Quebec ophthalmologists question low prices offered by LASIK MD for outsourced cataract surgeries

As several health-care institutions in the Montreal area prepare to award millions in contracts to the private sector when they outsource eye surgeries, Quebec's association of ophthalmologists is raising concerns about the quality of care that patients will receive.

An analysis of the bids submitted shows that one of the biggest players in the industry, Vision Group/LASIK MD, is offering its services at less than $600 per procedure.

But professionals in the ophthalmology industry argue that is below cost and could interfere with patient care.

"We don't want to impugn anyone's intentions, but we have to ask ourselves questions and ensure that the quality is good," said Dr. Salim Lahoud, president of the ophthalmologists association, AMOQ.

Other bids ranged from $850 to over $1,000 per procedure.

In the province's public health network, cataract surgery costs $1,573.

Those amounts, whether in the public or private sector, do not include the doctors' pay, which is covered by Quebec's health insurance board (RAMQ).

Over the next five years,185,000 cataract operations — expected to cost at least $115 million — will likely be outsourced, according to data compiled by Radio-Canada.

Dr. Lahoud says he shared his concerns with the Health Ministry and the Federation of Medical Specialists of Quebec.

But Vision Group/LASIK MD president Dr. Mark Cohen denies offering below-cost prices for cataract surgeries. He says his business' cost structure allows the group to make a lower bid.

"It's a little lower than $600 and we would never bid at a price where we would lose with each surgery. That I can guarantee," said Dr. Cohen, who explained that LASIK MD rooms are typically used one day per week."We have four days when it's empty, but we already have all the infrastructure and all the equipment, so we don't have any fixed costs to add."

Dr. Cohen says that his business has significant purchasing power, particularly for intraocular lenses, given that it performs more than 100,000 ophthalmic surgeries every year in Canada, while a typical hospital in Quebec will do 3,000 cataract surgeries a year.

The Health Ministry said by e-mail that it has "no reason to believe that the company that wins the call for tenders would not offer quality services, since the MSSS and the institutions have all the necessary leverage if the services are not up to standard."

Competition questions

Under Canada's Competition Act, it is illegal to charge below cost with the aim of squeezing out competition only to charge high prices later. But prices that are legitimately low can benefit the public purse.

"In the short term, if bidding at a low price allows the public to have a better price, and it affects competition without eliminating it, that's OK," said Prof. Pierre Larouche, who teaches competition law at the Université de Montréal

He also says it's in the best interest of the public health network to maintain competition among its private sector suppliers.

"If we take a long-term perspective, we must make sure to have competition during the first round of public contracts, but also for the second and third rounds," he said. "I don't know if the network has the foresight to do that with five-year contracts here [with options].

For its part, the Health Ministry said in an email that the call for tenders helps create competition with the hope of improving the performance of the health and social services network."