Local physicians are “overwhelmingly” opposed to a health plan imposed by Government to rein in unnecessary and expensive diagnostic testing.

The initiative, known as pre-certification, will force doctors to consult with insurance companies or other third party to obtain permission for tests on their patients.

It has been criticised as time-wasting, expensive and liable to cause “death by delay”.

The Ministry of Health did not respond to repeated questions on the proposal — but pre-certification was yesterday blasted by the Bermuda Medical Doctors’ Association (BMDA) as putting patients’ safety at risk.

In a statement sent to this newspaper by BMDA head Joanna Sherratt-Wyer, the group called on Government to rethink the scheme.

“It is with huge disappointment that we note the current plan to implement pre-certification as a method of cost containment,” Dr Sherratt-Wyer wrote.

“This decision was taken in the complete absence of consultation with physicians, and as such puts the safety and care of our patients at risk.

“We have been shown no definitive evidence to determine that this will cut costs as it is being stated — indeed, we have significant concerns that costs will instead be passed onto our patients either in the form of higher insurance premiums, or the costs of doctors’ visits will increase in order to reflect the increased administrative burden placed upon the doctors.”

The BMDA functions as the representative body for the Island’s physicians.

Pre-certification forces doctors to ask permission to order tests that they feel are clinically necessary, Dr Sherratt-Wyer explained.

She added: “We have canvassed opinions from physicians working with pre-certification in other jurisdictions, such as the Cayman and the US.

“Time and again, we hear stories of the hours spent trying to obtain tests that are necessary — something which can put patient safety at huge risk whilst they await permission to have necessary diagnostic testing.

“We also hear that costs have risen, as physicians have had to employ more staff just to deal with the necessary paperwork, make endless phone calls, deal with complicated appeals processes, etc.

“These costs will, of course, be passed onto the individual patients, but may appear on the surface as if overall spending on healthcare has decreased.”

Calling for “open, frank and honest dialogue”, the BMDA statement also suggested the implementation of the National Electronic Health Record to cut down on unnecessary duplications of tests.

“In addition, we are keen to ensure that we provide more guideline driven care, with standards of care agreed and adopted among physicians.

“This would allow for physicians to be guided in best practice, whilst still allowing for the ‘art’ of medicine to be practised — something that is utterly lost in the type of care that pre-certification demands.”

Dr Sherratt-Wyer called on Health and Environment Minister Trevor Moniz to “carefully re-examine the process by which they decided to implement pre-certification”.

She added: “By not involving physicians in the decision to implement pre-certification, we believe patient safety has been put at risk.”

Doctors who spoke with The Royal Gazette over pre-certification for procedures such as X-rays and CT scans were reluctant to be named — but physician Ewart Brown confirmed that opposition to the idea was widespread.

“Since I returned to Bermuda to practice medicine in 1990, I have never seen local doctors so universally united on any issue,” Dr Brown said.

“Doctors are united against any policy which allows anyone to intervene in the care of their patients. Forcing us to call an 800 number to ask a nurse to approve a diagnostic study is a dangerous policy which could result in death by delay.”

One physician who contacted this newspaper said doctors were “overwhelmingly against” pre-certification, and another who attended recent meeting with the Ministry accused one insurance company in particular of seeking to implement a scheme already used in the Cayman Islands.

“Our patients have told us they don’t want this,” the doctor said. “They have not been consulted. Why is the Government forcing this on us, instead of working with us?

“The real issue is this: who will be liable if the nurse we speak with at the 800 number makes an error and the patient dies because of a denial?”

Aside from the alleged lack of consultation, the top complaint cited was that Government hadn’t shown conclusively that overutilisation was a serious problem.

A Bermuda Health Council spokesperson confirmed that the organisation had been directed last year by Cabinet to implement pre-certification. According to the BHeC, a public document will be released “shortly” giving more detail on the proposal.

“The focus is on diagnostic testing, which includes medical imaging and clinical laboratory tests,” the spokesperson said.

“These currently represent 40 percent of all standard benefit claims and 8.5 percent of total health costs in Bermuda.

“The mechanism would be similar to what happens with overseas care at present: the provider identifies the care needed and submits for pre-approval, a utilisation review specialist confirms that a procedure is medically necessary and meets clinical standards and criteria, and approval is granted before the procedure takes place.

“This process has been in place for overseas care for many years in Bermuda, so providers and the public are familiar with it.”

The requirement would apply to “all eligible procedures regardless of who orders them or where”, according to the BHeC.

“The emphasis is on protecting medically necessary care to improve overall outcomes for patients.”

Bermuda residents spent more than $58 million on diagnostic tests in the fiscal year ending 2012, the spokesperson said.

“We are confident that pre-certification will reduce these costs by more than 10 percent.”

Asked about the level of opposition in the medical community, the BHeC spokesperson said the council was “aware of the position of some physicians on the Island”.

“However, there are a number of physicians, particularly those who have worked in systems that used pre-certification, who appreciate the need and its value.

“There is broad agreement that we need to manage utilisation better in Bermuda, though we recognise that opinions vary on the best way to do this.

“The Health Council has been charged with implementing pre-certification to manage utilisation of these costly procedures, as Bermuda has to take an assertive approach to reducing costs.”

Both the Council and the Ministry “continue to listen to the concerns voiced by the medical community”, the spokesperson added.

“We look forward to working with them to ensure the programme we will put forth protects quality of care and builds confidence in the medical community.

“It is imperative that we all work together to improve healthcare in Bermuda as the current system is simply not sustainable.

“Diagnostic testing increased 25 percent last year and health costs have increased over nine percent annually for nearly a decade. We have to focus on improving quality of care and investing our healthcare dollars in medically appropriate care.”