How the Ontario government hides costs spent on MAID

My recent FOI request to the Ontario Ministry of Health:

"Can you then please provide me with the fee codes that doctors are being told to use for MAID services...I would like to see whatever guide/memo/documentation that exists to inform doctors to appropriately bill for MAID services."

I received a Quick Reference Guide called OHIP Payments for Medical Assistance in Dying (MAID). (You won't find this document on the internet. I looked.)

Good grief--the Ontario government is telling doctors to use Palliative Care billing codes when they kill their patients:

"Procedural Planning and Case Management - K023 Palliative Care Support

• Discussions with other health care providers (e.g., physicians, pharmacist, coroner, CCAC) involved in management of the patient’s MAID

•Minimum of 20 minutes (cumulative) in a day of procedural planning/case management activity

• Medical record must indicate the name(s) of health care providers and the start and stop times

Provision of Medical Assistance in Dying - K023 Palliative Care Support

• Travel time for picking up and returning drugs used for the procedure

• Time spent with patient and family obtaining final consent

• Drug administration

• Pronouncement and certification of death

• Counselling of relatives

• Meeting reporting requirements

• Notification of the coroner’s office

• A maximum of two physicians are eligible to be paid K023 for the provision of medical assistance in dying.

K023 claims for procedural planning, case management, the provision of MAID and travel to patient’s home should be flagged to indicate patient encounter is for the provision of MAID. For these services, patient does not need to be palliative. (But they are using a code for palliative care and it doesn't have to be palliative care?)

Then this:

"If administration of the fatal dose of medication is by intravenous (IV), then G379 can be billed for insertion of the IV." (The charade continues.)

And this:

"A945 Special palliative care consultation is billed and time requirements are met (e.g., K023 is eligible for payment with A945 when duration of the consult exceeds 50 minutes)."

If you look at the Schedule of Benefits Physician Services Under the Health Insurance Act, nowhere does it say to use any of these codes for MAID. In fact MAID is never even mentioned at all in this 990 page document. Clearly a separate (hidden) document had to be created to guide doctors how to bill OHIP when they euthanize their patients. At least Quebec and Alberta don't hide their costs to kill patients. 

So this is really a double cover up: 1) no accurate costs of the dollars spent to kill patients, and 2) inflate the dollars spent on Palliative Care.

The adjective wicked comes to mind.