The Ontario Ministry of Health and Ontario Medical Association are assessing permanent adoption of the temporary virtual care billing codes introduced in March, according to a statement from the ministry this week.
Originally introduced to help contain the COVID-19 pandemic, Dr. Sacha Bhatia, a virtual care advocate and Chief Medical Innovation Officer at Women’s College Hospital, says the pandemic has made the benefits of virtual care clear, both in terms of safety and efficiency.
The codes allow healthcare providers to bill for virtual visits similarly to in-person ones, enabling providers to safely assess treatment needs without having to unnecessarily bring a patient out of isolation. They also reduce much of the patient-side cost of health care, minimizing time spent away from work and eliminating the cost of commuting.
“Patients like it,” says Bhatia, “pandemic or no pandemic.”
Dr. Sohail Gandhi, former President of the Ontario Medical Association (OMA), says although the emergency measures were supposed to end July 31, “we’re trying to see how many of those can be extended. Basically, it’s still up in the air. The agreement that was signed was: ‘Oh my God, we have a crisis, let’s do something right now.’ ”
Prior to the COVID-19 pandemic, only 10 to 20 per cent of healthcare visits in Canada were conducted virtually. Now, that number is closer to 60 per cent, according to Canada Health Infoway’s Weekly Tracking Survey, a rapid change driven by imminent need.
“These virtual visits have been widely used by physicians and will provide the ministry with valuable information as we modernize the healthcare system and expand access to digital and virtual care options through our Digital First for Health Strategy,” reads a statement from the ministry Wednesday. “The province continues to have regular conversations with the OMA and frontline physicians on a wide variety of issues, including at our Collaboration Table, Communications Table and Primary Care Advisory Table.”
If no agreement can be reached between the two parties, the alternative is the pre-existing Ontario Telemedicine Network (OTN), the only virtual care platform approved by OHIP before the pandemic. However, OTN is nowhere near a perfect substitute, says Bhatia.
Despite the name, OTN is almost exclusively a video platform. The majority of virtual visits enabled by this new billing system have been via telephone. According to Canada Health Infoway’s Experiences of health care during COVID-19 reported by Canadians, 41 per cent of routine visits in May were conducted over the phone compared to 12 per cent via video.
OTN also has a significant administrative overhead. Many patients have access to a cell phone or are already signed up for video services like Skype or Zoom while OTN requires cooperation and effort between patients and providers to set up. “The way we do it,” says Bhatia, “is that we have a (separate) secure patient platform and people have to be registered for that platform.”
In its pre-pandemic 2019 Annual Report, OTN reported that less than a quarter of the 9,000 primary care providers in Ontario used its eConsult program.
While OTN now reports 10 times the amount of daily video visits since the beginning of the pandemic, it’s still far from a perfect solution. As Bhatia points out, “there are some patients who can’t do video visits. They don’t have the technology available to them, they don’t have broadband or Wi-Fi, especially in rural communities, or they don’t have a private space to do video.”
Part of the reason OTN hadn’t been adopted widely before the pandemic, according to Bhatia, is simply because providers were not incentivised to use it. Considering that a virtual visit and an in-person visit take roughly the same amount of a doctor’s time, the administrative cost of setting up a patient with OTN was seen as unnecessary until COVID-19 amplified the risks of in-person visits.
Part of the negotiation is centered on expanding the number of services open to OHIP coverage, according to Gandhi.
Pre-pandemic, virtual care services across Canada were largely similar to the Ontario model: one or more primarily video-based platform(s) covered under that province’s provincial healthcare. Alberta indicated on June 8 that its virtual billing codes would be permanent, allowing patients to continue to access a broader range of virtual care for the foreseeable future. Other provinces have yet to follow suit.
“Virtual care gave physicians the flexibility to decide the best way to provide care during the challenging times, and we’ve seen a great uptake in virtual visits,” Tyler Shandro, Alberta’s Health Minister, said in a press conference in early June.
With many hospitals implementing the Ontario Hospital Recovery Plan requiring them to provide adequate physical distance and maintain a supply of personal protective equipment, Bhatia says Ontario’s hospitals are not ready to function without virtual care.
“We’re not even talking about previous volumes,” he says. “A lot of care has been delayed, a lot of doctors’ offices are closed, waiting lists for patients have increased significantly. We don’t just need to go back to normal, we need to figure out how we reduce this backlog in an environment where we can’t have as many patients in our hospitals or offices. The only way to do that is to use virtual care to supplement our care.”