Ontario doctor deals devalue phone appointments: critics

For a homeless patient in London, Ontario suffering from HIV or Hepatitis C, the phone is a medical lifeline.

Physicians and nurses working in the infectious disease care program at St. Joseph’s Health Care routinely call patients on pay-as-you-go phones 5 to 10 times before connecting .

A public health outreach worker in the city then connects the same doctor with the patient they are looking for in person over the phone.

Dr. Michael Silverman, the program’s medical director, says it’s a difficult and difficult task.

But a new Physician Services Agreement between the Ontario Medical Association and the government, the first to include a permanent framework for virtual appointments, has devalued this type of care.

The new agreement puts phone appointments with infectious disease programs on par with online doctors offering one-time virtual appointments. Pay as little as $15.Take care.

OMA says the low rates recognize the negative impact online sites have on continuity of care and system resources due to quality and duplication issues.

But Silverman said his program could be “the only way to interact with the health system” for patients. It is important not to lose them. “

He argues that the treatment patients receive keeps them alive and limits the occurrence of HIV.

“And the idea that it should be paid less, and because it’s a sloppy drug, we should discourage it,” Silverman asks. It’s the only medicine you can put in. The most important thing is to make sure these people are on the medicine, to give them counseling, and to solve the problems of getting the medicine and to help them. Help how to cover.

“And it saves lives,” says Silverman. “It’s not a house call.”

Before the pandemic, virtual visits by phone or video made up a small percentage of appointments.

However, COVID has dramatically changed the way healthcare is delivered. Online sites offering one-time appointments—critics compare them to home visits—have proliferated during the pandemic.

Research shows that over 90% of virtual bookings made in the first year of the pandemic were made by phone. Family physicians are also embracing the technology, with approximately 40% of Ontario physician appointments now being virtual.

As a result, the government and OMA have created a permanent framework for virtual care with the latest Physician Services Agreement ratified in March, one of the biggest transitions in healthcare.

Before the new agreement, Silberman said there was a rate code that could be used to bill HIV patients for treatment.

Currently, the contract states that patients must receive ongoing care in order to claim virtual appointments. This usually means that a doctor should see her once in her 24 months, or at least a patient on her roster. In that case, the doctor can charge the full amount of the video appointment. Telephone appointments with ongoing patients are paid her 85% of the normal rate.

However, one-time virtual appointments with no ongoing relationship are paid at a much lower rate. These doctors receive $20 for video appointments and $15 for phone appointments. That’s worth the cost of caring for an HIV patient, according to Silberman, and less than a quarter of what he has billed in the past ($69.10).

Critics of the new doctor services contract fear doctors will be less inclined to make phone appointments. This is because doctors do not receive the same degree of compensation. This can jeopardize healthcare for marginalized, low-income, or elderly patients. Have access to technology or a reliable internet.

The government said, “Virtual care is intended to complement in-person care, not replace it. “This agreement will ensure that people in Ontario continue to get the care they need, when they need it.”

Organizations such as the Ontario Cardiologist Association and some Ontario hospitals have contacted the government to claim that not only are phone appointments sometimes required, but they are effective and working well during the pandemic. did.

Doctors Star spoke to want to find a solution before the new fee structure kicks in on December 1.

However, OMA has said the next round of negotiations won’t be until the fall of 2023, when a new PSA will be launched.

Some medical organizations, including individual hospitals and the Ontario Cardiologist Association, contacted the government earlier this year to express concerns about the new virtual fees.

The contract states that if a patient is referred to a specialist, the initial consultation must be in person or via video, not over the phone.

Dr. Richard Davis, spokesperson for the Association of Cardiologists, said older patients without computers or without internet access would again have to travel long distances to see a specialist for a referral. Davies is a board member of the Ontario Cardiologist Association and vice chair of the OMA Section on Cardiology.

In a letter to the government, the association claimed: Get treated differently and for more than other patients. “

“It’s a huge burden,” says Davis. “Patients are usually exhausted by the whole experience and they are also scared because they don’t like being in waiting rooms with so many patients even now because of COVID.

Davis believes telephone counseling can be just as effective, something many experts have found during the pandemic. You can arrange an inspection before booking in person.

“It’s about patient-provider relationships and ensuring that information is available,” says Davies.

However, OMA said in an email that the reason why specialists must conduct initial consultations in person or by video is “to establish a patient-physician relationship.”

The new covenant could also affect many other clinics at St. Joseph’s Church.

Ms. Silberman treats HIV patients in rural areas of the state, but she treats HIV patients who don’t see doctors regularly because of infrequent bus services. As a result, they don’t come at all, he says.

The new contract classifies care for rural HIV patients in the same way as one-off virtual appointments, he says.

The contract also states that patients must receive a new referral to a specialist every two years.

“Who’s going to refer them?” he asks homeless patients, or HIV patients who don’t have a family doctor. “There is no one to introduce them. We need to end the intervention,” he says Silverman. “But this is HIV. It won’t go away.”

He also treats patients from all over Ontario and other provinces who have C. difficile, a bacterium that can cause colon problems. Silverman said most of his referrals are resolved over the phone. That means Mr Silverman can find a cure for his patients without having to come to London for a fecal transplant, a procedure not covered by OHIP.

Most of his patients are elderly and do not know how to use computers.

“To tell, Well, you have to get off for the first visit (when there is one), and 70% of the time you don’t need treatment,” Silverman says. If you say you need to drive down, are you going to adjust your meds?”

Dr Stan Van Uum, an endocrinologist at St Joseph’s Hospital in London, says a similar situation is likely occurring in many academic or large teaching hospitals across the state.

Van Uum is part of another clinic at the hospital that treats pregnant women with diabetes. Patients come from all over the state and several doctors are circling the clinic so they can do research and education.

According to Van Uum, the new fee structure means that virtual follow-up by a doctor other than the one who originally saw the patient will not be considered to have an existing relationship and will not provide ongoing care. means that it is not assumed to be present. As a result, the new pricing structure means he can only charge $15 for phone bookings and $20 for video bookings.

“I think there were a lot of areas that weren’t well thought out or well addressed,” says Van Uum.

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