Pre‐Operative Cardiac and Pulmonary Function Testing
Yes, medically necessary pulmonary function and cardiac testing prior to any surgery covered by OHIP.
Pre-operative cardiac tests are done on a patient’s heart before a patient has surgery and could include chest X-rays, echocardiograms and electrocardiograms. A pulmonary function test is a test that is used to diagnose and find lung disease. One example of a common lung disease is chronic bronchitis. Chronic bronchitis can reduce the amount of air that goes into the lungs and causes shortness of breath.
What does OHIP fund?
OHIP funds medically necessary pre-operative cardiac and pulmonary function testing.
What changes are included in the 2012 Physician Services Agreement and why?
- The agreement will restrict payment for routine pulmonary function testing and cardiac testing (chest X-rays and electrocardiograms, nuclear medicine and echocardiograms) before surgery for patients who have no symptoms, when the patient is having low or moderate risk non-cardiac surgeries.
- Before, routine cardiac tests were not eligible for payment before cataract surgery, colonoscopy, cystoscopy, carpal tunnel release and arthroscopic surgery. The agreement recommends that routine cardiac testing not be funded for all surgeries where the patient’s surgical risk is low to moderate.
- This change is being made because there is no evidence of benefit from routine cardiac testing before low or moderate risk surgery for patients who have no symptoms.
- Routine pre-operative testing has been identified by several expert bodies, including the ICES and the American College of Radiology, to have a limited role in improving the safety of patients during surgery, especially for operations that do not need a general anaesthetic and are not being done because of a medical emergency.
- This change will reduce unnecessary routine cardiac testing, decrease the overall costs of those tests and allow other patients who need them to access the tests more quickly.
- Medically necessary pulmonary function and cardiac testing prior to any surgery will still be insured by OHIP.
Will patients continue to be funded by OHIP for routine cardiac and pulmonary function testing before surgery?
Yes, medically necessary pulmonary function and cardiac testing prior to any surgery will still be funded by OHIP.
What are the savings from this change in the first and second years of the Agreement?
- Physician fee savings: $10.9 million (2012/13); $43.7 million (2013/14)