Controversy arises over the Department of Social Protection's decision not to lower payments to doctors, writes MARTIN WALL
FEES PAID by the Department of Social Protection to GPs and other doctors for signing medical certificates escaped cuts imposed on other State payments because the rates were considered to have fallen behind in monetary value over recent years.
There was considerable controversy several weeks ago when it emerged on foot of a parliamentary question that the Department of Social Protection was paying GPs and other doctors almost €500,000 a week to sign medical certificates for workers claiming illness benefit payments.
Employees who are sick and out of work for more than three days can claim for illness benefit from the Department of Social Protection. Payment of the benefit requires a doctor to sign an initial certificate – effectively an application – following a medical examination and then to sign a further certificate on a weekly basis.
Under an agreement dating back several years, doctors are paid a fee of €8.25 for completing and submitting a form to the Department of Social Protection where they are satisfied that a patient is incapable of work due to some specific illness, disease or bodily or mental disablement.
However, due to the volume of certificates signed by doctors to allow workers to claim illness benefit, the overall payments involved are quite considerable.
On average, about 5,000 initial certificates, known as MC1 forms, are sent to the department each week, while 50,000 of the weekly certificates, known as MC2 forms, are completed.
According to the figures obtained by Labour Party TD Kevin Humphreys, the State is paying GPs more than €450,000 per week or in excess of €23 million per year for completing these forms for the Department of Social Protection.
Annually, on average, the department is paying €10,000 to participating doctors. Last year, however, the highest payment was almost €83,000, to a practice with 13 GPs.
At the time, Humphreys criticised the payments as “a ridiculous and unnecessary top-up” to doctors that the department and the Government could ill afford.
However, department files, seen by The Irish Times, show that the fees for signing medical certificates were assessed following the introduction by the then government of financial emergency legislation in 2009, and it was decided that they should not be reduced.
As part of a public consultation process, the department received submissions from the Irish Medical Organisation, two individual GPs and two consumers.
The IMO argued that GPs had fixed overheads in the region of 40-60 per cent of gross turnover. It also argued that there was no pension provision made for GPs in respect of services provided to the department.
The IMO maintained that the level of fees payable by the Department of Social Protection had already fallen behind as the rates had not been revised since an agreement expired in 2004.
No further deal was put in place as by that time the question of whether under competition law State agencies could negotiate with trade unions on professional fees for contractors had emerged.
“The IMO asked the Minister not to apply any reduction in payments to GPs in respect of social welfare certification. If any reduction in professional fees is applied, the IMO is of the view that national wage round increases (applicable since the expiration of the last agreement in 2004) should be applied right through to the last phase of the Towards 2016 (social partnership deal) prior to any reduction in the service fee”, the files state.
The two consumers argued to the department that healthcare professionals were grossly overpaid for the service they provided. The department officials, in assessing the submissions, maintained that if the national wage rounds had been applied since the last fee deal expired, the rate for signing medical certificates would stand at €10.06. The application of an 8 per cent cut would bring this fee down to €9.26.
The department said that it was not contractually bound to pay any increase since the expiration of the 2004 deal. However, it accepted that the rates that applied since 2004 had not “maintained their monetary value and have therefore fallen behind”.
“In real terms, the current rates are approximately 18 per cent less than would have applied if the rates had been increased by reference to the consumer price index.
“Notwithstanding the extent to which the fees have fallen behind, it could not be considered appropriate or reasonable in the current economic climate that the fee level be increased. Equally, however, it could not be considered appropriate or reasonable to further reduce rates, which are acknowledged to be less, in monetary value terms, than those which applied in 2004.”
The files state that the Department of Finance agreed that it would be unreasonable to cut the rates.
“It was also agreed that it would be timely to amend the department’s agreement with certifiers to include a formula for maintaining the monetary value of the fees on an annual basis in the future so that the same issues do not arise again.”