Logging off? Will updates to fees prove to be the death knell for virtual care in Ontario?

As December kicks off, Ontario doctors get their fees cut to $20 for a video consultation and $15 for a phone appointment when they provide such care to patients with whom they don’t have an ongoing relationship. Some are marking Dec. 1 as the end of virtual care in the province. The new billing rules—part of the Physician Services Agreement ratified this year by Ontario doctors—significantly reduce fees for virtual care provided through such settings as virtual walk-in clinics. It doesn’t affect family physicians who provide virtual care to regular patients, or specialists who have virtual consultations with patients referred to them by a regular family physician. But many people have voiced concerns that the lower fees will make it hard for virtual clinics to continue operating, leaving certain patient groups with more limited or no access to the care they've been using. Read: Negative, unintended consequences of Ontario’s spring fee deal “This type of virtual care does serve as a pressure valve for the emergency department, a number of visits that would have otherwise taken plan in the ER unnecessarily are diverted,” Dr. Aviva Lowe, a Toronto pediatrician, told Global News. “Healthcare system capacity is going to be reduced as a result. Parents are telling me they will be going to the ER because they don’t have other options.” Dr. Lowe said up to 90% of patients she sees for initial consultations end up staying home after receiving a treatment plan, with just one in 10 needing emergency care. Connect-Clinic, which has 1,500 patients—and a 2,000-person waiting list—offers hormone therapy and surgery referrals for trans and gender-diverse people across Ontario through fully virtual appointments. As of next month, it will no longer accept new patients due to changes in Ontario's funding agreement with doctors. "My patients are very distressed," Dr. Kate Greenaway, founder of Connect-Clinic, which serves transgender and gender-diverse patients, told CBC News. "I had one patient who told me they'd waited more than a decade to receive gender-affirming care because they had no way out of their community to access it. Certainly that patient still has no way to access gender-affirming care within their community." Read: Addictions docs, Ontario govt. reach virtual care deal after outcry from physicians Ontario Medical Association president Dr. Rose Zacharias told Global News "we all understand that patient care is best delivered inside of a patient-doctor relationship. When it’s appropriate for things like reviewing lab results, prescription renewals and a lot of mental health consultations can be done very well, virtually.” Virtual care “gets tricky” for patients who don't have a relationship with a doctor, she added. “If you go to a virtual-only clinic and then it’s decided very quickly that this is a patient that needs to be seen in person, but the doctor that you’re seeing on the video call has no means by which to call you in and see you in person. Well, then that immediately translates to a second visit somewhere, and that patient is on their own to navigate the system.” "This is just not the right time, if ever, to bring in these cuts," a CBC News story quoted Dr. Harley Eisman, co-founder and chief medical officer at KixCare, which offers round-the-clock pediatric care, seeing 20,000 patients virtually over the past year. "We're not a service that was built to overburden the emergency departments or clinics and and to dump patients on emergency departments." Starting this month, KixCare—which sees patients without a referral—will start charging parents a monthly subscription fee of $29. Leah Littlepage, an Ottawa mom who has turned to KixCare at least four times this past year, said the service helped keep her 16-month-old daughter out of emergency. "It's deplorable that the funding for this program is being cut at the exact same time the pediatric hospitals are being overrun," said Littlepage, who lives in Ottawa. "Mommy groups are flooded with parents seeking medical advice from each other because they don't have anywhere else to turn." Daniel Flanders, owner and executive director of the Kindercare clinic in Toronto, told CBC News the province risks "throwing the baby out with the bathwater." "The changes that are coming down the road, which [are] really going to severely limit access to primary care, especially for patients in areas where they don't have a primary care provider . . . there will be patients who suffer because of it." Read: How the PPSA makes family medicine worse? Meanwhile, Ontarians rallied around virtual care RocketDoctor. A "save virtual care in Ontario" petition on change.org had close to 10,300 signatures by the afternoon of Nov. 30. One person took to Twitter to vent her anger about the new virtual care fees—and to give Ontario premier Doug Ford a piece of her mind.

Logging off? Will updates to fees prove to be the death knell for virtual care in Ontario?

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