Virtual Care: An Integral Part of Total Health Care Delivery

The pandemic has forced Ontario’s health care system to adjust and find a balance in caring for COVID-19 patients as well as patients with other health issues.  While this has required the provincial government to make some difficult decisions, such as ramping down at times non-emergent or non-urgent surgeries and procedures to preserve system capacity, the pandemic has also presented new opportunities to enhance the delivery of medical care.   A good example is the expanded use of virtual care and the experience this has given providers regarding the advantages of this method of delivery.

In general, 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.

In March 2020, the Ontario government introduced virtual care fee codes in the OHIP Schedule of Benefits on a temporary basis.  This change allowed for payment of physician consultations and assessments when provided to patients and/or patient representatives by telephone or video conferencing.  These codes have been essential to maintaining patient access to medical care during the pandemic while limiting the spread of COVID.  It is also now evident that, when used appropriately, it can be a valuable component of a total care delivery package.

The key advantages to virtual care include:

1. Convenience to patients, who are able to stay at home (or work) and still receive care.
2. Flexibility of scheduling, including extension of hours to evenings and week-ends.
3. Reduced cost to patients for travel and parking.
4. Environmental benefits related to reduced travel.
5. Improved access and safety for the frail and elderly.
6. A greater opportunity for participation in the patient visit by family members.
7. Reduced likelihood of transmission of infectious diseases to patients from the medical facility itself including of COVID and seasonal flu.

The virtual care fee codes allow Ontario’s cardiologists to see patients remotely, while at the same time provide in-office care under strict public health protocols when diagnostic testing or an in-person physical exam is needed.  Those who need to be seen or want to be seen, are seen in-person; and those who prefer virtual care, where medically safe, are accommodated.

The OAC strongly supports virtual care and believes it should be expanded and made an integral part of total health care delivery.  To do so effectively, three things are required.

First, the temporary virtual care fee codes in the OHIP Schedule of Benefits, which are set to expire on September 30, 2022, must be made permanent.

Second, the constituent element definitions of consultations and assessments contained in the OHIP Schedule of Benefits including the medical circumstances requiring an in-person physical exam, must be updated (the current definitions are more than 40 years old) to fully leverage virtual care services today and beyond the pandemic.

Third, professional guidance for employing virtual care services must be developed for each medical specialty, to ensure all physicians understand when and how virtual care services can best be employed in delivering overall patient care.  The OAC has undertaken the development of such professional guidance for Ontario’s cardiologists and looks forward to sharing it with the government and other provincial regulatory authorities.