When the Ontario government reduced the fees paid to doctors for virtual-only appointments in December, it was said the reason was to encourage family physicians to see patients in person as well as online.
It’s a model of comprehensive care that many experts say is preferable to virtual-only.
But the government’s own help line staffed by registered nurses — Health Connect Ontario — is referring to patients they believe should see a doctor to those same virtual services.
“Health Connect Ontario’s practice is to refer to OHIP-funded virtual care services where appropriate,” said the Ministry of Health in an email.
However, the Star used the service and was told to seek medical help within four hours, not in person at an emergency department, but with Rocket Doctor, a chat-based medical service that charges $55 for a single live chat, which is not covered by OHIP.
“It is deeply disturbing, and in contradiction to what (Premier) Doug Ford and (Health Minister) Sylvia Jones are saying, if our publicly funded services like Health Connect Ontario are referring people to pay to access services like corporate for-profit virtual care providers,” said Liberal health critic Dr. Adil Shamji, the MPP for Don Valley East, in an interview.
Health Connect Ontario was launched by the government in April and replaces Telehealth Ontario.
The government says it’s “a free, secure and confidential service Ontarians can call or access online 24 hours a day, seven days a week to get health advice from a registered nurse or find health services or information.”
The problem is that the virtual-only services that Health Connect Ontario is referring to are no longer covered by OHIP because most transitioned to a pay model after the pandemic waned and the Ontario government lowered the fees.
As of December, the fees paid for virtual-only appointments with doctors, where there is no possibility of an in-person follow-up, were reduced to $20 for video appointments, and $15 for appointments by phone.
In contrast, a family doctor that sees a patient in person as well as virtually by video can typically charge around $36 a visit and up.
The fees were part of a Physician Services Agreement that enshrined fee codes for virtual services for the first time. The result of the fee change, though, was that almost all the virtual-only sites changed the way they delivered their services.
Rocket Doctor and MD Connected stopped offering virtual appointments by video or phone and became chat-based medical services. Chat, or messaging, is not covered by OHIP, which means companies can charge patients for the uninsured service.
A statement on MD Connected’s website says: “In response to these changes, MD Connected has been preparing a new model of service to continue to provide virtual health care to our patients. We believe in what we are doing for our communities and do not support the unsustainable fee cuts made by the Ontario government.”
The company’s chat model launched this month.
Many other companies are using loopholes to get around OHIP rules.
Maple, partly owned by Loblaw, was always mostly chat-based. It says it still takes OHIP for video appointments, but it’s the luck of the draw if a patient happens to get a doctor located in the province. If not, the patient can be charged.
Others are using nurse practitioners online to deliver care. Nurse practitioners are not covered by OHIP, which means they can also be charged for their services.
One of the only virtual-only medical services left that takes OHIP, and has not transitioned to a pay model despite using chat to triage patients, is Cover Health.
But the virtual-only service is fully booked days in advance and closes at 8.
Ahmad Elkalza, its CEO, said the company hasn’t stopped taking OHIP patients because “there are tons of people who need it that can’t go to their family doctor or aren’t getting access that they need, whether it’s in rural areas or even urban areas or because the waiting times are too long.
“For Cover Health, our goal is to make sure that people get seen,” he told the Star.
Elkalza says the company thought it would lose doctors after the fees were lowered but they have managed to keep staff and continue offering the service. They are using technology to streamline appointments for doctors so that they can see patients faster.
The concern over virtual-only medicine is not just about the quality of care, but a fear that virtual-only doctors are referring too many patients to already clogged emergency departments because they can’t see a patient in person.
Shamji said there’s evidence to show that both concerns are real.
But having said that, he believes virtual care does have a role.
“I’m glad that (virtual services) are funded as an insured benefit. It opens up access to care for people in rural and remote communities,” said Shamji. “It does play a role for individuals who don’t have access to a physician.”
But he said it’s worrisome when virtual care is operating on a for-profit basis and going only to people who can afford it.
“Those are the individuals that are the least likely to come from those marginalized, vulnerable, remote communities that stand to benefit the most from virtual primary care.”
The Ministry of Health says if a patient feels they have been charged for an OHIP-insured service, they can contact the CFMA program at 1-888-662-6613 or by email at [email protected].
“The Ministry of Health reviews all possible violations that come to its attention and ensures that all OHIP-insured patients who are charged for an insured service are reimbursed in full,” according to an email.
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