Thursday, October 28

The private sector as reinforcement to reduce waiting times in radiology

Nearly 160,000 Quebecers are on a waiting list for a CT scan (a ” scan ”) Or a magnetic resonance imaging (MRI) exam. To reduce delays, the Legault government has given the green light to the conclusion of ten contracts between health establishments and private medical imaging laboratories. Amount of the bill: nearly $ 9.6 million, at most, assures Quebec.

The duty obtained five contracts concluded between health establishments and medical imaging laboratories (LIM, in the jargon), thanks to the Law on access to documents of public bodies. All were redacted, except the agreement between the CIUSSS de la Mauricie – Center-du-Québec and IRM Trois-Rivières. We learn that the amount obtained by the medical imaging laboratory for the performance of an MRI is $ 543.

In the agreement signed on April 26, 2021, it is written that IRM Trois-Rivières undertakes to “guarantee a minimum service capacity of at least 190 MRI examinations per period of 28 days, for an approximate total of $ 103,170 (or $ 543 per MRI, including taxes) ”. This amount of $ 543 excludes the professional fees of radiologists, which must be billed to the Régie de l’assurance-maladie du Québec.

The contract between the CISSS de la Mauricie – Center-du-Québec and IRM Trois-Rivières will end on March 31, 2022, or before if the amount of services offered reaches the maximum limit set at $ 1,143,083, can we read in the document.

A high price?

The duty wanted to know if the other medical imaging laboratories that have entered into agreements – Imagix, Réso-Médic Laval, Imagerie Medvue, among others – benefit from the price of $ 543 per MRI.

Yes, answers the Ministry of Health and Social Services (MSSS). “Ministerial funding is the same for all establishments authorized to enter into agreements with medical imaging laboratories,” said one in an email.

The MSSS indicates that the price set for MRI is $ 543.60, the same as that agreed by the Commission des normes, de l’énergie, de la santé et de la sécurité du travail (CNESST) with the LIMs. . As for the tomodensitometry, the price is $ 200, just like that of the CNESST.

Former Minister of Health and Liberal MP Gaétan Barrette considers this offer to medical imaging laboratories “generous”, which will benefit from additional traffic. “Magnetic resonance takes eight a day to cover our costs,” said the radiologist. From the ninth, it goes straight into the doctor’s pockets. “

But how much does an MRI cost in the public network? According to the MSSS, the fee per exam is $ 137.44. However, this does not include the cost of the device and administrative costs. It is therefore impossible to compare this amount to that of $ 543.60. It would be like putting clementines and oranges in the balance.

Annick Mongeau, spokesperson for about fifteen radiology clinics, points out that the government’s rates are those of the CNESST and that they “have not been indexed since 2010”. She explains that the amounts of $ 543.60 and $ 200 cover the “technical costs” of the LIMs. “Capital costs, salaries for technologists, receptionists, support staff, rent, electricity, equipment maintenance costs, IT costs, digitization, etc. », She enumerates.

The LIMs, says their representative, wanted to lend a hand to the network despite the challenges that this entails. “It’s not easy to run venues [d’imagerie médicale] 16 hours a day, says Annick Mongeau. The shortage of manpower in the health network is also true for technologists. “

A clause in the three agreements entered into by the CISSS de Laval is also provided to prevent employees from fleeing to the private sector. The three clinics thus undertake, “during the term of this agreement, and for a total period of two years following its entry into force, never, personally or through any other person, to solicit an employee or encourage the departure of any employee of the CISSS de Laval, except by general means of solicitation such as newspapers, radio, Internet or other similar means aimed at a community rather than targeted individuals ”.

Catching up to do

Radiology waiting lists have grown during the COVID-19 pandemic. In Quebec, 76,601 people are waiting for a CT scan, including 32% for more than three months, according to the most recent data from the MSSS. As of February 29, 2020, before the pandemic, they were 45,905 to wait, including 18% for more than three months.

For MRI scans, 82,012 patients are awaiting examination, 41% of which have been over three months. That’s about 2,000 more people than before the pandemic. The MSSS emphasizes that the situation has improved since June 20, 2020. The proportion of individuals waiting for an MRI for more than three months was then 62%.

The problem of access to medical imaging services remains more pressing in certain regions. The MSSS has enabled seven health establishments, including the CISSS de Laval, the CISSS de l’Outaouais, the CIUSSS du Saguenay – Lac-Saint-Jean and the CISSS des Laurentides, to use private clinics to carry out a catch-up in the exams.

The Dre Magalie Dubé, president of the Association des radiologistes du Québec, salutes “the gesture of the LIMs”, who have agreed to lend a hand to help. “If there is one good thing that happened during the pandemic, it is precisely to strengthen the partnership between the ministry, the LIMs and the integrated centers,” she thinks. Previously, we were perhaps more inclined to work in silos. “

Patients gain, she says. “Under the conditions we were in, it had to be done, to promote access to patients and ensure that those who are waiting for surgeries or oncological treatments, or others, can have access to their examinations as quickly as possible. , to be able to be treated adequately ”, affirms the Dre Magalie Dubé.

In Mauricie and Center-du-Québec, 324 exams have been carried out so far, according to the regional CISSS. At the CISSS des Laurentides, 35 patients have undergone an MRI at Imagix, in Sainte-Thérèse, since July 5.

In Laval, 3,460 patients have undergone a CT scan or MRI since April in a radiology clinic thanks to three agreements signed by the regional CISSS. The pandemic has disrupted radiology services. “Sanitary measures and staff absences have forced a reduction in scans, going from 133 patients per day to 59 patients per day during the pandemic, writes the CISSS in an email. Activities have partially resumed and there are currently 94 patients per day. The time to get an MRI is now 6 months, and it is 13 months for CT scans.

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