119 Responses to Senator Simons.pdf; MRI CT Analysis Comp Differences Query

180118.xlsx

Sorry I didn't get to send this yesterday bit here are the responses to Senator Simons. Tawanna - I don't have the board's emails at hand but I'd be grateful if you could circulate it to the board. Feel free to share with your staff too, in confidence of course Sent from a handheld device. Please excuse any typos -------- Original message -------- From: "Attride-Stirling, Jennifer" Date: 19/01/2018 11:53 am (GMT-04:00) To: Andrew Simons Cc: [email protected], Jeanne Atherden , "Kim N. Wilson ([email protected])" Subject: RE: Additional questions on the supplemental fees paid for MRI and CT services in excess of the diagnostic imaging fee schedule? Goodday, KindlyfindattachedtheresponseonbehalfofMinisterWilson.

JAttrideStirling,PhD PermanentSecretary GovernmentofBermuda|MinistryofHealth ContinentalBuilding|25ChurchStreet|HamiltonHM12 P.O.BoxHM380|HamiltonHMBX,Bermuda MinistryTelephone:4412784900|Email:[email protected]

From:AndrewSimons[mailto: Sent:Wednesday,January17,20183:02PMTo:AttrideStirling,JenniferCc:[email protected];JeanneAtherdenSubject:AdditionalquestionsonthesupplementalfeespaidforMRIandCTservicesinexcessofthediagnosticimagingfeeschedule? Dear Dr. Attride-Stirling, I write as the opposition spokesperson for health in the Senate.

2

I have just seen the _CT and MRI Fees Fact Sheet_ published by DCI. Could you provide further details, specifically:

1. For each affected CPT code: o CPT code short description o 2016-2017 DI fee o 2017-2018 DI fee o New supplemented fee ("Technical Recommended Fee")


3. How much has been paid thusfar to: o Bermuda Hospitals Board o Brown-Darrell Clinic o Bermuda Health Care Services

4. What is the estimated total cost to taxpayers of these supplemental fees to the end of March 31, 2018?

5. Where in Government will the funding for the special payments come from? o If money was paid from funds managed by the Health Insurance Department, were those

payments approved by the Health Insurance Committee? o Can you provide the minutes from those meetings?

6. What is the legal mechanism by which funds have been paid to a community provider?

7. Could you clarify whether claims paid by private insurers will be supplemented by government funds or just those paid by public plans?

8. The recent press release implies that the "technical recommended fee" is "what these facilities would have earned if all BHB fees had been set using the recommended fees (relative value, cost-neutral method)". Why are BHB fees referenced as the technical recommended fee for the community providers (Brown-Darrell Clinic and Bermuda Health Care Services)?

9. Is there a mechanism by which other diagnostic imaging providers (or SHB approved providers) can appeal the approved reimbursement rates and seek government support?

Regards, Senator Andrew Simons -- mobile:

19th January 2018 Senator Andrew Simons

Bermuda BY EMAIL TO: CC: [email protected]; Jeanne Atherden Dear Senator Simons RE: Additional questions on the supplemental fees paid for MRI and CT services in excess of the diagnostic imaging fee schedule Further to your email request of 17th January 2018, please find below responses to your questions on the above on behalf of the Minister of Health. Yours sincerely

RESPONSES 1. For each affected CPT code:

a) CPT code short description b) 2016-2017 DI fee c) 2017-2018 DI fee d) New supplemented fee ("Technical Recommended Fee")

RESPONSE: See attached spreadsheet. The supplemented fee is column G.


RESPONSE: The agreement was reached on 8th December 2017. 3. How much has been paid thus far to:

a) Bermuda Hospitals Board - The payment transaction is being processed at present b) Brown-Darrell Clinic - $120,000 c) Bermuda Health Care Services - $480,000
mailto:[email protected]

2

4. What is the estimated total cost to taxpayers of these supplemental fees to the end of

March 31, 2018?

RESPONSE: The amount estimated on the basis of the prior years utilization was $778,000 to Brown Darrell and Bermuda Health Care Services and $1.8 million to BHB.

5. Where in Government will the funding for the special payments come from?

RESPONSE: Supplementary funding.

a) If money was paid from funds managed by the Health Insurance Department, were those payments approved by the Health Insurance Committee?

RESPONSE: They were not paid from funds overseen by HIC.

b) Can you provide the minutes from those meetings?

RESPONSE: Not applicable. 6. What is the legal mechanism by which funds have been paid to a community provider?

RESPONSE: Cabinet Decision and Section 3 of the Public Treasury (Administration and Payments) Act 1969 which directs that a Minister of Finance can direct a public officer in respect of the custody and handling of the payment of public monies.

7. Could you clarify whether claims paid by private insurers will be supplemented by

government funds or just those paid by public plans?

RESPONSE: Yes. It will cover claims paid by all insurers. 8. The recent press release implies that the "technical recommended fee" is "what these

facilities would have earned if all BHB fees had been set using the recommended fees (relative value, cost-neutral method)". Why are BHB fees referenced as the technical recommended fee for the community providers (Brown-Darrell Clinic and Bermuda Health Care Services)?

RESPONSE: Because Brown Darrells and Bermuda Health Care Services fees for CT and MRI have been historically tied to BHB fees. Therefore, changes to the BHB fee schedule roll over to these two providers.

9. Is there a mechanism by which other diagnostic imaging providers (or SHB approved

providers) can appeal the approved reimbursement rates and seek government support?

RESPONSE: This was an extraordinary case that required this specific intervention. There is no precedent of this experience and it is not expected to occur again.

