DR. PAUL TAM, MBBS, FACP, FRCP (C) Nephrology, Hypertension & Internal Medicine Chief of Scarborough Regional = SENT BY EMA April 30, 2018 Dear Ms Warren, ‘Thank you for contacting me with your questions about why my name appears on the top ten list of highest billing doctors. As | explain below, this is the result of my name and billing number being used to bill the Ontario Health Insurance Plan (OHIP) on behalf of the 9 team physicians that provided care to patients in the Scarborough Dialysis Program in 2017. am a nephrologist and serve as the Medical Director and Chief of the Scarborough Dialysis Program. The program serves approximately 620 patients with kidney disease and renal failure. In 2017, the program provided dialysis services and related medical care in five treatment sites in Scarborough including: 1) the Main Unit at the ‘Scarborough Health Network General Hospital; 2) The Yee Hong Centre for Geriatric Care; 3) the Corporate Drive Satellite Unit; 4) Bridgepoint Hospital Satellite Unit; and 5) Dialysis Management Clinics (OMC) Satellite Centres. In 2018, the program added Centenary Hospital as an additional site. The program provides treatment, care, and support to patients who undergo dialysis at one of our sites or at home. Patients undergoing dialysis usually visit a site between three to five times per week with a typical session lasting between four to six hours. Our program currently has 13 team physicians who provide care to patients at our various sites at different times. There are three shifts per day in all sites (usually 7:00 a.m. to 11:30 a.m., Noon to 4:30 p.m., and 5:00 p.m. to 9:30 p.m.) and an additional shift at the Main Unit from 11:00 p.m. to 6:30 a.m. Our program bills OHIP using the Chronic Dialysis Team Fee, as provided for in the ‘Schedule of Benefits, which lists the services insured by OHIP and sets out the billing requirements for all physicians. Ihave enclosed a copy of page J32 of the Schedule of Benefits, which governs how the Chronic Dialysis Team Fee is to be billed. The team fee is an all-inclusive benefit billed per patient per week for professional aspects of managing chronic dialysis and end- ‘stage renal failure in dialysis patients.The team fee is payable to the most responsible physician on the team and cannot be billed by any other physician in respect of the services performed. The current Schedule of Benefits provides for a weekly benefit of $127.20 per patient per week for most forms of dialysis, Our program's patients are seen by different physicians, at different times, and at different sites. As a result of this feature of our program, we have found that having only ‘one most responsible physician for the team allows for the most efficient administrative and billing practices. AAs the Medical Director and Chief of the program, | am the most responsible physician. ‘As such, | bill the weekly team fee on behalf of all physicians that are part of the team. The revenue is then used to remunerate the program's physician team members and pay for the program's expenses. Therefore, it would be incorrect to describe the billings associated with my name as my “earings” as they represent the revenue of the program itself, with its multiple sites and physicians providing around the clock care to our dialysis patients. | would welcome that you include this distinction and explanation in your article. Please let me know if you have any other questions. We are very proud of our program and the services we provide to our patients, nearly all of whom are chronically ill lnng- term patients. Yours truly, vy Yiu Wing (Paul) Tah, M.D., FRCPCDIAGNOSTIC AND THERAPEUTIC PROCEDURES eee CHRONIC DIALYSIS TEAM FEE Chronic Dialysis Team Fee isthe alLinclusive beneft per patient per week for professional aspects of managing chronic alysis and end-stage renal file incalyss patients, is a modality independent fee and is equal a monetary value whether the dialysis is delivered in hospital, community or home and whathar itis haemodialysis or peritoneal dialysis. The team fee includes the services ofall physicians routinely or periodically partcipating in the patients calyss treatment 2 the patients principal treatment cant; oF b, ata place other than the patients principal eatment contre auxiliary treatment centre) where 3 or more dialysis ‘treatments are rendered tothe patient during the 7-day period referred to below. ‘The amount payable isin respect ofa 7-day period of care, commencing at midright Sunday and is payable to the most responsible physician, Except as set out balow, the amount payable to another physician in respect ofthese services rendered toa patentin respect of whom 2 claim is submitted and paid for this code i ni. \When 2 full 7-day period of team care is not rendered atthe patient's principal treatment centre due to absence ofthe patient with treatment at an auclary treatment centre, the amount claimed for treatment atthe princpal treatment centre is reduced na pro rata ‘basis to equal 17 ofthe weekly fee for each day thatthe patient isthe responsibilty ofthe pxncipa treatment centre In addition tothe common elaments of insured services and the specie elements of Diagnostic and Therapeutie Procedures, the team {ee includes the following elements: ‘A, All consultations and vist for management and supervision of chronic dialysis treatments regardless of frequency, type or location (of service and includes chronic calyss of hospital in-patients 'B. All consultations and visits within the scope of practice of nephrology and general internal medicine for assessment and treatment of ‘complications of chronic dialysis and management of end-stage renal d'sease and its complications in chronic dialysis patients. . Allrelated counseling, interviews, psychotherapy of patients and family members. D. Alrelated cose conferences. ‘The team fee does not include 'A. Assessments and special visit premiums for emergent call tothe emergency department B. Admission assessments and subsequent visits to acute care hospital in-patients for treatment of complications of dialysis, chronic renal ieease or intercurrent ines, (Any other diagnostic and therapeutic procedures, incuding acute dialysis treatments. . Consultations and assessments by specialists in other than intemal mesicine or intemal mecicine sub-speciaiss other than nephrologits , Primary care by the patients family physician F. Assessment by 8 renal transplantation specialist for entry into a transplantation program. & Intermittent chronic haemoctalysis veatment at an auxilary treatment centre if fewer than three dialysis treatments ae rendered to the patient in the 7-day period referred to above Chronic dialysis weekly team foo # 860 Hospital haemodiaysis 127.20 # GBE1 Hospital peritoneal dialysis 127.20 # 862 Hospital sel-cara haemodialysis or satelite haemodialysis 12720 # GB6S_ Independent health fcity haemodialysis. 127.20 # GBG4 Home penitoneal dialysis, 2720 # B65 Home haemodialysis 12720 # 866 Intermittent haemodialysis - at an auxiliary treatment centre (per treatment, ‘maximum 2 per patent per 7-day period reterred to above). e880 Note: 1. Claim the code representing the predominant location and modality 2. Where 3 or more treatments are rendered per 7-day period at an austlary treatment centre, the service comprises the Chronic dialysis weelty team fee paid athe full amount, regardless ofthe number of treatments rendered ss December 22,2015 ffctve March 1, 2016)