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
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OAC Information Webinar on the OMA-Ministry of Health Proposed Physician Services Agreement
The OAC is holding an information webinar on Wednesday, March 16, 2022 at 8:00pm to review the proposed physician services agreement (PPSA), including the financial agreement, virtual care changes and other components of the agreement.
We invite you to attend the webinar to learn more and share your views about the PPSA. Please click on the following link to register for the webinar: https://attendee.gotowebinar.com/register/7303991293617492748.
Voting on the PPSA opens on Tuesday, March 22 and will conclude at the OMA’s special meeting of members on Sunday, March 27.
If you have any questions or comments, please contact the OAC office at:
34 Eglinton Ave. West, Suite 410
Toronto, Ontario M4R 2H6
Tel: 416-487-0054
Toll-Free: 1-877-504-1239
E-mail: [email protected]
OAC’s Recommendations for 2022 Ontario Budget
Dr. Richard Davies, Dr. Michael Hartleib and Dr. John Parker presented the Ontario Association of Cardiologists’ recommendations for the 2022 Ontario Budget at the Standing Committee on Finance and Economic Affairs this week as part of the committee’s budget consultations public hearings.
The OAC urges the provincial government to use the 2022 Budget to maintain and enhance virtual care services, support community-based congestive heart failure patient care, and better resource Ontario’s outpatient, ambulatory care infrastructure to ensure cardiac patients can get care when and where they need it.
To view the presenation, click here: https://youtu.be/dJLb-K9tPz0.
To read the OAC’s written submission to the committee, click here: OAC 2022 Ontario Budget Submission – SCFEA (January 26, 2022).
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]
24th Annual Canadian Society of Echocardiography Weekend: Feb. 4-6, 2022
The 24th Annual Canadian Society of Echocardiography (CSE) Weekend: Digital Edition is being held virtually from February 4-6, 2022.
This year a special session, the inaugural Dr. Jim Swan Lecture, has been added to the program. The OAC is pleased to be working with the CSE, with sponsorship provided by CorHealth Ontario, to promote this session in honour of former long-time OAC President Dr. Jim Swan, who passed away in June 2021 and whose contributions to the cardiology specialty and the field of echocardiography in Ontario are renowned. The special session will be held on Sunday, February 6th at 11:45am.
This year’s guest speakers are Dr. Tony Sanfilippo and Dr. Parvathy Nair who will be speaking on the topic: “Evaluation of competency in echocardiography training”. OAC Board member Dr. John Parker will introduce the session and guest speakers.
For more information on the 2022 CSE Echo Weekend, including the “Program-at-a-Glance” and registration details, click here: https://csecho.ca/2021/10/19/24th-annual-cse-echo-weekend-digital-edition-save-the-date/.
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2021 Monthly Update Webinar Series Event: Wednesday, November 24, 2021 at 8:00pm
The next event in the OAC’s 2021 Monthly Update Webinar Series will be held on Wednesday, November 24, 2021 at 8:00pm.
Join us to receive updates on the EQI program, OMA issues (including the 2021 PSA Negotiations), COVID-19 developments, and other advocacy initiatives.
To register your attendance for the webinar, click here: https://attendee.gotowebinar.com/register/4073947184218688782
If you have any questions or comments, please contact the OAC office at:
34 Eglinton Ave. West, Suite 410
Toronto, Ontario M4R 2H6
Tel: 416-487-0054
Toll-Free: 1-877-504-1239
E-mail: [email protected]
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OAC Position on COVID-19 In-Person and Virtual Care Services
November 5, 2021
Dr. Kieran Moore
Chief Medical Officer of Health
Ministry of Health
Mr. Patrick Dicerni
Assistant Deputy Minister
OHIP, Pharmaceuticals and Devices Division, Ministry of Health
Dr. Nancy Whitmore
Registrar and CEO
College of Physicians and Surgeons of Ontario
Dear Dr. Moore, Mr. Dicerni, and Dr. Whitmore:
On behalf of the Ontario Association of Cardiologists (OAC), we are writing to express concerns over your recent letter to Ontario physicians regarding the provision of in-person and virtual care at this stage of the COVID-19 pandemic. Specifically, we take issue with (1) your assertion that COVID-19 no longer poses a barrier to in-person practice; (2) your contention that physicians’ offices are not providing in-person care; and, (3) the implied threat of disciplinary action that may be taken against physicians if they do not see patients in-person.