MRI & CT FEES ANALYSIS - COMPARISON OF 2017/18 VS RVU-BASED FEES

CPT Adj OUT-PATIENT TREATMENT

Past Year

2016/17

Current Year

2017/18

RVU Price at

CF 111.49

Difference

bet 2017/18

vs RVU

70450 CT HEAD LIMITED STUDY 1,642.00$ 275.00$ 365.70$ 90.70

70450 CT HEAD WITHOUT CONTRAST 1,642.00$ 275.00$ 365.70$ 90.70

70460 CT HEAD WITH CONTRAST 1,642.00$ 383.00$ 510.64$ 127.64

70470 CT HEAD WITH/WITHOUT CONT 1,642.00$ 454.00$ 604.29$ 150.29

70480 CT HEAD/IAMS WITHOUT CONT 1,642.00$ 551.00$ 733.62$ 182.62

70480 CT MASTOIDS WITHOUT CONTR 1,642.00$ 551.00$ 733.62$ 182.62

70480 CT ORBITS WITHOUT CONTRST 1,642.00$ 551.00$ 733.62$ 182.62

70480 CT PITUITARY WITHOUT CONT 1,642.00$ 551.00$ 733.62$ 182.62

70481 CT HEAD/IAMS WITH CONTRAS 1,642.00$ 651.00$ 867.41$ 216.41

70481 CT MASTOIDS WITH CONTRAST 1,642.00$ 651.00$ 867.41$ 216.41

70481 CT ORBITS WITH CONTRAST 1,642.00$ 651.00$ 867.41$ 216.41

70481 CT PITUITARY WITH CONTRST 1,642.00$ 651.00$ 867.41$ 216.41

70482 CT HEAD/IAMS W/WO CONTRAS 1,642.00$ 711.00$ 946.57$ 235.57

70482 CT MASTOIDS W/WO CONTRAST 1,642.00$ 711.00$ 946.57$ 235.57

70482 CT ORBITS WITH WITHOUT CO 1,642.00$ 711.00$ 946.57$ 235.57

70482 CT PITUITARY W AND WO CON 1,642.00$ 711.00$ 946.57$ 235.57

70486 CT FACIAL BONES WITHOUT C 1,642.00$ 329.00$ 438.17$ 109.17

70486 CT SINUSES WITHOUT CONTRA 1,642.00$ 329.00$ 438.17$ 109.17

70487 CT FACIAL BONES WITH CONT 1,642.00$ 396.00$ 527.36$ 131.36

70488 CT FACIAL BONES W/WO CONT 1,642.00$ 483.00$ 643.31$ 160.31

70490 CT NECK WITHOUT CONTRAST 1,642.00$ 456.00$ 607.64$ 151.64

70491 CT NECK WITH CONTRAST 1,642.00$ 557.00$ 741.43$ 184.43

70492 CT NECK WITH WITHOUT CONT 1,642.00$ 656.00$ 874.10$ 218.10

70496 CT ANGIO HEAD WITH CONTR 1,642.00$ 693.00$ 923.16$ 230.16

70498 CT ANGIO NECK WITH CONTR 1,642.00$ 691.00$ 920.93$ 229.93

70540 MR -ORBIT FACE NECK W/O C 1,642.00$ 714.00$ 951.03$ 237.03

70542 MR -ORBIT FACE NCK W/CONT 1,642.00$ 802.00$ 1,068.10$ 266.10

70543 MR -ORBIT FACE NCK W&W/O 1,642.00$ 984.00$ 1,311.16$ 327.16

70544 MR -MRA HEAD W/O CONTRAST 1,642.00$ 927.00$ 1,234.23$ 307.23

70545 MR -MRA HEAD W/CONTRAST 1,642.00$ 917.00$ 1,221.96$ 304.96

70546 MR -MRA HEAD W&W/O CONTRA 1,642.00$ 1,414.00$ 1,883.11$ 469.11

70547 MR -MRA NECK W/O CONTRAST 1,642.00$ 931.00$ 1,239.80$ 308.80

70548 MR -MRA NECK W/CONTRAST 1,642.00$ 976.00$ 1,300.01$ 324.01

70549 MR -MRA NECK W&W/O CONTRA 1,642.00$ 1,422.00$ 1,894.26$ 472.26

70551 MR -BRAIN W/O CONTRAST 1,642.00$ 546.00$ 726.93$ 180.93

70552 MR -BRAIN W/CONTRAST 1,642.00$ 757.00$ 1,007.90$ 250.90

70553 MR -BRAIN W&W/O CONTRAST 1,642.00$ 892.00$ 1,188.51$ 296.51

71250 CT CHEST LIMITED STUDY 1,642.00$ 427.00$ 568.61$ 141.61

71250 CT HI-RES CHEST 1,642.00$ 427.00$ 568.61$ 141.61

71250 CT CHEST WITHOUT CONTRAST 1,642.00$ 427.00$ 568.61$ 141.61

71260 CT CHEST WITH CONTRAST 1,642.00$ 542.00$ 722.47$ 180.47

71270 CT CHEST WITH/WITHOUT CON 1,642.00$ 650.00$ 865.18$ 215.18

71275 CT -ANGIO CHEST W&W/O CON 1,642.00$ 710.00$ 945.46$ 235.46

71275 CT ANGIO CHEST WITH CONTR 1,642.00$ 710.00$ 945.46$ 235.46

71550 MR -CHEST W/O CONTRAST 1,642.00$ 981.00$ 1,306.70$ 325.70

71551 MR -CHEST W/CONTRAST 1,642.00$ 1,091.00$ 1,452.75$ 361.75

71552 MR -CHEST W&W/O CONTRAST 1,642.00$ 1,369.00$ 1,824.02$ 455.02

72125 CT C-SPINE POST MYELOGRAM 1,098.00$ 437.00$ 581.99$ 144.99

72125 CT C-SPINE WITHOUT CONTRA 1,098.00$ 437.00$ 581.99$ 144.99

72126 CT C-SPINE WITH CONTRAST 1,455.00$ 540.00$ 719.13$ 179.13

72127 CT C-SPINE WWO CONTRAST 2,734.00$ 638.00$ 849.58$ 211.58

72131 CT L-SPINE POST MYELOGRAM 1,098.00$ 425.00$ 566.38$ 141.38

72131 CT L-SPINE WITHOUT CONTRA 1,545.00$ 425.00$ 566.38$ 141.38

72132 CT L-SPINE WITH CONTRAST 2,734.00$ 539.00$ 718.01$ 179.01

72133 CT L-SPINE W/WO CONTRAST 1,098.00$ 637.00$ 848.46$ 211.46

72141 MR -SPINE CERV W/O CONTRA 1,545.00$ 531.00$ 706.86$ 175.86

