OAC Information Webinar – Wednesday, June 7, 2023 at 8:00pm
The next event in the OAC’s 2023 Monthly Update Webinar Series will be held on Wednesday, June 7, 2023 at 8:00pm.
Join us to receive updates on the OAC’s advocacy initiatives this spring and summer.
To register your attendance for the webinar, click here: https://attendee.gotowebinar.com/register/1527184698973639002.
Ontario Association of Cardiologists
410 – 250 Eglinton Ave. East
Toronto, ON M4P 1K2
Tel: 416-487-0054
Toll-Free: 1-877-504-1239
E-mail: [email protected]
Web: www.ontarioheartdoctors.ca
OAC Information Webinar – Wednesday, March 29, 2023 at 8:00pm
The next event in the OAC’s 2023 Monthly Update Webinar Series will be held on Wednesday, March 29, 2023 at 8:00pm.
Join us to receive updates on the Association’s advocacy initiatives this spring.
To register your attendance for the webinar, click here: https://attendee.gotowebinar.com/register/2909426942642716757.
Ontario Association of Cardiologists
34 Eglinton Ave. West, Suite 410
Toronto, ON M4R 2H6
Tel: 416-487-0054
Toll-Free: 1-877-504-1239
E-mail: [email protected]
Web: www.ontarioheartdoctors.ca
2023 Budget: Recommendations for Enhancing Cardiac Patient Care in Ontario
Ontario’s cardiologists welcomed the opportunity to provide the Ontario government with fiscal recommendations for enhancing cardiac patient care in the 2023 Ontario Budget through its submission to the Standing Committee on Finance and Economic Affairs on Tuesday, February 14, 2023.
Our recommendations include:
1. Remove restrictions to telephone-based virtual care for seniors, people on social assistance, and those who live in rural and remote areas of the province that lack access to high-speed internet needed to support the use of video technology. Telephone-based virtual care services should be funded equal to video conferencing and in-person care for these patients.
2. Permanently restore the chronic disease assessment supplement for cardiac specialist treatment and care of heart failure patients in the community beginning April 1, 2023.
3. Sign a bilateral agreement with the federal government to secure new health care funding and use a portion of it to support and improve the delivery of cardiac care through the province’s community-based outpatient clinic infrastructure. The creation of a professional practice expense recovery fee for out-of-hospital ambulatory care in the OHIP Schedule of Benefits is proposed as a mechanism for achieving this objective.
We look forward to working with the provincial government to implement these ideas in 2023.
Click here to read the OAC’s 2023 Ontario Budget submission.
For more information, contact:
Tim Holman, Executive Director
Ontario Association of Cardiologists
Tel: 416-487-0054
E-mail: [email protected]
OAC Information Webinar: Wednesday, January 25, 2023 at 8:00pm
The next event in the OAC’s 2023 Monthly Update Webinar Series will be held on Wednesday, January 25, 2023 at 8:00pm.
Join us to receive updates on various initiatives including the EQI Program, virtual care advocacy and more.
To register your attendance for the webinar, click here: https://attendee.gotowebinar.com/register/748133428581186649.
Ontario Association of Cardiologists
34 Eglinton Ave. West, Suite 410
Toronto, ON M4R 2H6
Tel: 416-487-0054
Toll-Free: 1-877-504-1239
E-mail: [email protected]
Web: www.ontarioheartdoctors.ca
OHIP INFOBulletin: Virtual Health Care in Ontario
The Ministry of Health issued an OHIP INFOBulletin today outlining the details of Ontario’s virtual care framework implemented on December 1, 2022.
The INFOBulletin can also be accessed here: OHIP Bulletin- Virtual Care (December 2022)
The OAC continues to advocate for exemptions to the virtual care framework to permit better access to telephone-based virtual care services for those who do not or cannot use video conferencing technology (e.g. many seniors) and/or do not have access to high speed internet that is needed to deliver video-based virtual care.
For more information, contact:
Tim Holman, Executive Director
Ontario Association of Cardiologists
34 Eglinton Ave. West, Suite 410
Toronto, ON M4R 2H6
Tel: 416-487-0054
Toll-Free: 1-877-504-1239
E-mail: [email protected]
Web: www.ontarioheartdoctors.ca
Ontario Seniors and Rural Patients Will Be Hurt By New Virtual Care Rules
Cardiologists say Doug Ford Government Must Make Changes Before December 1st Deadline
TORONTO, Nov. 17, 2022 /CNW/ – Ontario cardiologists are appealing to the Ontario government to make changes to new rules that will govern the delivery of virtual care services across the province starting December 1, 2022.
