More than 12,000 people have signed a petition calling for the reversal of a new fee structure in Ontario that significantly reduces the amount doctors get paid to provide virtual care—leading some providers to shutdown their services.
The new fee structure, agreed upon by the province and the Ontario Medical Association (OMA), came into effect on Thursday.
Most physicians can bill the government up to $80 per video visit with a patient under the Ontario Health Insurance Plan (OHIP). During the pandemic, the province allowed doctors to bill the same amount for virtual sessions in an effort to curb the spread of COVID-19.
But as of Dec. 1, that changes. Doctors can only charge $80 if they have seen the patient in person at some point in the last two years. If they haven’t seen them in person, the cost drops to $20 for a video visit and $15 for a telephone visit.
“The problem is that 1.8 million people in Ontario don’t have a family doctor,” said the Dr. William Cherniak, the founder of Rocket Doctor, a technology company that enables physicians to connect with patients on a digital platform.
“The physicians that, you know, spend time on the platform are uniformly quite upset. And they don’t feel that the service that they’re delivering to patients is limited…that’s what they call the new fee codes: ‘limited care.’”
According to the OMA, telephone services will be paid by OHIP at 85 per cent of in-person care for patients with an existing relationship with a physician. Core mental health treatments via telephone will be paid at 95 per cent of in-person care.
“There was no publicly funded virtual care in Ontario before the pandemic, except for limited services through the Ontario Telemedicine Network,” the OMA said in a statement Thursday.
“The OMA believes the best care is inside the patient-doctor relationship. Virtual care is fully funded by OHIP under this new agreement when there is this ongoing relationship.”
Cherniak told CTV News Toronto that while the services he provides virtually are different than what he does in the emergency department, they are still incredibly valuable. He said he has helped fill prescriptions, help patients manage mental health issues and diagnose health problems such as asthma or upper respiratory tract infections.
He added that virtual care is especially valuable for those who can’t drive to a doctor’s office or who live in rural areas.
“There’s so many ways that virtual care helps and it’s not limited care when done correctly.”
With the new fee system in place, Cherniak said they will no longer be able to offer primary or emergency care services covered by OHIP.
Rocket Doctor is not the only provider being negatively impacted by this change. Kixcare, a company that offered 24/7 virtual access to pediatric healthcare experts, has said it will be shutting down its urgent care services.
“It makes no sense,” Dr. Harley Eisman from Kixcare said. “If Kixcare or other services have the means and capacity to avoid one unnecessary (hospital) visit we win. The system wins.”
“If there is a 75 per cent reduction in fees being paid, it just doesn’t become a tenable option for us.”
Instead, the company is charging families a monthly $29 fee for access to health practitioners.
Cherniak started a petition in hopes of getting the government and the OMA to delay the implementation of this new agreement so they can engage with stakeholders and other physicians. As of Dec. 1, more than 12,000 people have signed it.
In the last few months Ontario emergency rooms have been experiencing a backlog of patients. Surgeries have been cancelled due to a lack of beds and families have spent hours—and sometimes days—in emergency departments waiting to be admitted.
According to the Ontario Health report released in early November, there was an average of about 946 patients waiting for a hospital bed in an emergency room across the province at 8 a.m. daily in the month of September.
On average, patients spent about 21.3 hours in an emergency room waiting to be admitted that month.
“We get 500 to 800 people every single day, asking to see a physician,” Cherniak said.
“The question is, where do they go? I’m an ER physician. I’m working Christmas Eve and Christmas Day in the emergency department. I anticipate I’m going to see a lot of these patients in the emergency department.”
In a statement to CTV News Toronto, the OMA said the policy change will lead to “better outcomes and a better patient experience.”
“The physician is familiar with the patient’s history and has their medical records,” they said.
According to the OMA, only five per cent of family physicians in Ontario are practicing exclusively on virtual platforms.
In a statement issued in November, the association said a solution to the overburdened health-care system would be to bring more doctors in by next spring.
The federal government, meanwhile, has said it is concerned the policy change could lead to the patient being billed for services and intends to follow up with the provincial government to get a better understanding of the fee structure.
“As virtual care services provided by a physician are insured health services under the Ontario Health Insurance Plan (OHIP), any additional amount charged to patients in respect of these services would raise extra-billing concerns under the Canada Health Act, as they could pose a barrier to care,” a spokesperson said in a statement.
“Health Canada is following up with Ontario to better understand the practices of this clinic.”
The Ministry of Health said Wednesday their agreement with the OMA was ratified by members. A spokesperson stressed that virtual care is “intended to compliment in-person care, not replace it.”
We want to be clear, all medically necessary virtual care services, including initial patient visits by telephone, will continue to be insured under OHIP,” the spokesperson said.
“This approach has resulted in meaningful changes for virtual care that ensures a positive patient-physician relationship is fostered.”
With files from CTV News Toronto’s Jon Woodward and Beth Macdonell