While hospitalizations and incidents of severe illness have dropped recently in Ontario, COVID-19 remains a concern for all front-line doctors, including cardiologists, who must continue to vigilantly operate their clinical practices in ways that ensure the protection of their patients and staff when seeing vaccinated and unvaccinated patients. While not insurmountable, it must be acknowledged that COVID-19 continues to present important barriers to in-person practice.
Ontario’s cardiologists have remained accessible to their patients since the beginning of the COVID-19 pandemic by keeping their offices open for in-person visits as well as through virtual care appointments. Throughout all stages of the pandemic, cardiologists worked hard to strike a suitable balance between providing in-person and virtual care services taking into account such factors as PPE availability, social distancing protocols, staffing requirements, patient preferences, vaccination rates, and much more. In so doing, we succeeded in ensuring that patients had access to elective and emergency cardiac care in the community and hospitals all across the province.
Your letter asserts that the standard of care is often difficult to meet in a virtual environment. We disagree. In the Cardiology specialty, a significant amount of objective information comparing past and present test results is used along with an updated history from the patient, which can readily be obtained virtually. In fact, cardiologists have found that having several family members present in the patient residence at the time of a video or telephone virtual visit results in a more robust and reliable history about matters such as functional status and symptoms. There are many circumstances in our specialty in which virtual care is superior to an in-office visit.
Cardiac patients are often extremely elderly with advanced poly-morbidities. These factors as well as their cardiac condition itself put them at great risk from exposure to viral pathogens like COVID-19 and others such as Influenza. Conducting virtual visits, where clinically appropriate, and avoiding crowded waiting rooms reduces their exposure to these pathogens.
Virtual care expansion in the province has also improved access to specialist care for patients who live in remote areas, reducing the need to travel many hours to urban centres for routine cardiovascular care. This expansion in reach and scope of services is an important enhancement to the provision of cardiovascular care across the province. Furthermore, the response from the general public has been very positive. Patients are pleased to receive care in their own locations without the need to travel or wait in crowded waiting rooms. Primary care physicians in remote areas have also indicated that their access to cardiology specialty support has improved during the pandemic due to new virtual care options.
The OAC agrees that in-person care is essential for certain conditions or where physical assessments are necessary to make an appropriate diagnosis or treatment decision; however, the COVID-19 pandemic has taught us that the standard of care can be met without an in-office visit in certain circumstances. When used properly and responsibly, virtual care can be an extremely effective way to provide excellent care that reduces COVID risk to all patients and staff regardless of vaccination status.
Our profession must live up to the responsibility of providing timely and appropriate care for patients. Cardiologists in Ontario believe we have done this, and we object to a generalization that we may not have done so. If it is the case that some patients no longer have reasonable access to care (virtual or in-person) then the Ministry of Health and/or the College of Physicians and Surgeons of Ontario should develop a mechanism to quantify and address the problem on a specialty-by-specialty basis. As individual practitioners in specialty practice, cardiologists have heard many patients state they feel abandoned with respect to certain aspects of their care. We encourage the College, the Ministry and the OMA to explore this in more detail. Best practice guidelines for virtual care are long overdue and will benefit many Ontario patients. We encourage our leaders to develop such guidelines, and stand ready to provide our clinical expertise and experience to help accomplish this.
Finally, Ontario physicians are best suited to decide which patient visit is appropriate to do virtually and which requires in-person assessment. To assist cardiologists in making these decisions, the OAC is developing a guideline framework outlining the appropriate circumstances for in-person and virtual visits for meeting the standard of cardiac patient care. We believe this timely initiative will improve patient outcomes, protect physicians and staff, and meet broader public health objectives. We look forward to working with you to improve Ontario’s virtual care framework and ensure it is used appropriately and in a way that improves access to, and the safety of, health care for all Ontario residents.
Sincerely,
John D. Parker, MD, FRCPC Richard Davies, MD, PhD, FRCPC
Board Member Board Member
c.c. Dr. Adam Kassam, OMA President
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OAC supports call to publicly fund transcatheter valve-in-valve implantation for adults with degenerated mitral or tricuspid bioprosthetic valves
The Ontario Association of Cardiologists (OAC) supports Ontario Health’s recommendation, based on guidance from the Ontario Health Technology Advisory Committee, for publicly funding transcatheter valve-in-valve implantation for adults with degenerated mitral or tricuspid bioprosthetic valves who are considered inoperable or high-risk for surgery.