The new rules prohibit or cut funding for virtual care services that cardiac patients have been able to receive by telephone for the past two-and-a-half years. Specifically, virtual consultations on new patients will only be allowed if provided by video conferencing (e.g. Zoom). Furthermore, funding for follow-up virtual patient visits provided by telephone will be cut. These restrictions will affect many Ontario seniors and rural patients, who either do not use video technology or are unable to use it because of a lack of high-speed internet, and will force them to go to their cardiologist’s office to receive these services.
“We are very concerned about elderly patients who don’t use computers and those without internet access who will once again have to travel long distances to see a specialist,” said Dr. Richard Davies, Vice Chair of the OMA Section on Cardiology and Board Member of the Ontario Association of Cardiologists. “With COVID cases expected to rise this winter, patients may be anxious about going into a busy cardiologist’s office. Unnecessary travel is also difficult and time consuming for them and their family members who often must accompany them.”
Since the onset of the pandemic, patients have embraced telephone virtual care services. Cardiologists use telephone virtual care for appropriate patients for whom video conferencing does not work. This can occur because of a lack of sufficient internet bandwidth, or because the patient is simply uncomfortable using the necessary technology. An important lesson cardiologists learned during the pandemic is that medically appropriate, high quality virtual cardiac consultations and follow up visits can be performed successfully by telephone as long as best practice guidelines are followed.
Significant Patient Cost Savings Associated With Virtual Care
Last month, researchers at ICES, Lawson Health Research Institute, and Western University published a study showing that virtual care provided in Ontario during the pandemic was associated with a significant reduction in patient travel-related expenses. For more than 10 million patients with at least one virtual appointment during the study period (63 million visits in total), virtual care was associated with estimated savings of:
- 2 billion kilometres of patient travel; and
- $569 to $733 million in patient expenses for gasoline, parking, or public transit.
Importantly, 91% of the virtual patient visits done during the study were conducted by telephone. With the new virtual care rules that restrict telephone patient visits coming into effect on December 1st, patient costs associated with accessing care will rise.
“There is no medical, financial, or clinical reason to prohibit new patient visits or reduce funding for follow-up visits provided by telephone. The new rules make it more difficult and more expensive for patients to receive the timely cardiac care they need,” said Dr. Davies. “For the sake of Ontario seniors and rural patients across the province, we call on the Ford government to remove the restrictions on telephone virtual care services contained in the new rules that come into effect on December 1, 2022.”
For further information:
Tim Holman, Executive Director
Ontario Association of Cardiologists
Tel: 416-487-0054
E-mail: [email protected]
Toronto Star: Phone appointments with doctors can be life-changing. So why is Ontario devaluing them?
On November 10, 2022, Toronto Star Data Reporter Patty Winsa’s article was published outlining the impact that Ontario’s new virtual care rules will have on patient care starting December 1, 2022. The article, which is behnd the Toronto Star’s paywall, can be found here: https://bit.ly/3TqCpak
The OAC is mentioned in the article and OAC Board Member Dr. Richard Davies was interviewed. An excerpt is provided below:
Organizations such as the Ontario Association of Cardiologists, as well as some Ontario hospitals, have contacted the government to make the case that phone appointments are not only necessary in some cases, but are effective and worked well during the pandemic.
The [Physician Services] agreement says that when a patient is referred to a specialist, that first consultation has to be done in person or by video, and not by phone.
Dr. Richard Davies, spokesperson for the cardiologists association, says he’s very concerned that elderly patients who don’t use computers, or those without internet, will once again have to travel long distances to see a specialist for a referral. Davies is on the board of the Ontario Association of Cardiologists and is also the vice-chair of the OMA section on cardiology.
In its letter to the government, the association argued that “the new requirements do not acknowledge the current ‘digital divide’ i.e. inequality in patient access to technology in Ontario, and (will) force patients with limited digital literacy or without access to technology to obtain care differently and at greater expense than other patients.”
“It’s a tremendous burden,” says Davies. “Patients are usually exhausted by the whole experience. And then they’re scared as well, because even now they don’t like being in waiting rooms with lots of patients,” due to COVID.
Davies believes a consultation by phone is just as effective, something many specialists discovered during the pandemic. Doctors can get to know a patient, ask about their medical history and arrange tests before they have an in-person appointment.
