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
E-mail: [email protected]