72142 MR -SPINE CERV W/CONTRAST 2,734.00$ 768.00$ 1,023.50$ 255.50

72146 MR -SPINE THOR W/O CONTRA 1,098.00$ 531.00$ 707.98$ 176.98

72147 MR -SPINE THOR W/CONTRAST 1,545.00$ 763.00$ 1,016.81$ 253.81

72148 MR -SPINE LUMB W/O CONTRA 2,734.00$ 529.00$ 704.63$ 175.63

72149 MR -SPINE LUMB W/CONTRAST 1,098.00$ 760.00$ 1,012.36$ 252.36

72156 MR -SPINE CERV W&W/O CONT 1,545.00$ 898.00$ 1,196.32$ 298.32

72157 MR -SPINE THOR W&W/O CONT 2,734.00$ 900.00$ 1,198.55$ 298.55

72158 MR -SPINE LUMB W&W/O CONT 1,098.00$ 895.00$ 1,191.86$ 296.86

72159 MR-MRA SPINAL W OR W/O CN 1,455.00$ 983.00$ 1,310.04$ 327.04

72191 CT ANGIO PELVIS WITH CONT 2,734.00$ 723.00$ 963.30$ 240.30

72192 CT PELVIS LIMITED STUDY 1,098.00$ 346.00$ 460.47$ 114.47

72192 CT PELVIS WITHOUT CONTRST 1,201.00$ 346.00$ 460.47$ 114.47

72193 CT PELVIS WITH CONTRAST 1,558.00$ 534.00$ 711.32$ 177.32

72194 CT PELVIS WITH WITHOUT CO 2,891.00$ 614.00$ 818.36$ 204.36

72195 MR -PELVIS W/O CONTRAST 1,201.00$ 886.00$ 1,180.71$ 294.71

72196 MR -PELVIS W/CONTRAST 1,201.00$ 970.00$ 1,292.20$ 322.20

72197 MR -PELVIS W&W/O CONTRAST 1,201.00$ 1,194.00$ 1,591.00$ 397.00

72198 MR-MRA PELVIS W OR W/O CO 1,558.00$ 948.00$ 1,263.21$ 315.21

73200 CT UPPER EXTREMITY WO CON 2,891.00$ 424.00$ 565.27$ 141.27

73201 CT UP EXTRM W/WO CONT W/W 2,891.00$ 526.00$ 700.18$ 174.18

73201 CT GUIDANCE W/WO CONTRAST W/WO DYE 1,201.00$ 526.00$ 700.18$ 174.18

73202 CT UPPER EXTREM WWO CONT 1,201.00$ 655.00$ 871.87$ 216.87

73206 CT ANGIO UPPER EXT W CONT 1,558.00$ 776.00$ 1,033.54$ 257.54

73218 MR -UP EXT NONJT W/O CONT 2,891.00$ 863.00$ 1,149.49$ 286.49

73219 MR -UP EXT NONJT W/CONTRA 1,201.00$ 949.00$ 1,264.33$ 315.33

73220 MR -UP EXT NONJT W&W/O CO 1,201.00$ 1,181.00$ 1,573.16$ 392.16

73221 MR -UP EXT JT W/O CONTRAS 1,558.00$ 561.00$ 747.00$ 186.00

73222 MR -UP EXT JT W/CONTRAST 2,891.00$ 893.00$ 1,189.63$ 296.63

73223 MR -UP EXT JT W&W/O CONTR 1,201.00$ 1,111.00$ 1,479.51$ 368.51

73225 MR-MRA UP EXTR W OR W/O C 1,201.00$ 966.00$ 1,286.63$ 320.63

73700 CT LOWER EXTRE WO CONTRAS 1,558.00$ 425.00$ 566.38$ 141.38

73701 CT LOWER EXTREM WITH CONT 2,891.00$ 534.00$ 711.32$ 177.32

73702 CT LOWER EXTREM W/WO CONT 1,201.00$ 647.00$ 861.84$ 214.84

73706 CT ANGIO LOWER EXT W CONT 1,201.00$ 840.00$ 1,119.39$ 279.39

73718 MR -LOW EXT NONJT W/O CON 1,558.00$ 861.00$ 1,147.26$ 286.26

73719 MR -LOW EXT NONJT W/CONTR 2,891.00$ 957.00$ 1,274.36$ 317.36

73720 MR -LOW EXT NONJT W&W/O C 768.00$ 1,187.00$ 1,580.97$ 393.97

73721 MR -LOW EXT JNT W/O CONTR 1,201.00$ 560.00$ 745.89$ 185.89

73722 MR -LOW EXT JNT W/CONTRAS 1,558.00$ 901.00$ 1,199.66$ 298.66

73723 MR -LOW EXT JNT W&W/O CON 2,891.00$ 1,112.00$ 1,480.63$ 368.63

73725 MR-MRA LOW EXTR W OR WO C 1,201.00$ 948.00$ 1,263.21$ 315.21

74150 CT ABDOMEN LIMITED SCAN 1,558.00$ 354.00$ 471.61$ 117.61

74150 CT ABDO WITHOUT CONTRAST 1,098.00$ 354.00$ 471.61$ 117.61

74160 CT ABDO WITH CONTRAST 768.00$ 546.00$ 726.93$ 180.93

74170 CT ABDO WITH WITHOUT CONT 768.00$ 620.00$ 826.16$ 206.16

74175 CT ANGIO ABDOMEN W CONTRS 768.00$ 726.00$ 966.64$ 240.64

74175 CT -ANGIO ABDO W&W/O CONT 768.00$ 726.00$ 966.64$ 240.64

74176 CT ABDOMEN & PELVIS 768.00$ 475.00$ 633.28$ 158.28

74177 CT ABDOMEN & PELVIS W/CONTRAST 768.00$ 736.00$ 980.02$ 244.02

74178 CT ABDOMEN & PELVIS 1/>REGNS 768.00$ 835.00$ 1,112.70$ 277.70

74181 MR -ABDOMEN W/O CONTRAST 839.00$ 786.00$ 1,046.92$ 260.92

74182 MR -ABDOMEN W/CONTRAST 1,922.00$ 1,074.00$ 1,430.45$ 356.45

74183 MR -ABDOMEN W&W/O CONTRAS 1,922.00$ 1,197.00$ 1,594.35$ 397.35

74185 MR-MRA ABDOMEN W OR W/O C 2,038.00$ 953.00$ 1,268.79$ 315.79

75571 CT HEART W/O CONT, W/O DYE QUAL CAL 1,201.00$ 239.00$ 317.75$ 78.75

75574 CT HEART W/CONT CCTA W/WO STRXR QUA 1,558.00$ 995.00$ 1,325.65$ 330.65

75574 CT HEART W/CONT, HEART FUNC ADD ON 2,891.00$ 995.00$ 1,325.65$ 330.65

1

D'Alessio, Sarah C.