“It’s about the patient and the relationship with the provider and making sure you have the information,” says Davies.
For more information, please contact:
Ontario Association of Cardiologists
34 Eglinton Ave. West, Suite 410
Toronto, Ontario
M4R 2H6
Tel: 416-487-0054
Toll-Free: 1-877-504-1239
E-mail: [email protected]
Web: www.ontarioheartdoctors.ca
ICES: Virtual care associated with significant environmental and patient cost savings
Prior to the pandemic, less than two per cent of patient visits with physicians took place virtually. The beginning of the pandemic (April-June 2020) triggered a rapid transition to virtual visits, which soared to 70 to 80 per cent, and then stabilized at 50 to 60 per cent of all physician visits.
This cross-sectional study published in JAMA Network Open used healthcare administrative data from Ontario, Canada to identify all patients with at least one virtual care visit between March 2020 and December 2021.
“Virtual care has become an important part of the healthcare system in Ontario, and in addition to improved patient convenience, it results in significant environmental and financial benefits for patients” says lead author Dr. Blayne Welk, associate professor of surgery at Western’s Schulich School of Medicine & Dentistry, urologist at St. Joseph’s Health Care London, associate scientist at Lawson, and adjunct scientist at ICES Western. “The financial and environmental benefits of virtual care will likely continue beyond the pandemic and are particularly relevant for some patients who were frequent recipients of virtual care.”
Findings show that for more than 10 million patients with at least one appointment during the study period (63 million visits in total), virtual care was associated with estimated savings of:
- 3.2 billion kilometres of patient travel;
- 545 to 658 million kilograms of carbon dioxide (CO2) emissions; and
- $569 to $733 million (Canadian [US $465-$599 million]) in expenses for gasoline, parking, or public transit.
The avoidance of carbon dioxide emissions during the pandemic due to virtual visits represented approximately 0.2 per cent of the total annual carbon dioxide emissions (150 megatons) from Ontario.
The number of virtual care visits was greater for those aged 65 and older, individuals with multiple health conditions, and those living in urban areas. Due to distance travelled, virtual care may offer more potential environmental benefits and patient cost savings for rural residents. Other factors, such as decreased time off work (given that some virtual visits can be done during the day with little interruption to work) may have had additional benefits for some working adults and parents of young children.
“Virtual visits should not replace all in-person visits, but they are an important option that can enhance the care that physicians provide for patients” says Dr. Alexandra Zorzi, a paediatric oncologist at Children’s Hospital at London Health Sciences Centre and associate scientist at Lawson. “Our findings suggest that physicians should continue to offer virtual care appointments when appropriate, especially for patients living in more remote areas and those that have barriers to accessing in-person health care.”
The study, “Association of virtual care expansion with environmental sustainability and reduced patient costs during the COVID-19 pandemic in Ontario, Canada” was published in JAMA Network Open.
Author block: Welk B, McArthur E, Zorzi AP.
ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario
Lawson Health Research Institute is one of Canada’s top hospital-based research institutes, tackling the most pressing challenges in health care. As the research institute of London Health Sciences Centre and St. Joseph’s Health Care London, our innovation happens where care is delivered. Lawson research teams are at the leading-edge of science with the goal of improving health and the delivery of care for patients. Working in partnership with Western University, our researchers are encouraged to pursue their curiosity, collaborate often and share their discoveries widely. Research conducted through Lawson makes a difference in the lives of patients, families and communities around the world. To learn more, visit www.lawsonresearch.ca.
ABOUT WESTERN
Western University delivers an academic experience second to none. Since 1878, The Western Experience has combined academic excellence with life-long opportunities for intellectual, social and cultural growth in order to better serve our communities. Our research excellence expands knowledge and drives discovery with real-world application. Western attracts individuals with a broad worldview, seeking to study, influence and lead in the international community.
Globe & Mail: Changes to virtual care billing in Ontario raise concerns over health care access
On October 7, 2022, Globe and Mail Health Reporter Carly Weeks wrote an article on the issue of Ontario’s new virtual care rules that will be implemented on December 1, 2022. The article, which is behind the Globe and Mail’s paywall, can be found here: https://t.co/cJrOOY5qRB.
