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| An eye chart for dogs hanging in the specialist's office |
The past week ushered in a surprise adventure in veterinary
ophthalmology. Readers know that Humphrey is not entirely new to this type of
adventure: several years ago, he developed a puzzling condition that was
initially misdiagnosed as pink eye. When his regular veterinarian made a
referral to Toronto’s veterinary ophthalmologist, Dr. Wolfer, Humphrey
investigated fees. Just to get “in the door,” Humphrey would have to be
re-tested for diagnostics, because the specialist would not accept the results
furnished by the regular vet, and was subject to a steep specialist
consultation. The total fee was estimated at $1,000.00. Humphrey did a little
research and decided he would go to Blue Pearl veterinary hospital in
Southfield, Michigan, since he was travelling to Detroit later that week. His
diagnosis (blepharitis) and treatment (oral cyclosporine) totalled about
$110.00 and the problem resolved.
Given that history, it’s no surprise that Humphrey is wary
of veterinary fees to this day. He is reeling from the sticker shock of on day
of veterinary procedures and drops: $3,000.00.
But, in an emergency situation, there’s no option for
comparison shopping! This past week, Humphrey had his regular consultation
because his right eye was read and sensitive. He had an immediate referral to
that same ophthalmologist Dr. Wolfer, who accommodated him on a cancellation. The
diagnosis this time was
melting
corneal ulcer, and Humphrey had to make a quick decision whether to attempt
to save the eye with the recommended procedure called
corneal
crosslinking or CXL. That procedure involves putting riboflavin drops into
the affected eye at 5 minute intervals, then shining a UVA light into the eye.
The riboflavin promotes collagen production, which can speed healing. The estimate
for the procedure was $1,100 for the process, $90.00 for the riboflavin, and
another $300.00 for various drops to be used post-operatively. And about $700 worth of tests from his regular vet earlier that day. Plus HST.
UPDATE: Four and five days later, Humphrey didn't know whether the appearance of his eyes were normal, so he called Dr. Wolfer's office and got little insight. Upon their advice (which included "Why don't you photograph it and send that?", he sent and email and got a response from the specialist. Then, he went to his regular vet to inquire if the eye required immediate attention. The regular vet was unsure, so the vet took photos and Humphrey sent those to the specialist. The response he got was appalling. The Doctor "read your email and reviewed the photographs you so kindly included. Unfortunately photos are rarely (if ever) truly diagnostic. If you feel Humphrey's left eye is deteriorating you may want to consider having him seen prior to your scheduled progress exam." Humphrey did not respond but wondered why they would instruct him to send photos, when they are not useful. And he wondered why, given the prose description, the "specialist" would not offer specific advice beyond "suit yourself."
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The moment Humphrey was out of the procedure, looking very glam-rock with tousled hair and
asymmetrical streaks of riboflavin on his temple, cheek and ear |
Humphrey is hoping for the best and that his right eye will
survive. While he heals, his is satisfying his curiosity about late capitalism
and healthcare costs, and the difference in costs for the same or similar
procedures for dogs versus humans.
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| The psychological trauma of the "cone of shame" exceeds any physical discomfort. |
Let’s take a moment to contrast fees billed for Ontario
humans versus dogs. In the province, OHIP (the universal, single-payer medical system)
dictates maximum fees physicians and other health professionals can charge. For
humans, a regular appointment with a family physician is $77.20 (though a
comprehensive assessment is $144.75 for 50 minutes or $217.15 for 75 minutes.
The veterinary equivalent is an appointment with a generalist or “regular” vet,
and the base fee is comparable (Humphrey’s vet charges $77.90 for an “office
examination and consultation” plus $156.30 for an “advanced wellness check”
(the equivalent of a physical). While a human emergency room (ER) exam is
$76.90, a veterinary ER exam is substantially more expensive, varying by
hospital though at least double that fee in Humphrey’s experience.