From: Attride-Stirling, JenniferSent: Tuesday, January 23, 2018 4:33 PMTo: Kennedy, Catherine L.Subject: RE: MEDIA QUERY: BDC settlement

Thanks. I watched the programme yesterday so I will get to the answers and get approval tonight and have a response by the morning J Attride-Stirling, PhD Permanent Secretary

From: Kennedy, Catherine L. Sent: Tuesday, January 23, 2018 4:31 PM To: Attride-Stirling, Jennifer Subject: RE: MEDIA QUERY: BDC settlement

Hello, IjustheardfromPatBurchallthatsheisworkingonthestoryandhopestogetitfinalisedtomorrow.ItoldJeremyandPatthatIwasnotcertainIcouldgetaresponsetoday.soallgood. Regards,Catherine From:AttrideStirling,JenniferSent:Tuesday,January23,20184:30PMTo:Kennedy,CatherineL.Subject:RE:MEDIAQUERY:BDCsettlement I'm in a board meeting now. I can get to this in the evening. Does Jeremy have a deadline? J Attride-Stirling, PhD Permanent Secretary

From: Kennedy, Catherine L. Sent: Tuesday, January 23, 2018 4:13 PM To: Attride-Stirling, Jennifer Subject: MEDIA QUERY: BDC settlement

HelloPS, Incaseyouwishtoviewtheshorterversion.Notetheninequestionsbelow.IhavenotcopiedtheMinisterassheisinCabinet. Regards,Catherine From:PatriciaBurchall Sent:Tuesday,January23,20184:08PM

2

To:JeremyDeacon Cc:Kennedy,CatherineL.Subject:Re:BDCsettlement Hi, shorter video here [working on story now] its like 12 mins in.....bit he talks about "court action pending" https://www.youtube.com/watch?v=DvRuvCdrQ0I On Tue, Jan 23, 2018 at 3:48 PM, Jeremy Deacon wrote: Good afternoon, As you may be aware, I interviewed Dr Ewart Brown yesterday (http://bernews.com/2018/01/live-video-interview-dr-ewart-brown/) and one of the subjects was the issue existing with the Brown Darrell clinic. During the interview and with reference to the $778,000 grant given to the BDC by the Government, Dr Brown said this: It was called a grant, it was a settlement in the sense there was court action pending from EB against the Health Council, and we agreed to withdraw that action. The court case was about this unfair targeting that we say we experienced from the Health Council. We say that the lapsing of time and exchange of emails does not necessarily constitute consultation. Real consultation would have put me across the table at least once. I would like to ask some questions to follow up on this:

1. Can you confirm that Ewart Brown/Brown Darrell clinic had threatened/sought to take legal action over the level of consultation re the payments for MRIs and CT scans.

2. When was this action threatened? 3. Was Government advised by counsel/the AG to settle this case before it reached court? 4. Why was it settled? 5. Dr Brown suggests that Government settled this case without going to court by giving the $778,000, is

that correct? 6. Is this a one-off payment or were terms agreed whereby there would be follow-up payments 7. Who decided the payment and on what the amount based on 8. Have other medical practices threatened legal/are threatening legal action over the levels of consultation 9. The Minister has said that a review of fees is on-going

If there is anything else you would like to address, please do feel free! Cheers jeremy

1

D'Alessio, Sarah C.

From: Attride-Stirling, JenniferSent: Tuesday, January 23, 2018 9:35 PMTo: Wilson, Kim N.Cc: Kennedy, Catherine L.; Attride-Stirling, JenniferSubject: RE: MEDIA QUERY: BDC settlement

Minister - Here are draft responses for Bernews/Jeremy Deacon for your review and approval: 1. Can you confirm that Ewart Brown/Brown Darrell clinic had threatened/sought to take legal action over the level of consultation re the payments for MRIs and CT scans. The Ministry can confirm that a letter before action was received in relation to the fee levels. However, as the matter was settled via legal counsel, details about the particulars of the action will not provided. 2. When was this action threatened? The letter before action was received on ... XX October 2017 3. Was Government advised by counsel/the AG to settle this case before it reached court? No. 4. Why was it settled? On reviewing the history and background the Government determined that the fee levels set by the previous Government had been excessively low. The fees could not be reversed as that would have resulted in premium increases mid-year. Instead, the Government determined that to avoid premium increases, it would award a special financial grant to the three facilities affected to mitigate the impact of the low fees for MRI and CT; namely, the Brown Darrell Clinic, Bermuda Health Care Services and the Bermuda Hospital Board. 5. Dr Brown suggests that Government settled this case without going to court by giving the $778,000, is that correct? The $778,000 figure is an estimate based on the 2016/17 utilisation. If the same number of MRI and CT procedures were done this year, the total payment would be of that amount. However, the amount being paid is based on actual claims for procedures performed, so the final figure will not be known until the end of the fiscal year. 6. Is this a one-off payment or were terms agreed whereby there would be follow-up payments Per above, terms were agreed. 7. Who decided the payment and on what the amount based on The payment format was approved by Cabinet, based on the relative value method to determine the fee levels. 8. Have other medical practices threatened legal/are threatening legal action over the levels of consultation One other practice joined Dr Brown in the letter before action. There was no grounds to that claim. 9. The Minister has said that a review of fees is on-going Yes. The BHB fee schedule is being revised to apply a rational, transparent relative value method to all fees. J Attride-Stirling, PhD Permanent Secretary

