Drop in virtual care fees could lead to ‘unintended consequences,’ Ontario doctors warn

An upcoming reduction in virtual care fees in Ontario could have “unintended consequences,” according to some pediatric physicians, who claim the decision could divert additional patients to overwhelmed emergency departments in the province.

An agreement between the Ontario government and Ontario Medical Association would see a drop in fees for virtual care visits beginning on Dec. 1, allowing more patients to be seen in person rather than behind a screen.

“Virtual care is intended to complement in-person care, not replace it,” said a spokesperson for the Ministry of Health.

But days before the policy is set to take effect, some pediatric doctors are warning the lower fees will serve as a disincentive for doctors to conduct virtual care visits — potentially making the situation in emergency departments worse.

Dr. Aviva Lowe told Global News that up to 90 per cent of her initial consultations with pediatric patients result in the child remaining at home after receiving a treatment plan, while just one-in-10, Lowe says, need emergency care.

“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,” Lowe told Global News.

The Ministry of Health will now allow doctors to bill the Ontario Health Insurance Plan (OHIP) $20 for a “limited virtual care service,” which is the treatment equivalent of an initial visit with a family doctor.

Lowe said the cut in fees, which she says is a 75 per cent reduction from what doctors were allowed to charge during the pandemic, will result in pediatric patients having “fewer care options” as doctors opt to withdraw virtual care services. Lowe is one of several doctors Global News has spoken to with the same concerns.

“Health-care system capacity is going to be reduced as a result,” Lowe told Global News. “Parents are telling me, they will be going to the ER because they don’t have other options.”

The Ontario Medical Association (OMA), however, is defending the new billing codes, which were negotiated by the association and ratified by the membership.

“I think what we all understand is that patient care is best delivered inside of a patient-doctor relationship,” said OMA president Dr. Rose Zacharias. “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.”

The existing patient-doctor relationship seems to be key to the new billing codes. A “comprehensive virtual care service” — the equivalent of a second visit with a family doctor or a specialist — will carry a higher fee.

Zacharias said the situation “gets tricky” when that relationship doesn’t exist.

“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.”

Critics of the Ford government want the decision to be deferred until pediatric hospitals can resume surgical procedures that were paused this month to preserve capacity in hospitals.

“If we’re in a situation where we can offer health care to children so that we keep them out of waiting rooms and emergency rooms where they have an increased chance of picking something up, then why would you not do that, that’s a mistake on the government’s part,” said NDP interim leader Peter Tabuns, arguing that the lower fees will dissuade virtual care.

The Ford government has not indicated whether a change is being considered.

“For the first time, and through this agreement, virtual care will be covered through OHIP,” a ministry of health spokesperson said in a statement. “This approach has resulted in meaningful changes for virtual care that ensures a positive patient-physician relationship is fostered.”

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