Québec Update

The recipe for success in the film industry is quite simple. All you need are supernatural characters (namely superheroes), a good cause, and an exceptional storyline. Québec politics have found a remarkable character in the Minister of Health as well as a suspenseful narrative that is sure to keep people awake at night. In this article, I will provide a brief update on Bill 28 followed by a more exhaustive review of Bill 92, which was introduced in April 2016 by the Minister of Health.

Update on Bill 28: An Act mainly to implement certain provisions of the Budget Speech of 4 June 2014 and return to a balanced budget in 2015–2016

The release of the revised PA implementation on April 13th by the Québec Minister of Health has infuriated pharmacists and L'Association québécoise des pharmaciens propriétaires (AQPP). Given the financial repercussions pharmacists would face, the AQPP has responded by initiating a legal challenge to enforce the previous agreement signed in June 2015. Both parties have now agreed to end the legal proceedings and engage in another round of negotiations with a targeted completion date of September 16th, 2016. So the drama continues.

Bill 92: An Act to extend the powers of the Régie de l’assurance maladie du Québec and to amend various legislative provisions

In November 2015, the Auditor General of Québec, Ms. Guylaine Leclerc, noted that the honoraria paid to physicians exceeded the budget between 2010 and 2015 by $415 million. She further highlighted that the Régie de l’assurance maladie du Québec (RAMQ) does not have sufficient control over the administration of and budget for physicians’ remuneration. "To be more precise, the RAMQ has difficulty detecting errors and potential frauds when physicians submit their claims. Their control system cannot determine with certainty if the acts being billed were actually performed."

In Québec, there are a total of 21,000 practicing physicians. The budget associated with their remuneration represents 62% of the total RAMQ budget. It is important to note that this is not a matter of keeping an eye on the expenditure but, rather, of ensuring that a control system is put into place. Such an arrangement would provide the Minister of Health with the assurance that the acts undoubtedly took place and that physicians should, therefore, be paid according to the agreement previously negotiated by various physician associations.

Fixing the RAMQ system will require important adjustments in order for it to become more efficient. In the meantime, imposing precautionary measures to prevent errors and fraud only presents a temporary solution to the problem.

Overview of Bill 92 The Minister of Health first presented Bill 92 in April 2016. Special consultations took place in early May, followed by a parliamentary subcommittee debate in early June. The Bill is, thus, making progress and is scheduled for final review and adoption this fall.

Here are some of the key points of the legislation:

• It will enable the RAMQ to augment its power over remuneration and inspections, impose higher penalties, and curb (or at least slow down) illegal practices.
• It targets health care professionals (physicians, pharmacists, nurses, etc.), pharmaceutical manufacturers, and wholesalers.
• The RAMQ must notify the health care professional within 36 months following the payment of an act suspected of being wrongly described, not performed, or invoiced with the incorrect amount, either accidentally or intentionally.
• The RAMQ will be granted an additional 12 months to complete the investigation of a health care professional. This additional period will begin once the health care professional has been informed of the investigation.
• The health care professional must provide an explanation within 30 days of an RAMQ notice. Following this delay, he or she will be notified of the RAMQ’s final decision. This decision can be disputed at the Québec administrative court over a period of 60 days.
• The RAMQ can impose an administrative fee (between 10 and 15% of the claimed amount) in addition to a penalty fee.
• The RAMQ can increase fines by five-fold from the previous legislation and double it with recurring offences.
• The RAMQ will have the right to request access to patient files if it will help build evidence. This disposition is not without serious concerns over confidentiality from health care professionals.

In summary, Bill 92 does not address all of the concerns raised by the Auditor General of Québec last November but instead proposes significant measures to discourage health care professionals from abusing the system. Although malpractice is costing the health care system near half a billion dollars, many health care organizations continue to firmly believe that the majority of their employees comply with regulations.

The Minister of Health has certainly made an effort to contain health care spending. During the public consultations of Bills 28 and 92, many ideas were shared with the Minister that will almost certainly evolve into new legislations. More to come…

Originally published in Canadian Pharmaceutical Marketing Sept/ Oct 2016

For further information, please contact Ghislain Gauthier, Director, The Pangaea Group