November 11, 2013 by Greg Meckbach, Associate Editor
The Ontario Legislature last week passed a motion calling on the government to establish regulations limiting the fees charged for medical records, which, politicians suggest, are often requested by lawyers in auto insurance lawsuits.
Ontario members of provincial parliament who spoke last Thursday in favour of the motion noted some doctors and other professionals are charging up to $100 per page of printed medical records, and insurance firms are passing on the costs to clients.
“Fees to access medical records have become a lucrative revenue sideline for some doctors and others who have custody of a patient’s health information,” Liberal MP Bob Delaney noted in the legislature.
Delaney, MPP for Mississauga-Streetsville, cited several examples, including a chiropractic office in Mississauga that charged $120 for nine pages of records and a plastic surgeon in Oakville who charged $500 for a five-page printout of records.
“The lawyers and insurance companies that act for those patients have to pass along these costs to their clients,” Delaney said.
Another MPP speaking in favour of the motion was Jeff Yurek, the Progressive Conservative Party’s critic for auto insurance reform.
“As a pharmacist, I saw it — daily, in fact,” said Yurek, who represents Elgin-London-Middlesex at Queen’s Park. “Lawyers involved in lawsuits, mainly with auto insurance, would send me a letter saying, ‘I’d like a profile of so-and-so patient with the proper consent forms sent with it. Please send your bill along with the papers.’ The first time I received one such letter, I called the lawyer and said, ‘We’ve never charged for this service. What do you mean, “Send a bill?”’ They said, ‘You can bill us whatever price you want. It doesn’t matter, because we’ll just take that money and charge it to the consumer, or whatever comes out at the end of the day.’ I was really quite shocked at the fact that they didn’t care what we billed.”
The motion that Delaney introduced was that “in the opinion of this House, the Ministry of Health and Long-Term Care should establish and enforce regulations pertaining to the Personal Health Information Act, 2004, subsection 54(11) with respect to fees charged for medical records, and ensure consistent billing for the Ontario Harmonized Sales Tax.”
Delaney noted the records for which some medical professionals are charging fees are only records of services for which they have already been paid.
“The health professional has already been paid, or has collected a fee, to provide the service and document the information,” Delaney told the legislature. “All that’s been requested from them, most of the time, is a copy of what they already have, and if their practice is properly computerized, that information comes in the form of a query that is both quick and may often be very cheap to produce.”
Delaney noted that in March 2006, the Ontario Ministry of Health and Long-Term Care published a draft regulation that, had it been adopted, would have limited fees to a maximum of $40 for all such records held by a health provider.
He added the Ontario Medical Association publishes a Physician’s Guide to Third Party and Other Uninsured Services, which is not binding on doctors. OMA is a voluntary association that represesents the political, clinical and economic interests of Ontario doctors. Delaney noted the OMA suggests that doctors providing medical records to their patients or third parties charge $30, plus 25 cents per page above and beyond 20 pages, he said.
“As well, a physician can ethically charge for out-of-pocket disbursements, if any are incurred, for shipment, long-distance faxing and other expenses of a similar nature,” Delaney said of the OMA guidelines. “If, and only if, the physician must review the records before providing copies, may he or she bill at the normal hourly rate.”
Liberal MPP Shafiq Qaadri also spoke in favour of the motion but noted that when providing medical records, there may be other administrative costs.
“For example, if a secretary has to take, let’s say, 20 minutes or half an hour, there may be a cost to that tacked on,” said Qaadri, MPP for Etobicoke North. “If there’s a summary letter that the physician is required to create from a new cognitive interaction with the file, that is also, presumably, a billable expense.”
Qaadri added physicians are sometimes asked to write summary sheets, especially in cases where files are 170 pages or more.
“I think, when the physician is busy practising medicine, they really don’t want to be having this kind of administrative burden, so it’s only fair that there should be some compensation involved,” Qaadri said.