OAC Board member Dr. Richard Davies was interviewed for the article. An excerpt follows:
Richard Davies, an Ottawa cardiologist and board member of the Ontario Association of Cardiologists, said the elimination of coverage for phone-based new patient visits will make it difficult for vulnerable patients to access virtual care. For instance, Dr. Davies said he sees many elderly patients who live outside of Ottawa who aren’t able to use technology for video calls, leaving them to travel lengthy distances for a visit that could have been done over the phone.
The changes will make it harder for people who live in parts of Ontario that don’t have high-speed internet or people who can’t afford the technology to access virtual care, he said.
“It becomes an accessibility barrier,” Dr. Davies said.
For more information, contact:
Tim Holman, Executive Director
Ontario Association of Cardiologists
34 Eglinton Ave. West, Suite 410
Toronto, Ontario M4R 2H6
Tel: 416-487-0054
Toll-Free: 1-877-504-1239
E-mail: [email protected]
New Virtual Care Rules in Ontario Delayed Until December 1, 2022
The Ontario Association of Cardiologists (OAC) welcomes the delay in the implementation of the new virtual care rules in the province to December 1, 2022; however, without substantive change, we remain concerned that patient access to virtual care will be severely restricted under the new rules.
The new rules severely restrict patient access to telephone-based virtual services, which will hurt those patients who cannot or choose not to use video conferencing technology (i.e. many seniors); cannot afford video conferencing technology; or live in areas of the province without access to high-speed Internet required to support video conferencing technology.
OAC Position on Virtual Care
Virtual care is intended as a tool for use by a physician who will at other times see the patient in person according to their needs. It is not intended for use by physicians who would not otherwise see the patient in person, and who cannot provide the patient with appropriate in-patient services, testing and follow up as needed in a location that is geographically accessible to the patient. Virtual care must be conducted in a way that does not compromise the standard of care. More background can be found here: OAC Virtual Care Position.
Ontario’s cardiologists call on the Ministry of Health to postpone indefinitely the implementation of the new virtual care rules to allow for further discussions on a new virtual care framework aimed at preserving patient access to telephone-based consultations and follow-up virtual visits if medically appropriate and it is their preference.
For more information, contact:
Tim Holman, Executive Director
Ontario Association of Cardiologists
34 Eglinton Ave. West, Suite 410
Toronto, Ontario M4R 2H6
Tel: 416-487-0054
Toll-Free: 1-877-504-1239
E-mail: [email protected]
2022 Annual General Meeting – Wednesday, September 28, 2022 at 8:00pm
The OAC is holding the 2022 annual general meeting for members on Wednesday, September 28, 2022 at 8:00pm for the following purposes:
- to approve the minutes of the previous members’ meeting (September 29, 2021);
- to approve the financial statements of the Corporation for the year ended June 30, 2022;
- to confirm the directors of the Corporation;
- to appoint the accountants and authorize the directors to fix their remuneration;
- to transact such further and other business as may properly come before the meeting or any adjournment or adjournments thereof.
In addition to the above, the following items will be addressed on the agenda:
- Board Report
- Membership Update
- 2021 Physician Services Agreement – Cardiology Allocation (Years 1 & 2)
- 2021 Physician Services Agreement – Virtual Care
- EQI Program
- Other Initiatives
- New Business
- Adjournment
OAC members may register their attendance by clicking here: https://attendee.gotowebinar.com/register/3471479690927519246.
Members who are not able to be present are requested to sign, date and return the proxy form electronically to [email protected] .
If you have any questions or comments, please contact the OAC office at:
Ontario Association of Cardiologists
34 Eglinton Ave. West, Suite 410
Toronto, Ontario M4R 2H6
Tel: 416-487-0054
Toll-Free: 1-877-504-1239
E-mail: [email protected]
Fall 2022 Information Webinar Schedule Announced
The OAC has announced its Fall 2022 Information Webinar schedule. These members-only meetings will be held on:
- Wednesday, September 28, 2022 at 8:00pm. Note: This will also be the 2022 OAC Annual Meeting. For more details, please consult the Official Notice. Registration link: https://attendee.gotowebinar.com/register/3471479690927519246
- Wednesday, October 26, 2022 at 8:00pm. Registration link: https://attendee.gotowebinar.com/register/8933959010835152396
- Wednesday, November 30, 2022 at 8:00pm. Registration link: https://attendee.gotowebinar.com/register/3752978856894225420
We invite all OAC members to join us for these meetings to learn more about the Association’s advocacy initiatives and provide feedback on our activities.