2


HelloPS, Incaseyouwishtoviewtheshorterversion.Notetheninequestionsbelow.IhavenotcopiedtheMinisterassheisinCabinet. Regards,Catherine From:PatriciaBurchall[mailto: Sent:Tuesday,January23,20184:08PMTo:JeremyDeacon Cc:Kennedy,CatherineL.Subject:Re:BDCsettlement Hi, shorter video here [working on story now] its like 12 mins in.....bit he talks about "court action pending" https://www.youtube.com/watch?v=DvRuvCdrQ0I On Tue, Jan 23, 2018 at 3:48 PM, Jeremy Deacon > wrote: Good afternoon, As you may be aware, I interviewed Dr Ewart Brown yesterday (http://bernews.com/2018/01/live-video-interview-dr-ewart-brown/) and one of the subjects was the issue existing with the Brown Darrell clinic. During the interview and with reference to the $778,000 grant given to the BDC by the Government, Dr Brown said this: It was called a grant, it was a settlement in the sense there was court action pending from EB against the Health Council, and we agreed to withdraw that action. The court case was about this unfair targeting that we say we experienced from the Health Council. We say that the lapsing of time and exchange of emails does not necessarily constitute consultation. Real consultation would have put me across the table at least once. I would like to ask some questions to follow up on this:




3


-- --------------------------------------------------------------------- Patricia Burchall Bernews | Videos | Facebook | Twitter | Instagram 2017 Best Of Bermuda Award Winner for 'Best Source Of Local News & Information'

1

D'Alessio, Sarah C.

From: Attride-Stirling, JenniferSent: Wednesday, January 24, 2018 11:42 AMTo: Kennedy, Catherine L.Subject: Re: MEDIA QUERY: BDC settlement

Yes please Sent from a handheld device. Please excuse any typos -------- Original message -------- From: "Kennedy, Catherine L." Date: 24/01/2018 10:49 am (GMT-04:00) To: "Attride-Stirling, Jennifer" Subject: RE: MEDIA QUERY: BDC settlement HelloPS, JustreleasingshouldthisbefromaMinistryofHealthspokesperson? Regards,Catherine From:AttrideStirling,JenniferSent:Wednesday,January24,20188:50AMTo:Kennedy,CatherineL.Cc:Wilson,KimN.;Simmons,Kathy(AttorneyGeneral)Subject:RE:MEDIAQUERY:BDCsettlement CatherineTheMinisterapprovedtheseresponses.PleaseholdhimoffonaninterviewwithJeremy.Thatcanbeconsideredatalaterdate. 1. Can you confirm that Ewart Brown/Brown Darrell clinic had threatened/sought to take legal action over the level of consultation re the payments for MRIs and CT scans. The Ministry can confirm that a letter before action was received in relation to the fee levels. However, as the matter was settled via legal counsel, details about the particulars of the action will not provided. 2. When was this action threatened? The letter before action is dated 3rd October 2017 3. Was Government advised by counsel/the AG to settle this case before it reached court? No. 4. Why was it settled? On reviewing the history and background the Government determined that the fee levels set by the previous Government had been excessively low. The fees could not be reversed as that would have resulted in premium

2

increases mid-year. Instead, the Government determined that to avoid premium increases, it would award a special financial grant to the three facilities affected to mitigate the impact of the low fees for MRI and CT; namely, the Brown Darrell Clinic, Bermuda Health Care Services and the Bermuda Hospital Board. 5. Dr Brown suggests that Government settled this case without going to court by giving the $778,000, is that correct? As stated above, the Government decided that, to avoid premium increases mid-year, a special financial grant would be provided. This was agreed on the condition that the letter before action would be withdrawn. The $778,000 figure is an estimate based on the 2016/17 utilisation. If the same number of MRI and CT procedures were done this year, the total payment would be of that amount. However, the amount being paid is based on actual claims for procedures performed, so the final figure will not be known until the end of the fiscal year. 6. Is this a one-off payment or were terms agreed whereby there would be follow-up payments Per above, terms were agreed. 7. Who decided the payment and on what the amount based on The Cabinet considered all options, and decided on the payment and method to be applied, based on the relative value method to determine the fee levels. 8. Have other medical practices threatened legal/are threatening legal action over the levels of consultation One other practice joined Dr Brown in the letter before action. There was no grounds to that claim. 9. The Minister has said that a review of fees is on-going Yes. The BHB fee schedule is being revised to apply a rational, transparent relative value method to all fees. J Attride-Stirling, PhD Permanent Secretary


HelloPS, Incaseyouwishtoviewtheshorterversion.Notetheninequestionsbelow.IhavenotcopiedtheMinisterassheisinCabinet. Regards,Catherine From:PatriciaBurchall[mailto: Sent:Tuesday,January23,20184:08PMTo:JeremyDeacon Cc:Kennedy,CatherineL.Subject:Re:BDCsettlement Hi, shorter video here [working on story now] its like 12 mins in.....bit he talks about "court action pending" https://www.youtube.com/watch?v=DvRuvCdrQ0I On Tue, Jan 23, 2018 at 3:48 PM, Jeremy Deacon wrote: Good afternoon,

3

As you may be aware, I interviewed Dr Ewart Brown yesterday (http://bernews.com/2018/01/live-video-interview-dr-ewart-brown/) and one of the subjects was the issue existing with the Brown Darrell clinic. During the interview and with reference to the $778,000 grant given to the BDC by the Government, Dr Brown said this: It was called a grant, it was a settlement in the sense there was court action pending from EB against the Health Council, and we agreed to withdraw that action. The court case was about this unfair targeting that we say we experienced from the Health Council. We say that the lapsing of time and exchange of emails does not necessarily constitute consultation. Real consultation would have put me across the table at least once. I would like to ask some questions to follow up on this:





-- --------------------------------------------------------------------- Patricia Burchall Bernews | Videos | Facebook | Twitter | Instagram 2017 Best Of Bermuda Award Winner for 'Best Source Of Local News & Information'

1

D'Alessio, Sarah C.

