Failed Execution - Update 1
July 6, 2019
I followed up with the Mb Medical Director for Dynacare and MB Health.
MB Health replied promptly and said that they would pass my information up the chain.
Dynacare bills MB Health for a negotiated set of services which does not include UBT. As such, Dynacare can charge patients for the test (i.e. $90 per patient) but appear to be very interested in being able to provide the test as a MB Health insured medical service (i.e. $82.30 as per current fee codes). Given that Dynacare has the shortest wait time in the province (i.e. ~ 2 weeks versus over a year at HSC) this could help to reduce patient wait times for UBT. It is interesting to note that UBT breath samples , irrespective of whether collected at HSC or Dynacare, are all sent to an Ontario Dynacare lab for processing and analysis.
If I had to wait over a year with stomach pains and had a chance to get a study done in two weeks, I would gladly pay the $90 to rule out, or confirm, an H pylori infection. However, not all patients can, or should have to, afford this. Given that this is an insured health service provided to outpatients in Winnipeg and Brandon hospitals it would be reasonable to consider allowing Dynacare to bill MB Health for UBT as one strategy to help reduce wait times and better serve patients.
A short follow up on the story. We had feedback from patients that they are being charged $90 at Dynacare for a UBT. This is strange as it is an insured health service in MB with both a technical and a professional fee which is meant to cover all costs including supplies and physician billing (i.e. MB Health Physician Manual – April, 2019 - fee code #9988 = $82.30 total reimbursement). I have calls into Dynacare and MB Health about why Manitobans are being charged for his test at Dynacare but not at HSC, SBGH or at the Brandon Hospital. I will post the results from follow up communications as well as following up to see if there have been any solutions to the wait time disparities (i.e. from 2 weeks to over a year depending on where you get the test done).
Image - Public Domain - Content Providers(s): CDC/ Dr. Patricia Fields, Dr. Collette Fitzgerald
June 11, 2019
An example of failed execution in Manitoba’s health care system. What part of this is “patients first”?
People with chronic stomach aches may be suffering from a treatable infection called Helicobacter pylori gastritis which is often shortened to H pylori gastritis. Left untreated the gastritis can turn into stomach ulcers and is also linked to an increased risk for stomach cancer.
Diagnosing H pylori gastritis can be done in two ways. The first is a blood test looking for specific H pylori antibodies. However, this test can’t tell you if you are actively infected or were exposed in the past but may not be infected at present. The second, most common test is a called a carbon urea breath test (UBT). For the UBT a patient ingests a small amount of liquid contain compounds metabolized by H pylori and after a short time the patient provides a breath sample into a plastic bag. Their breath is analyzed for constituents which are relatively unique if H pylori is present and active. A positive UBT supports a diagnosis of active H pylori infection. Patients need to follow specific instructions regarding how long to fast and how long to be off of specific medications to ensure the results are accurate. Based on a patient’s symptoms a doctor determines if a UBT will be beneficial.
These tests were historically done in Nuclear Medicine Departments for technical reasons (i.e. initially used medical isotopes). Due to longstanding expertise in providing this service they are still primarily done in Nuclear Medicine Departments in Manitoba. However, they can be done in any diagnostic medical laboratory setting with the appropriate training, quality assurance and UBT test kits as medical isotopes are no longer required.
What are the wait times to get a UBT in Manitoba?
If you are booked for a UBT at Health Sciences Center Nuclear Medicine the wait time is over a year!
If you are booked at Saint Boniface the wait time is about four months.
If you are booked in Brandon (Nuclear Medicine) the wait time is about a month.
According to Dynacare you can get a UBT done in their main lab in Winnipeg (Main Clinic at 830 King Edward open for UBT between 8:30 –noon, 1- 800-565-5721 ext. 7253). You can walk in with your requisition or call to make an appointment and get in with a week or two noting that you may need to be off of some drugs for at least two weeks before the test. It may be best to call ahead. Your referring Doctor should explain how long you need to fast and what other preparations are needed so the test can be done (i.e. being off certain drugs for specific periods of time).
Based on their web site Shared Health (formerly DSM) does not offer UBT in their outpatient or inpatient labs.
Up to a thousand UBTs are done in MB a year and this may be an underestimate as it does not include Dynacare UBT testing.
What do you say to a patient who has been waiting for over a year with stomach pain that the test may have been available in two weeks? How would a patient know where the shortest wait times are for their UBT? What part of this is “Patients First”?
Another issue is that patients from up north currently fly into Winnipeg or Brandon to have this relatively simple outpatient test done. It would be better for the patient, and more economical, to do UBT testing in Norther medical lab centers or, perhaps, nursing stations.
This is a clear example of lack of attention to detailed systems planning and service delivery at the ground level.
Dr. Sandor Demeter
Faculty of Health Sciences
University of MB
Dr. Demeter is a Public Health researcher with particular interests in health policy and health economics. By investigating and reporting on stories like the above he hopes to create a dialogue on health care in MB and to increase awareness of issues which positively, or negatively impact, Manitobans. Feedback and comments are welcomed directly at firstname.lastname@example.org or through his blog at https://www.codeblue.me