For more information, please contact the OAC office at:
Ontario Association of Cardiologists
34 Eglinton Ave. West, Suite 410
Toronto, ON M4R 2H6
Tel: 416-487-0054
Toll-Free: 1-877-504-1239
E-mail: [email protected]
Web: www.ontarioheartdoctors.ca
Cardiac Patient Access to Virtual Care Services in Ontario Threatened Effective October 1, 2022
Issue
In February 2022, the Ontario Medical Association and the Ministry of Health signed a physician services agreement (PSA) that makes virtual care – i.e. the provision of quality medical care without in-person contact – a permanent part of Ontario’s healthcare landscape. A close examination of the PSA’s virtual care provisions, however, reveals a fatal flaw. These provisions require that all new patient virtual visits be conducted by videoconferencing, not by telephone. These provisions also significantly reduce the already very low fees paid for follow-up patient virtual visits if they are conducted by telephone.
These measures will dramatically restrict virtual care services for patients without access to video conferencing technology. This includes some of Ontario’s most vulnerable populations: the elderly who are uncomfortable with video conferencing technology; those who cannot afford it; and those who live in rural and remote areas that have insufficient internet access or bandwidth to support it.
Background
Virtual Care Experience
For more than two years, Ontario physicians have embraced virtual care as a way of providing quality patient care without in-person contact. This strategy, which was done in an effort to limit the spread of COVID, has proven to be very effective. While only 1.3 per cent of Ontario residents had participated in virtual care prior to the pandemic, by the second quarter of 2020 utilization had exploded to 29.2 per cent, with 85.9 per cent of Ontario physicians participating.
Temporary Fee Codes
This virtual care activity was supported by the Ministry of Health via the addition of temporary fee codes in the OHIP Schedule of Benefits. Under the temporary codes, fees paid for specialist consultations and assessments provided by telephone or video conferencing were equivalent to the fees provided for an in-person consultation or visit. Under the new PSA however, new patient visits provided by telephone are prohibited and fees paid for follow-up visits provided by telephone are cut by 15%.
Telephone vs. Video Conferencing
There is no medical, financial, or clinical reason to prohibit new patient visits or discount follow-up visits provided by telephone. The same staff time, chart preparation, advance patient interaction (i.e. booking and confirmation) is required regardless of the virtual care visit format.
Experience during COVID has shown that video often adds very little to a virtual visit over that which can be accomplished by telephone alone. Patients are very comfortable talking on the phone, and often give more detailed histories. Often one or several family members become part of the call. This enriches the information available to the physician and can often take more time.
OAC Concerns
Patients who do not have access to, or are uncomfortable with, video conferencing technology will be forced to go to their physician’s office to receive care that they can easily get via telephone. In so doing, the OAC is concerned that:
Health: Patients will be exposed to the transmission of infectious diseases in the physician’s office or other places on their way to and from the in-person visit.
Economic: Patients and their families will be hit in the pocketbook e.g. cost of fuel, parking, etc. by driving to unnecessary in-person medical appointments.
Environment: More people will be forced to use personal vehicles, which are a major cause of global warming and climate change, to get to their in-person medical appointments.
Increased Government Expenditures: Government spending will increase on such programs as the Northern Health Travel Grant, which helps patients and their families pay for transportation and hotel costs when going to other regions for in-person medical care.
Digital Divide Blind Spot: The new requirements do not acknowledge the current “digital divide” i.e. inequality in patient access to technology in Ontario, and force patients with limited digital literacy or without access to technology to obtain care differently and at greater expense than other patients.
Timing
The PSA’s virtual care provisions come into effect on October 1, 2022. In the meantime, the existing temporary virtual care fee codes remain in effect.
Proposed Solution
Ontario’s cardiologists call on the Ministry of Health to work with the OAC and the OMA to restore funding for telephone-based new patient virtual visits and follow-up virtual visits after October 1, 2022 to ensure that all Ontario patients, regardless of their digital proficiency, economic circumstances, and geographic location, have access to the full suite of virtual care services.
For more information, contact:
Tim Holman, Executive Director
Ontario Association of Cardiologists
Tel: 1-877-504-1239
E-mail: [email protected]
Dr. Joel Niznick (1954-2022)
The OAC mourns the passing of former OAC Board member Dr. Joel Niznick. We remember his significant contributions to the Cardiology specialty in Ontario, to his patients in Ottawa and to our organization. In addition to his family and friends, he will be greatly missed by his many colleagues and patients.
Dr Joel Marvin Niznick
Peacefully on Friday, April 8, 2022, Joel Niznick passed away. His passing is an incredible loss to his family and friends and to the Ottawa community.
Joel will be missed by his wife, Dr. Barbara Power, and their three children, Harrison, Naomi and Liam and his siblings Judi Donoff (his twin sister), Sharon Glass (Arnold Glass) and Gerald Niznick (Reesa Niznick), his sisters-in-law and brothers-in-law Ellen Power, Mary Power, Edward Power, P.J. Powers (AnneMarie Talent) and George Power (Lorraine Vardy) and his many nieces and nephews.
Joel was born in Fort Frances, Ontario and was raised in Winnipeg. His Jewish faith and commitment to the Jewish community was very important to him. He was a proud protector and provider for his children and family, and he always made sure they were well looked after. His interests were broad and varied from medicine to wine, cooking, traveling, design, cars, golf, NFL and music. There was nothing Joel wasn’t interested in – he embraced each interest with depth and passion.
He completed his Medical school at the University of Manitoba, his internal medicine training in Toronto and his cardiology subspecialty training in Ottawa. He led the development of the Ottawa Cardiovascular Centre (OCC), one of Ontario’s most advanced Cardiology care providers. Joel was a strong advocate and champion for excellence and continuity in patient care. He was a forward thinker and always was looking to ensure excellence in the delivery of care. He loved his patients and he thought of them like family that needed to be protected. He became a vital link in building community-academic hospital bridges.
The world has lost an extraordinary and admirable man who will be deeply missed by his family and friends.
Ontario Association of Cardiologists
34 Eglinton Ave. West, Suite 410
Toronto, Ontario M4R 2H6
Tel: 416-487-0054
E-mail: [email protected]
Davies: Making virtual visits a permanent part of Ontario health care is good. But it must be done right
The Ontario Medical Association and the Ministry of Health have proposed a new Physician Services Agreement and physicians are now voting on the proposal. There are important flaws, however.
Opinion | Ottawa Citizen | March 24, 2022 | https://bit.ly/3ICdrPS
Over the past two years, one of the ways COVID-19 affected health care was to reduce access to in-person visits with physicians. This was done to help limit the spread of COVID but had the unintended side effect of jeopardizing the care of non-COVID medical conditions. Ontario’s physicians identified and rose to this challenge, embracing virtual care as a way of providing quality care without in-person contact.
This strategy proved very effective. While only 1.3 per cent of Ontario residents had participated in virtual care prior to the pandemic, by the second quarter of 2020 utilization had exploded to 29.2 per cent, with 85.9 per cent of Ontario physicians participating. This activity was supported by the Ministry of Health via the addition of temporary fee codes.
Two years of hands-on experience have shown that virtual care can also have a tremendous, positive impact on patients and their families beyond COVID. Most medical visits can be effectively conducted virtually without a decrease in the quality of care. Virtual care avoids the tremendous time loss, inconvenience and expense experienced by patients and their families that is associated with in-person visits.
We also learned that most virtual visits could be effectively conducted by telephone alone and that the addition of video added surprisingly little medical value. Also, while video was relatively easy to implement on the physician’s side, it was often a technological challenge and hassle for patients. As a result, 91.2 per cent of virtual visits conducted in Ontario in 2020 were done by telephone alone, with overwhelmingly positive feedback from our patients.
Today, we are at an important crossroad. The Ontario Medical Association and the Ministry of Health have proposed a new Physician Services Agreement (PSA) that will make virtual care a permanent part of Ontario’s health-care landscape. All Ontario physicians are voting on this proposed agreement from March 22 to 27.
While much of it is worthy of support, a close examination of the virtual care provisions reveals a fatal flaw. Specifically, these provisions require that all virtual care patient consultations be done by videoconferencing, not by telephone. These provisions also significantly reduce the already very low fees paid for follow-up visits if they are conducted by telephone.
Taken together, these important details will dramatically limit access to virtual care services for patients without access to video conferencing technology. This includes some of Ontario’s most vulnerable populations: the elderly who are uncomfortable with this technology; those who cannot afford it; and those who live in rural and remote areas that have insufficient internet access or bandwidth to support it.
Virtual care should not compromise the standard of care, nor should it be conducted in circumstances where a virtual visit will not be equivalent to an in-person visit. Accordingly, physicians providing telephone care must also be able to provide video care at the patient’s discretion, and in-person care whenever it is medically necessary or the patient’s preference.