From: Attride-Stirling, JenniferSent: Wednesday, February 14, 2018 8:25 AMTo: Kennedy, Catherine L.Subject: FW: MEdia Query: Health query over diagnostic fees

CatherineHereistheresponseapprovedforJonathanattheRG:RESPONSE:TheMinistryofHealthreceivedaletterbeforeactioninOctober2017pertainingtojudicialreviewoftheBermudaHospitalsBoard(HospitalFees)AmendmentRegulations2017,withrespecttothereductioninfeeschargeablefordiagnosticimagingunderstandardhealthbenefit(SHB).Severalpartieswereinvolvedandthematterwasresolvedwithoutlegalproceedings.Asitwasalegalmatter,therewillbenofurtherdetailsprovided.From:Wilson,KimN.Sent:Tuesday,February13,20188:38PMTo:AttrideStirling,JenniferSubject:Re:MEdiaQuery:Healthqueryoverdiagnosticfees

TheHon.KimN.Wilson,JP,MPMinisterofHealthGovernmentofBermudaOn13Feb2018,at2:47PM,AttrideStirling,Jenniferwrote:

MinisterTheRGcamebackwithanotherquestion,followingtodaysstory.Isthisresponseokforyou?QUERY:CouldweclarifywhethertheGovernmentfeltitwasatriskoflegalactionoverthefeecutstodiagnosticimaging:RESPONSE:TheMinistryofHealthreceivedaletterbeforeactioninOctober2017pertainingtojudicialreviewoftheBermudaHospitalsBoard(HospitalFees)AmendmentRegulations2017,withrespecttothereductioninfeeschargeablefordiagnosticimagingunderstandardhealthbenefit(SHB).Severalpartieswereinvolvedandthematterwasresolvedwithoutlegalproceedings.Asitwasalegalmatter,therewillbenofurtherdetailsprovided.From:Kennedy,CatherineL.Sent:Tuesday,February13,20182:28PMTo:AttrideStirling,JenniferSubject:MEdiaQuery:HealthqueryoverdiagnosticfeesFYI,PSCatherine

2

From:JonathanBell[mailto:[email protected]]Sent:Tuesday,February13,20181:30PMTo:Kennedy,CatherineL.Subject:HealthqueryoverdiagnosticfeesCatherine,goodafternoonIcouldseerightawayyesterdaythattheMinisterwasgoingtobetoobusy;perhapswecanrenewyesterdaysquestion?Idontwanttopileontoomuch,butintodaysarticlewegotsomeextradetailsfromFridaysHansard,andIthinkitsonlyfairtoputinanadditionalqueryjustforclarification.ItappearsthattheministerissuggestingtherewassomesortoflegalthreattotheGovernment,butitsnotexactlyclear.CouldweclarifywhethertheGovernmentfeltitwasatriskoflegalactionoverthefeecutstodiagnosticimaging:thequoteisjustbelow:

He said [Trevor Moniz] he had asked the minister whether the Progressive Labour Party administration had been threatened with legal action.

Ms Wilson responded: Prior to this agreement being settled on December 8, 2017, there were discussions taking place between the Government and the Attorney-General.

Illbearounduntil7pmatleast;wedbegratefulforanyclarification.Cheers,

Jonathan Bell Senior Reporter D 441 278-0153 M 441 595-0151 [email protected] www.royalgazette.com 2 Par-la-

Ville Road, Hamilton HM08 T 441 295-5881 F 441 292-2498

Visit www.royalgazette.com for Bermuda's trusted daily news digests and breaking news alerts

CONFIDENTIALITY NOTE: The information contained in this transmission is privileged and confidential information intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this transmission in error, do not read it. Please immediately notify the sender that you have received this communication in error and then delete it BPHL | The Royal Gazette Limited

1

D'Alessio, Sarah C.

From: Attride-Stirling, JenniferSent: Wednesday, February 14, 2018 3:39 PMTo: Wilson, Kim N.Cc: Kennedy, Catherine L.Subject: RE: MEDIA QUERY: Health query over diagnostic fees

CatherineTheseresponsesareapproved.Thetruthisthatthisiscomplex.Butwecanttakeanymoredripdripinquisition.JBQUERY:therecommendedcutstothescanningfees,andtheactualcutsthatwereimposedbytheMinistryRESPONSE:WhatMinisterWilsonhasexplainedisthattheMinistryofHealth,undertheformeradministration,receivedatechnicalrecommendationthatallofBHBsFeesbesetusingtherelativevaluemethod.Useofthismethodologyhasbeenrecommendedbythreeseparateindependentreviews.Thatrecommendationwasnotaccepted.Instead,thecommunityRVUfeeswereappliedtoBHBsdiagnosticimagingfees.ThesefeeswerelowerthanwouldhavebeenifthefullBHBFeeSchedulehadappliedRVUs.Thediagnosticimagingfeescheduleappliedispubliclyavailable.AYOQUERY:Andhowwilltheprivateclinicfeesbeset?Willthosefeesremainastheyare?orrevertbacktowhattheywere?RESPONSE:Privateclinicsdonothaveregulatedfees.Diagnosticimagingfeesforapprovedstandardhealthbenefitprovidershavebeencalculatedusingtherelativevaluemethodsince2014.Thiswillcontinuetobethecase.From:Kennedy,CatherineL.Sent:Wednesday,February14,201812:31PMTo:AttrideStirling,JenniferSubject:MEDIAQUERY:HealthqueryoverdiagnosticfeesHelloPS,ThisisahottopicRegards,CatherineFrom:JonathanBell[mailto:[email protected]]Sent:Wednesday,February14,201812:29PMTo:Kennedy,CatherineL.Subject:RE:MEDIASTATEMENT:HealthqueryoverdiagnosticfeesMuchappreciated,Catherine.FollowinguponMondaysquery,wouldwebeabletogetsomebackgroundontherecommendedcutstothescanningfees,andtheactualcutsthatwereimposedbytheMinistry?Andifthefeesareexpectedtoberaisedsomewhat,areweabletogetsomedetailonbyhowmuch,andwhenthatmightkickin?Thanks,Jonathan Bell Senior Reporter D 441 278-0153 M 441 595-0151 [email protected]

2

www.royalgazette.com

2 Par-la-Ville Road, Hamilton HM08 T 441 295-5881 F 441 292-2498

From: Kennedy, Catherine L. [mailto:[email protected]] Sent: Wednesday, February 14, 2018 9:47 AM To: Jonathan Bell Subject: MEDIA STATEMENT: Health query over diagnostic fees HelloJonathan,PleaseseeherearesponsefromtheMinistryofHealth:TheMinistryofHealthreceivedaletterbeforeactioninOctober2017pertainingtojudicialreviewoftheBermudaHospitalsBoard(HospitalFees)AmendmentRegulations2017,withrespecttothereductioninfeeschargeablefordiagnosticimagingunderthestandardhealthbenefit(SHB).Severalpartieswereinvolvedandthematterwasresolvedwithoutlegalproceedings.Asitwasalegalmatter,therewillbenofurtherdetailsprovided.Regards,CatherineFrom:JonathanBell[mailto:[email protected]]Sent:Tuesday,February13,20181:30PMTo:Kennedy,CatherineL.Subject:HealthqueryoverdiagnosticfeesCatherine,goodafternoonIcouldseerightawayyesterdaythattheMinisterwasgoingtobetoobusy;perhapswecanrenewyesterdaysquestion?Idontwanttopileontoomuch,butintodaysarticlewegotsomeextradetailsfromFridaysHansard,andIthinkitsonlyfairtoputinanadditionalqueryjustforclarification.ItappearsthattheministerissuggestingtherewassomesortoflegalthreattotheGovernment,butitsnotexactlyclear.CouldweclarifywhethertheGovernmentfeltitwasatriskoflegalactionoverthefeecutstodiagnosticimaging:thequoteisjustbelow:

He said [Trevor Moniz] he had asked the minister whether the Progressive Labour Party administration had been threatened with legal action.