Human specialist fees vary. For instance, a “normal
neurology consultation” (one of the more expensive ones) is $176.35 with
subsequent visits in the following six months capped at $31.00, but a special
consultation of 75 minutes or longer is $300.70. The cost for similar “normal”
veterinary specialist consultations (as is the case with Humphrey’s internal
medicine doctor, and the ophthalmologist) are double those of humans (the going
rate in Toronto is about $300.00 for a normal consultation – something Humphrey
has paid to several specialists in different practices over the past year).
Additional diagnostics are paid for individually, on top of the specialist
consultation fee. Follow-up visits have never been less than $85 for Humphrey.
Two years ago, he was urged to have a cardiac workup. In Toronto, the
consultation and tests were estimated at about $1000 and with a lengthy wait (6
weeks to 3 months). At Blue Pearl in Michigan, the same workup was about $230
and could be done within days.
Frances Wolley’s October 21, 2011 Globe & Mail article, “Visit to vet an eye-opening adventure in
private care,” described the ten-fold difference in the price of identical
cataract surgery for dogs versus humans. In the 8 years since that article was
published, little has changed. Consider the following ophthalmology fees:
Procedure
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Current OHIP billing fee
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Approximate veterinary fee for same or similar service in Toronto
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Major eye examination and/or ocular assessment in office
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$48.90 to $51.10
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$300.00 for first visit, $85 for subsequent
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Corneal testing (pachymetry, keratometry, etc.)
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$5.00 per test
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Within consult
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Local anasthetic for ophtho
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153.00
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Within procedure fee
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General anaesthetic for ophtho
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150.00
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Within procedure fee
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Human chelation of band keratopathy with EDTA VS canine CXL for
keratosis with riboflavin and EDTA
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$496.00 plus anaesthetic (approximately $650)
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$1,350.00
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Cataract (with no complications) including retrobulbar injection administered
by surgeon and including insertion of intraocular lens
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$397.75
Plus $50.00 per post-op visit
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$5,000.00
Plus approximately $3,000.00 for post-op follow up
|
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| No wonder the veterinary staff are grinning! That's Humphrey being brought out from his initial tests. |
One other important financial consideration for health care
professionals is who profits (and how much) from pharmacological dispensing.
While perhaps some physicians have a stake in a pharmacy, veterinarians often
dispense on their own medications – and often with steep mark-ups beyond those
applied to humans for the same medications (the
CBC
reported on this). Humphrey usually performs price-comparisons with local
pharmacies and compounding pharmacies, and has been successful in negotiating
reduced medication prices from veterinarians. For instance, the cost of
Caninsulin varies between $85 per case from most veterinary pharmacies, to
upwards of $200 at some veterinary clinics. Accompanying needles vary in price
between $19 and $50 per carton for identical or nearly identical products. Pain
medications are often half (or less) the price at a human pharmacy (they accept
veterinary prescriptions).
This time around, price comparisons were impossible since
Humphrey had to begin medications immediately. However, it appears that at
least some of the drops (most of which were $75 to $80 per bottle from the specialist)
cost only about $25 from a human pharmacy based on a cursory investigation.
UPDATE: a price check before refills revealed that the most staggering difference was Atropine 1% which is $77 from the vet, but $17 from the local pharmacy. Wow.
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Humphrey in his protective "Doggles" from last year.
The ophthalmologist recommended Rex Specs (since they are a single unit) over these,
so Humphrey went ahead and ordered himself a pair. |
To be clear: Humphrey is grateful for the competent
veterinary care he receives, and he strongly supports living wages for all
workers (not just in health care!). He recognizes that operating a clinic is
costly, and veterinarians must be fairly compensated for their education,
expertise, and skill. But undoubtedly some of the fees he has experienced seem
to be unjustly inflated. The College of Veterinarians of Ontario considers charging
fees that are excessive in relation to what is normally charged professional
misconduct, but since fees are high across the board, the examples here would not
be problematic under Reg. 1093 of the
Veterinarians Act.
AND ONE MORE UPDATE: The seven-day follow up revealed healing! The eye is saved, but drops and protective gear will continue for 2 more weeks and then be re-assessed.
Sources:
