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.
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.
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.
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.
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
E-mail: [email protected]