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