The evidence supporting public funding of transcatheter valve-in-valve implantation for these patients is clear. The procedure is minimally invasive, safe, and effective. Morbidity and mortality risks are generally lower with this bioprosthetic heart valve replacement option than with open-heart surgery. It requires less time spent in hospital, shorter recovery times, and has shown dramatic improvement in patient quality of life.
In addition to these benefits, the procedure is preferred by patients over open-heart surgery. It is also cost effective. The OAC notes and supports Ontario Health’s estimate that publicly funding transcatheter valve-in-valve implantation for failing mitral or tricuspid bioprosthetic valves could lead to a cost saving over a five-year period.
The OAC represents Ontario’s cardiologists, who are medical specialists with in-depth expertise and experience in managing these patients. We urge the Ministry of Health to act on Ontario Health’s recommendation and extend public funding for transcatheter valve-in-valve implantation for adults with degenerated mitral or tricuspid bioprosthetic valves who are considered inoperable or high-risk for surgery.
To review Ontario Health’s review, click here: https://www.hqontario.ca/Evidence-to-Improve-Care/Health-Technology-Assessment/Reviews-And-Recommendations/Transcatheter-Valve-in-Valve-Implantation-for-Degenerated-Mitral-or-Tricuspid-Bioprosthetic-Valves.
For more information, 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
Ontario Health Issues New Funding Recommendation for Transcatheter Valve-in-Valve Implantation
Ontario Health, based on guidance from the Ontario Health Technology Advisory Committee, is recommending publicly funding transcatheter valve-in-valve implantation for adults with degenerated mitral or tricuspid bioprosthetic valves who are considered inoperable or high-risk for surgery.
The provincial government agency is seeking feedback on its recommendation from healthcare stakeholders and the public by October 25, 2021.
Click here to share your feedback: https://www.hqontario.ca/Evidence-to-Improve-Care/Health-Technology-Assessment/Reviews-And-Recommendations/Transcatheter-Valve-in-Valve-Implantation-for-Degenerated-Mitral-or-Tricuspid-Bioprosthetic-Valves.
For more information, please contact the OAC office:
34 Eglinton Ave. West
Suite 410
Toronto, Ontario M4R 2H6
E-mail: [email protected]
Tel: 416-487-0054
Toll-free: 1-877-504-1239
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Canadian Cardiovascular Society Reminder: Emergencies are Emergencies!
Patients with heart conditions should continue to seek medical attention in the case of an emergency. Hospitals and emergency departments can keep patients safe from exposure to COVID-19.
Ontario Association of Cardiologists
34 Eglinton Ave. West
Suite 410
Toronto, Ontario M4R 2H6
E-mail: [email protected]
Tel: 416-487-0054
Toll-free: 1-877-504-1239
Dr. James Swan (1946-2021)
It is with deep sadness that we announce the passing of Dr. James Swan on Friday, June 4, 2021.
Dr. Swan served as president of the Ontario Association of Cardiologists since June 2013. In this capacity, he championed patient access to high quality cardiac care throughout all parts of Ontario, whether one lived in a big city or a small community. He also strongly advocated for the development and maintenance of high professional standards for the practice of cardiology in Ontario.
Dr. Swan graduated from Queen’s University and did his residency training in internal medicine and cardiology in Toronto. He undertook postgraduate training at Emory University in Atlanta in cardiac ultrasound and returned to Canada in 1977 to introduce 2-dimensional echocardiography.
He held an appointment in the Division of Cardiology of the Department of Medicine at the University of Toronto since 1977 and appointments in the Divisions of Cardiology at St. Michael’s Hospital, Rouge Valley Health System, Southlake Regional Health Centre, Toronto East General Hospital, North York General Hospital and the Barrie Royal Victoria Hospital.
Dr. Swan was a founding member of the Cardiac Care Network of Ontario and was instrumental in setting up one of the first non-University cath labs in Canada, at Centenary Hospital in 1986. He was also active in the Ontario Medical Association serving as chair of the Section on Cardiology, and participating on numerous committees including the Central Tariff Committee and the tripartite Diagnostic Service Committee.
Dr. Swan was a leader in developing new digital technologies in his cardiac ultrasound lab in Scarborough, which are now used at major institutions throughout the world to improve cardiac patient care. He continued to perform diagnostic cardiac catheterization services and non-invasive cardiac testing and deliver cardiac care to patients in Scarborough, Ajax and Collingwood until last year.
