Doctors contest fee splitting with HSA

Dr Robert Glatz, former
president of CIMDS

Monday,  May  30, 2005

A number of private doctors have reported receiving renewal of hospital privileges from the Health Services Authority (HSA), which require them to pay a percentage of their professional fee to the George Town Hospital if they want to continue treating patients there.

This practice is called ‘fee splitting,’ which according to Dr Robert Glatz, former president of the Cayman Islands Medical and Dental Society and ENT physician, “is inappropriate in the healthcare industry.”

Dr Glatz said that the question of contributing to overhead is different from fee splitting, which is when a physician maintains an office and clinic and pays fees to support the overhead of those services. 

“Fee splitting is taking the portion of the professional fee to pay for the hospital fees, which are paid separately by the patient or insurance company for items such as the bed, medication and equipment,” added Dr Glatz.

“The hospital wants to take part of the physician’s fee to recoup its losses. They are holding physicians hostage to sign over part of their fees that legitimately are meant for them.

“Physicians bring patients to the hospital because they are pleased with the service the patient receives at the hospital.” 

He said a lot of the problems are with the hospital fees, which are published in the Gazette. There are numerous fees that are below the cost of doing business so every time the hospital sees a patient on a service, they are losing money. One example is the hip replacement. 

“The fee is less than the cost of the prosthesis. So every time the hospital does a hip replacement it loses money.”

He added the hospital needs to recoup the money for expensive equipment by charging fees that allow for the cost of replacing equipment over time. Furthermore, many of HSA hospital fees are significantly lower than what insurance companies would normally pay.

“In the past, shortfalls were made up by the Government so no one had to think about cost accounting,” said Dr Glatz.

“Insurance companies are specific, they only pay doctor’s value of the procedure and they will reimburse hospitals based upon doing business with that hospital.”

He added the Cayman Islands Medical and Dental Society (CIMDS) had not increased the prices on its fee schedule in four years.

“Cayman Islands Medical and Dental Society (CIMDS) still uses a fee schedule that it agreed to in 2001,” he explained. “Those fees have not been raised in the last four years purposely in order to attempt to keep health care costs in line. But we are at a point where we have to increase fees again.”

Cayman Net News contacted the Minister of Health Services, Hon Anthony Eden; however, he stated that given the few days he was in office, he was not familiar enough with the issue to comment. HSA Acting CEO Shirline Henriques, and HSA Chairman Stephen Scott could not be reached for comment.

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