Ms Wilson responded: Prior to this agreement being settled on December 8, 2017, there were discussions taking place between the Government and the Attorney-General.

Illbearounduntil7pmatleast;wedbegratefulforanyclarification.Cheers,Jonathan Bell Senior Reporter D 441 278-0153 M 441 595-0151 [email protected]

www.royalgazette.com

2 Par-la-Ville Road, Hamilton HM08 T 441 295-5881 F 441 292-2498

From: Attride-Stirling, JenniferTo: Kim N. Wilson ([email protected])Subject: Emailing: MRI CT PP Minister 180121Date: Thursday, February 8, 2018 10:46:00 AMAttachments: MRI CT PP Minister 180121.pptx

Your message is ready to be sent with the following file or link attachments:

MRI CT PP Minister 180121

Note: To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of fileattachments. Check your e-mail security settings to determine how attachments are handled.

PATI Act Section.19.b: PS Attride-Stirling was requested to review the Minister's powerpoint for accuracy of technical details.
mailto:[email protected]:/o=Bermuda Government/ou=Exchange Administrative Group (FYDIBOHF23SPDLT)/cn=Recipients/cn=Wilson, Kim N.8e5
What causes health cost to rise?

Benefits

Cost of services

Utilization

We have to pay for the services which are included in the Standard Health Benefit. Such benefits include hospital, diagnostic imaging, dialysis, kidney transplants, palliative care, artificial limbs

It currently doesnt include doctors visit, personal home care, etc.

Benefits

Cost of services

Cost of hospital services

Cost for testing

Cost for dialysis

Cost of transplants

Utilization

The more people use medical services, i.e. hospitals, tests, medication, etc. the more increases we will likely see in our premiums.

Average cost annually for utilization is 4% increase if people are sicker like last years flu epidemic this translates to increased utilization

4

2017 premium changes

Utilization change 11% - $29.41

Fees for imaging, long stay & dialysis $23.03

Increased FutureCare transfer - $2.50

Added/increased benefits $7.78 (approx.)

Artificial limbs increase, palliative care, oral chemotherapy, kidney transplant increase

Relative Value Based Fees (RVU)

RVU is a international accepted model used in order to put in place a logical, rational and transparent fee structure which will help contain the cost of health care.

Bermuda does not use this model across the board*, despite the recommendation to do so by 3 separate healthcare reviews: Arthur Andersen, Ernst and Young and PWC since the year 2000.

*RVUs are used for community fees for SHB diagnostic imaging (mammography, x-ray, ultrasound)

RVUs continued

At present, each vendor is able to set their own fees, which often results in high and at times, prohibitive co-pays. The hospital fees do not have co-pays but the lack of transparency or methodology in their current rates has also led to high premiums.

The application of RVU will help contain healthcare costs by presenting appropriate fees that are fair to healthcare users. Fair prices will reduce health costs.

The Government is committed to address the rising cost of health care and will be moving to apply the RVU in 2018.

7

Former Government ignored the advise to apply RVUs

Realizing the importance of the RVU in 2017 the OBA Government received a technical recommendation to apply RVUs to all BHB fees.

The former Government ignored this technical advice and instead opted for fees, the majority of which, were lower than BHB RVUs would have been

Sample fees of CT Scan comparisons.

75571 CT abdomen

CT scan in USA public$131

CT scan in USA private$153

CT scan in Bermuda $239

74187 CT heart

CT scan in USA public$458

CT scan in USA private$537

CT scan in Bermuda $835

Some fees went up and some decreased
CPT AdjOUT-PATIENT TREATMENTPast Year 2016/17 Current Year 2017/18 RVU Price at CF 111.49 Difference bet 2017/18 vs RVU74178CT ABDOMEN & PELVIS 1/>REGNS $ 768.00 $ 835.00 $ 1,112.70 277.70 75571CT HEART W/O CONT, W/O DYE QUAL CAL $ 1,201.00 $ 239.00 $ 317.75 78.75
Total amount expected to be paid using Government financial supplement:

$ 778,000 Brown Darrell & Bermuda Health Care Services

$1.8 million BHB

Ignoring this advice resulted in drastic reductions in the fees which could be charged by both BHB and BDHC and BHCS

PLP Government takes steps to mitigate the impact of the significant fee reductions

Because the OBA decision would have significantly adversely affected BHB, BDC and BHSC by the reduction in fees the were able to charge for CT and MRI services, the PLP Government reviewed the matter and considered several options, all designed to mitigate the adverse impact caused by the former governments rate reductions.

Several options were explored by the Government in an effort to right the wrong caused to BHB, BDHC and BHCS

Options:

Revert to pre June 2017 fee schedules

Increase in premiums $31.49

Change fees to all DI

Increase $23.03

Change fees for CT and MRI only

increase $18.53

Plus cost to Government the sum of $8.5 million for FA, War Vets, GEHI and subsidies

After review it was decided to supplement the fees for MRI and CT services

Performed at all entities from Government funds rather than raise Residents health insurance premiums mid year.

