The Ministry of Health and eye doctors are accusing each other of clouding the picture when it comes to cutting the cost of medical procedures and the impact on patient care.

The province is saving $338 million by unilaterally overhauling the fees doctors charge for services after talks with the Ontario Medical Association disintegrated. At least 10 per cent of the cuts apply to ophthalmologists, who say patients will see longer wait times and less service if the charges on cataract surgery, injections into the eye and diagnostic tests are reduced — a claim the province denies.

A particular concern is the Optical Coherence Tomography test, a routine procedure used to get high-resolution images of the eye to identify glaucoma and other blinding eye diseases.

The fee is being reduced by about 60 per cent to $25 and the test is now restricted by OHIP coverage to four times a year instead of six.

“(With fewer tests) there is a potential that patients could lose vision,” says Dr. Navdeep Nijhawan. This would particularly affect sight-impaired seniors, he said.

“We’re not going to be able to monitor their disease.”

Some tests may now actually cost the doctors money to perform because the machines are so expensive, said Nijhawan.

Health Minister Deb Mathews says the cuts will have zero impact on patient care — though the incomes of some specialists will fall. “We are rebalancing fees that have got out of whack because of technological advances,” she said.

“I think it’s important that we all share in the technology benefit . . . that speeds things up for patients and increases productivity doctors. It should not be a windfall for some specialists,” she said.

Nijhawan says that the increase in payments to doctors come from performing more procedures to reduce wait times. Plus, his specialty has particularly high overheads (40 per cent on average) because of expensive machines.

A loss of income could encourage ophthalmologists to head west toward more lucrative salaries, leaving Ontario in the lurch, he said.

On average, ophthalmologists bill the province $642,503, according to the Canadian Institute for Health Information.

And they are not against cutbacks, said Nijhawan, noting that eye doctors and surgeons already voluntarily reduced the cost of cataract surgery by 16 per cent, and the cost of other tests by 10 per cent.

Arthur Sweetman, a health policy professor at McMaster University, said the ministry is heading in the right direction given that fee structures have not caught up with technology.

While a decrease in earnings might cause some doctors to leave, the province is expecting a large incoming supply of physicians from doubled enrollment in medical schools and international graduates who want to work in Ontario, he said.

The ministry also has a lot at stake, he noted. There would be a “giant political backlash” if the fee cuts suddenly led to a decline in service provision.

Michael Decter, health economist and former deputy health minister of Ontario, said he doesn’t anticipate the fee change to cause a patient care crisis.

“There is a tendency for doctors to predict dire consequences,” he said. “It’s a battle for the hearts and minds of the public.”

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Sweetman agrees.

“At the end of the day this is public sector collective bargaining which is increasingly done through the media these days,” said Sweetman.

“It’s part of a public relations exercise on both sides.”