When done under these guidelines, the amount of expertise, work and physician time that goes into a telephone visit is at least equivalent to a video or in-person visit. Experience has shown that patients are very comfortable speaking at length with their physician on the phone and often involve their families in these visits. As a result, telephone visits often take the physician more time than an equivalent in-person visit.
Virtual care, when conducted properly, offers tremendous benefits to patients in terms of time saved and expenses avoided. The proposed PSA correctly makes virtual care a permanent part of Ontario health care, but important details are wrong and need to be made right so that all of Ontario’s patients will benefit. For this reason, the OMA Section on Cardiology Executive and the Board of the Ontario Association of Cardiologists call on all doctors in Ontario to reject the proposed PSA, then work together to get it right.
Dr. Richard Davies is a practising cardiologist in Ottawa, vice-chair of the OMA Section of Cardiology, and a board member of the Ontario Association of Cardiologists.
For more information, contact:
Ontario Association of Cardiologists
34 Eglinton Ave. West, Suite 410
Toronto, Ontario
M4R 2H6
Tel: 416-487-0054
E-mail: [email protected]
Proposed Physician Services Agreement Eliminates Equitable Access to Patient Care
Ontario’s cardiologists recommend all physicians reject agreement
Toronto, March 18 – Ontario’s cardiologists say the Proposed Physician Services Agreement (PPSA) reached by the Ontario Medical Association and the Ministry of Health will hurt many patients, particularly seniors, low-income residents, and those living in rural and remote parts of the province by making virtual care services inaccessible to them.
This is because the new virtual care framework contained in the PPSA eliminates the opportunity for consultation by telephone. It also cuts payments for assessments performed by telephone such that doctors will no longer be able to offer this service. As a result, virtual care will only be available to those patients with access to the technology required for video conferencing.
“Patients have embraced telephone virtual care services since the onset of the COVID-19 pandemic,” said Dr. Richard Davies, Deputy Chair of the OMA Section on Cardiology, and a member of the Ontario Association of Cardiologists (OAC) Board of Directors. “The new services agreement makes virtual care inaccessible to many patients for whom travel to a medical appointment is often a significant burden to them and their families. Similarly, some elderly patients are not comfortable with the technology required for video consultations, and lower-income patients and patients in rural and remote locations may not have sufficient internet access or bandwidth. For two years, physician payments for all virtual care services have been equivalent to in-person visits, and physicians have found that it is often possible to deliver high quality care by telephone alone. Video and in-person visits can be targeted to specific situations where they truly benefit patients. There is no medical reason to restrict the use of telephone visits, and there are tremendous benefits in terms of reducing travel and the burden of care on patients and their families.”
Virtual Care – By the Numbers[i]
- The uptake of virtual care grew exponentially during the COVID-19 pandemic.
- Patients with the following health conditions were the greatest users of virtual care: mental health conditions, heart failure, COPD, angina, diabetes, hypertension and asthma; three of which (heart failure, angina, and hypertension) are primarily cared for by cardiologists.
- By the second quarter of 2020, 29.2 per cent of Ontario residents had one or more virtual visits, up from 1.3 per cent in 2019.
- In this same period, the percentage of physicians providing virtual care to meet the needs of Ontario patients rose to 85.9 per cent.
- Only 8.8 per cent of virtual visits in 2020 used video. The remaining 91.2 per cent were conducted successfully by telephone alone.
Ontario cardiologists strongly support virtual care because of its potential to improve access to high quality care while reducing time lost and unnecessary travel by patients and their families. It can also reduce the risk of exposure to infectious disease in doctors’ offices. However, to achieve these benefits, virtual care needs to be made accessible to all Ontario patients and the PPSA does not achieve this.
Ontario doctors vote on this agreement from March 22-27. The leadership of the OMA Section on Cardiology and the OAC call on all Ontario doctors to vote no, and demand from the Ontario government a PPSA that makes virtual care services available and accessible to all of Ontario’s patients.
For more information, visit: www.ontarioheartdoctors.ca
[i] R. Sacha Bhatia, Cherry Chu, Andrea Pang, Mina Tadrous, Vess Stamenova and Peter Cram. Virtual care use before and during the COVID-19 pandemic: a repeated cross-sectional study. CMAJ Open. February 17, 2021 9 (1) E107-E114. https://www.cmajopen.ca/content/9/1/E107