An avid hockey player, Dr. Swan was team cardiologist for the NHL Old Timers in the ’70s and ’80s. In recent years, he was involved with the University of Toronto’s Global Surgery program travelling to China, Nunavut and Jamaica participating in medical exchanges and advancing patient care at home and abroad. He was also involved in acquiring and distributing personal protective equipment to healthcare organizations across Canada to help meet increased demand brought on by COVID-19. He was instrumental in establishing a fund at the University of Toronto to help find the genetic causes of glioblastoma in order to prevent others from developing the disease.
Dr. Swan is survived by his wife Carolyn, sons Matthew (Rachel) and Marc (Caroline), grandchildren David and Sarah and by his nieces Dr. Kathryn Swan (Will), Jennifer (Jorge) and Erica (James) and golden retriever Hennessy.
Ontario Association of Cardiologists
34 Eglinton Ave. West, Suite 410
Toronto, Ontario M4R 2H6
E-mail: [email protected]
Web: www.ontarioheartdoctors.ca
2021 Monthly Update Webinar Series Event: Wed., May 26, 2021 at 8:00pm
The next event in the OAC’s 2021 Monthly Update Webinar Series will be held on Wednesday, May 26, 2021 at 8:00pm.
We hope you can join us to receive updates on the EQI Program Facility Agreement (and other echocardiography accreditation matters), OMA issues (including the 2021 PSA Negotiations), COVID-19 developments, and other OAC advocacy initiatives.
To register your attendance for the webinar, click here: https://attendee.gotowebinar.com/register/6621991709470574094.
If you have any questions or comments, please contact the OAC office at:
34 Eglinton Ave. West, Suite 410
Toronto, Ontario M4R 2H6
Tel: 416-487-0054
Toll-Free: 1-877-504-1239
E-mail: [email protected]
OAC supports gradual resumption of non-emergent and non-urgent surgeries and procedures
The OAC supports the decision of the Chief Medical Officer of Health to rescind Directive #2 for Health Care Providers to enable hospitals and community-based ambulatory facilities to perform non-emergent and non-urgent surgeries and procedures if specific criteria outlined by Ontario Health are met.
For more information, click here: https://www.ontariohealth.ca/sites/ontariohealth/files/2021-05/Memo%20-%20Gradual%20resumption%20of%20non-emergent%20and%20non-urgent%20surgeries%20and%20procedures%2019May2021%20-%20EN.pdf.
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2021 Monthly Update Webinar Series Event: Wed., April 28, 2021 at 8:00pm
The next event in the OAC’s 2021 Monthly Update Webinar Series is on Wednesday, April 28, 2021 at 8:00pm. The focus of this webinar will be the OAC’s advocacy to improve the Echocardiography Quality Improvement (EQI) Program Facility Agreement recently circulated by Accreditation Canada Diagnostics. Join us to receive an update and learn more about how to get involved in achieving fairness for echocardiography service providers in Ontario.
To register your attendance for the webinar, click here:
https://attendee.gotowebinar.com/register/2961797764953064462
If you have any questions or comments, please contact the OAC office at:
34 Eglinton Ave. West, Suite 410
Toronto, Ontario M4R 2H6
Tel: 416-487-0054
Toll-Free: 1-877-504-1239
E-mail: [email protected]
OAC meets with Office of the Auditor General of Ontario re: Cardiac and Stroke Care Audit
OAC representatives met with officials from the Office of the Auditor General of Ontario (OAGO) regarding the audit it is conducting this year on cardiac and stroke care in Ontario. The audit, which was initiated in 2020 but suspended due to the COVID-19 pandemic, will focus on the work of the Ministry of Health and its agencies (e.g. CorHealth Ontario) in the management of patient services including the challenges and opportunities for improvement. It will be released in late 2021.
The OAC welcomed the chance to provide input, on behalf of Ontario’s cardiologists, on various issues including the evolution of the echocardiography quality improvement program, funding support for congestive heart failure patient care, physician billing, and other hospital and community-based issues that have arisen during the pandemic.
We look forward to providing the OAGO with more information and feedback in the coming months.
For more information, please contact the OAC office at:
Ontario Association of Cardiologists
34 Eglinton Ave. West
Toronto, Ontario M4R 2H6
Tel: 416-487-0054
Toll-Free: 1-877-504-1239
E-mail: [email protected]
Web: www.ontarioheartdoctors.ca