BHB 1.863,305

BD $778.107.08

13

Health Council Board Members

Previous Board

Simone Barton (Chairman)

Kirsten Beasley (Deputy)

Lorraine Lipschutz

Alena Crockwell

Dr Edgar Griffith

Dr Darrien Ray

Venetta Symonds

Alexis Swan

Andrew Simons

Current Board

Dr Alicia Stovell-Washington (Chair)

Granville Russell (Deputy)

Claudette Fleming

Dr Annabel Fountain

Dr Darrien Ray

Sandro Fubler

Venetta Symonds

Michelle Jackson

Laure Marshall

Cynthia Thomas

Resigned: Richard Winchell

Ex Officio members

CEO, Tawanna Wedderburn

Permanent Secretary, J. Attride-Stirling

Chief Medical Officer, Dr Peek-Ball

Financial Secretary, Anthony Manders

What causes health cost to rise?1. Benefits2. Cost of services3. Utilization

We have to pay for the services which are included in the Standard Health Benefit. Such benefits include hospital, diagnostic imaging, dialysis, kidney transplants, palliative care, artificial limbs

It currently doesnt include doctors visit, personal home care, etc.

Benefits

Cost of services

Cost of hospital services Cost for testing Cost for dialysis Cost of transplants

Utilization

The more people use medical services, i.e. hospitals, tests, medication, etc. the more increases we will likely see in our premiums.

2017 premium changes

Utilization change 11% -$29.41 Fees for imaging, long stay & dialysis $23.03 Increased FutureCare transfer -$2.50 Added/increased benefits $7.78 (approx.)

Artificial limbs increase, palliative care, oral chemotherapy, kidney transplant increase

Relative Value Based Fees (RVU)

RVU is a international accepted model used in order to put in place a logical, rational and transparent fee structure which will help contain the cost of health care.

Bermuda does not use this model across the board*, despite the recommendation to do so by 3 separate healthcare reviews: Arthur Andersen, Ernst and Young and PWC since the year 2000.

*RVUs are used for community fees for SHB diagnostic imaging (mammography, x-ray, ultrasound)

RVUs continued

At present, each vendor is able to set their own fees, which often results in high and at times, prohibitive co-pays. The hospital fees do not have co-pays but the lack of transparency or methodology in their current rates has also led to high premiums.

The application of RVU will help contain healthcare costs by presenting appropriate fees that are fair to healthcare users. Fair prices will reduce health costs.

Former Government ignored the advise to apply RVUs

Realizing the importance of the RVU in 2017 the OBA Government received a technical recommendation to apply RVUs to all BHB fees.

The former Government ignored this technical advice and instead opted for fees, the majority of which, were lower than BHB RVUs would have been

Sample fees of CT Scan comparisons.

75571 CT abdomen CT scan in USA public $131 CT scan in USA private $153 CT scan in Bermuda $239

74187 CT heart CT scan in USA public $458 CT scan in USA private $537 CT scan in Bermuda $835

Some fees went up and some decreased

CPT AdjOUT-PATIENT TREATMENT

Past Year 2016/17

Current Year 2017/18

RVU Price at CF 111.49

Difference bet 2017/18 vs RVU

74178CT ABDOMEN & PELVIS 1/>REGNS $ 768.00 $ 835.00 $ 1,112.70 277.70

75571CT HEART W/O CONT, W/O DYE QUAL CAL $ 1,201.00 $ 239.00 $ 317.75 78.75

Total amount expected to be paid using Government financial supplement: $ 778,000 Brown Darrell & Bermuda Health Care Services $1.8 million BHB

Ignoring this advice resulted in drastic reductions in the fees which could be charged by both BHB and BDHC and BHCS

PLP Government takes steps to mitigate the impact of the significant fee reductions

Because the OBA decision would have significantly adversely affected BHB, BDC and BHSC by the reduction in fees the were able to charge for CT and MRI services, the PLP Government reviewed the matter and considered several options, all designed to mitigate the adverse impact caused by the former governments rate reductions.

Several options were explored by the Government in an effort to right the wrong

caused to BHB, BDHC and BHCSOptions:1. Revert to pre June 2017 fee

schedules Increase in premiums $31.49

2. Change fees to all DI Increase $23.03

3. Change fees for CT and MRI only increase $18.53

Plus cost to Government the sum of $8.5 million for FA, War Vets, GEHI and subsidies

After review it was decided to supplement the fees for MRI and CT services

Performed at all entities from Government funds rather than raise Residents health insurance premiums mid year.

Health Council Board MembersPrevious Board Simone Barton (Chairman) Kirsten Beasley (Deputy) Lorraine Lipschutz Alena Crockwell Dr Edgar Griffith Dr Darrien Ray Venetta Symonds Alexis Swan Andrew Simons

Current Board Dr Alicia Stovell-Washington (Chair) Granville Russell (Deputy) Claudette Fleming Dr Annabel Fountain Dr Darrien Ray Sandro Fubler Venetta Symonds Michelle Jackson Laure Marshall Cynthia ThomasResigned: Richard Winchell

Ex Officio membersCEO, Tawanna Wedderburn

Permanent Secretary, J. Attride-StirlingChief Medical Officer, Dr Peek-Ball

Financial Secretary, Anthony Manders
Fact SheetFW MEDIA CT statementsFW MEdia Query Health query over diagnostic feesFwd MEDIA STATEMENT CT MRI scansFW MEDIA QUERY fact sheet on financial supplement CT MRI scannersFwd Additional questions on the supplemental fees paidMRI CT PP Minister 180121 with ppt attchmntEmailing_ MRI CT PP Minister 180121MRI CT PP Minister 180121 attachment to emai with this titleSlide Number 1Slide Number 2Cost of servicesUtilization2017 premium changesRelative Value Based Fees (RVU)RVUs continuedFormer Government ignored the advise to apply RVUsSample fees of CT Scan comparisons.Some fees went up and some decreasedIgnoring this advice resulted in drastic reductions in the fees which could be charged by both BHB and BDHC and BHCSPLP Government takes steps to mitigate the impact of the significant fee reductionsSeveral options were explored by the Government in an effort to right the wrong caused to BHB, BDHC and BHCSHealth Council Board MembersRE CT StatementRE CT Press ReleaseRE Draft statement subsidy for MRI CT servicesRE MEDIA CT statementsRE Additional questions on the supplemental fees paidRE MEDIA QUERY Health query over diagnostic feesRE MEDIA QUERY BDC settlement 1RE MEDIA QUERY BDC settlement 2RE--MEDIRE--RE--

Documents

D'Alessio, Sarah C. - royalgazette.com · 3 they were able to charge for CT and MRI services. When the current Government came into office, the situation was reviewed and several