Epilepsy Ontario :: Neurologists concerned about future availability of EEGs in Ontario

EEG in Peril in Ontario - Neurologists concerned about future availability of EEGs in Ontario

Dr Ranjit Singh, MD

Electroencephalography (EEG) is a technique used for measuring the brain's electrical activity. Such activity was first recorded in 1875 by the English physician, Richard Caton, who showed electrical activity produced by the exposed brains of rabbits and monkeys. Groundbreaking as this was, it was not until 50 years later that a German neurologist, Hans Berger, was able to record similar responses from the human brain.

Since then, EEG has become the gold standard by which epileptic disorders are diagnosed. The EEG recording is especially useful in non-convulsive epileptic states. Newer applications of ambulatory EEG, depth recordings, digital EEG and more advanced wave form analyses of EEG activity show usefulness in the management of epilepsy. The EEG is also useful in diagnosing some degenerative brain disorders such as Creutzfeldt-Jakob and Alzheimer diseases and is invaluable in helping to diagnose brain death in potential organ donors. EEG is of great importance to patients with episodes of altered consciousness because of the requirements for the test by the Ministry of Transportation.

The EEG is, as you can see, an invaluable medical tool and it should be noted that other tests such as MRI and CT scanning do not replace it in terms of its usefulness.

There are many EEG laboratories in Ontario and other parts of Canada. Some are located in the larger teaching hospitals but many are located in community-based settings, either in hospitals or in private laboratories in doctors' office buildings. This has proved very convenient for people with epilepsy. All laboratories operate under the supervision of a specially trained neurologist and his or her technologist who also holds a special qualification to perform the tests. The equipment and operating costs are borne by the owner of the laboratory and subsidized by a 'technical fee' (to help cover the salary of the technologist and equipment costs) and 'professional fee' (to pay the neurologist for interpreting the record) provided by OHIP for each patient. For the physician, who purchases equipment and pays staff much like a small business, this is often an almost 'break even' operation and is maintained only because of the obvious benefit of having the procedure available locally. Unfortunately, this cost structure neither produces extra funds for new equipment, nor does it ensure that the physician provides this service at all. Similarly, the teaching and hospital-based laboratories also operate through the efforts of hospital-based neurologists. The technical fees (and, in some places, part of the professional fee) go to the hospitals, which are not obliged to use these fees to fund the actual EEG equipment and service itself.

In most places it takes at least 20-30 minutes to record the EEG. The neurologist then reads, interprets and reports on the recording, which takes about 15 minutes per recording. The technical fee paid by OHIP is $23.00 per recording and the Professional fee paid to the neurologist is $21.95. From these fees, recall, physicians must not only take their own personal salaries, but must also pay their support staff, office rent, medical supplies and insurance.
Following months of study, a commission known as the Resource Based Relative Value Schedule (RBRVS) Commission, set up by the Government of Ontario, has now proposed that, the professional fee to be paid to neurologists interpreting EEGs be dropped to $12.28 — a reduction of 44.1%!
Neurologists in the province who interpret EEGs are most seriously concerned by this proposal both for its effects on our medical practices and, most importantly, for the adverse effects it will have on the health of our patients. We have written a letter of protest to the commission, available online at www.aoneuro.on.ca/HTML/RBRVS-EEG.htm.

The premise of our letter is that if this process of fee changes is allowed to proceed, many laboratories will be forced to close. This will prove to be a great hardship for patients (which often include small children) who may have longer waiting lists and larger distances to travel to get their EEG testing. In addition to this, recent Guidelines for the Performance of EEG in the Province of Ontario published by the College of Physicians and Surgeons of Ontario will be difficult to comply with, because of this drastic reduction in funding.

We are also concerned that the climate produced by such changes will not be conducive to our younger colleagues embarking on the special training needed to interpret EEG recordings. These fee adjustments take place in the context of many young students turning away from medicine, and many of our most experienced colleagues leaving to practise in other parts of the world, where their practices are augmented by modern and easily available diagnostic equipment.

The Association of Ontario Neurologists and the Ontario Medical Association (OMA) (Section of Neurology) feel that it is important that our patients know what is happening. We intend to present our protest to the RBRVS Commission in February 2002. If you share our alarm about this situation, we ask that you voice your concern directly to the RBRVS Commission, by writing to the Chairman.

Your support as concerned patients is vital to us at this stage to enable accessible EEG to survive in this province.

Dr. Singh, a specialist in neurology and electrodiagnostic medicine, and a Member of the Royal College of Physicians in the United Kingdom, a Fellow of the College of Physicians and Surgeons in Canada, and Vice-President of the Association of Ontario Neurologists, practises in Guelph.

You can voice your concern about this decision by writing to

Background Information

Association of Ontario Neurologists
www.aoneuro.on.ca/HTML/RBRVS-EEG.htm

Guidelines for the Performance of EEG in the Province of Ontario
College of Physicians and Surgeons of Ontario
www.cpso.on.ca/Publications/eeg.htm