Ottawa

Ontario doctors may not get paid for telemedicine until July

Doctors in Ontario won't be able to bill the Ministry of Health for telemedicine services they've been providing during the COVID-19 pandemic for several weeks, adding to financial uncertainty at some of the province's clinics.

Health Ministry expects to start processing bills for over-the-phone visits in June

Nili Kaplan-Myrth, a family doctor in Ottawa, says primary care physicians are busy counselling patients over the phone but aren’t able to bill the province for the work, leaving some clinics in dire financial straits. 1:15

Doctors in Ontario won't be able to bill the Ministry of Health for telemedicine services they've been providing during the COVID-19 pandemic for several weeks, adding to financial uncertainty at some of the province's clinics.

In a statement to CBC News, Health Minster Christine Elliott's office said new billing codes for over-the-phone care were introduced in mid-March to make it easier to adhere to physical distancing rules.

They have seen a "considerable uptake, demonstrating a clear need" for telemedicine, her office said; however, doctors say the new codes haven't been added to the province's billing system. 

"Recognizing the need to compensate doctors for this work, the province expects to be ready to start processing claims in early June," the statement said.

Dr. Nili Kaplan-Myrth has switched the vast majority of her central Ottawa office over to telemedicine, in part due to the lack of personal protective equipment.

"My colleagues in my family health group and other family doctors across Ontario are scared because we don't know how we can continue to provide the quality care that we are so committed to and survive financially," Kaplan-Myrth said.

"We are being asked to work, to see all of our patients, to manage the front line in the community and we're not being paid for it."

Kaplan-Myrth said she's helping manage chronic illnesses for her patients and checking in on COVID-19 positive patients every 24 to 48 hours with phone calls.

She said she can bill little more than $250 for the handful of in-person visits she's had in the last month but she still has bills, rent and staff to pay.

Family health groups like hers rely entirely on payments based on the services it provides. Other practices in Ontario are structured to receive some funding based on how many patients are registered with them. 

Doctors negotiating with province

Sohail Gandhi, president of the Ontario Medical Association (OMA), said the delays are "inappropriate." He said if claims don't start getting processed until June, physicians likely won't be paid until July.

"You just can't tell small businesses … that there's no payment for three months," Gandhi said.  

"That money goes to pay for nurses, it goes to pay for overhead, it goes to pay for receptionists and you can't put those people out."

Ontario Medical Association president Dr. Sohail Gandhi says he regularly hears concerns from physicians about personal protective equipment. (Ontario Medical Association)

Gandhi said the OMA is in talks with the Ministry of Health for ways to get physicians the money they are owed, since the telemedicine codes are meant to be equivalent value to other billing codes without any bonuses.

He said he could not disclose the proposed solutions due to the ongoing talks.

"We really need the bureaucrats to do the right thing here."

Gandhi said other provinces, such as Saskatchewan, have agreements with fee-for-service physicians to provide stability during the pandemic.

Gandhi said he's raised that issue with Ontario's Ministry of Health so X-ray and urgent care clinics will be ready after having their operations shut down or reduced in recent weeks.

The Orléans Urgent Care Centre has experienced a drop in patient visits during the implementation of physical distancing rules related to COVID-19. (Simon Lasalle/CBC)

"If there is an urgent care clinic and if it's not viable and if it goes under, when we start to see a recovery, the patients will have no place to go but the emergency department," Gandhi said. 

"That's just going to put an incredible stress on our health-care system. We don't want to be in a situation like that."

Drastic drop in visits

The Orleans Urgent Care Clinic has also started taking telemedicine calls and — while it will have to wait for the ministry to accept those billing codes — it also saw a 66 per cent drop in visits in the last month.

Dr. Raymond Aubin, president of the medical associates at the clinic, said the clinic normally sees 150 to 170 patients a day and helps prevent visits to emergency rooms. 

"We expect the volume will pick back up eventually but we have this existential threat," Aubin said. 

Dr. Raymond Aubin, with the Orleans Urgent Care Clinic, says the centre is facing a monthly shortfall of around $30,000 amid a decrease in patient volume. 1:03

Aubin said they've gone from five doctors in the clinic to two, plus a third on-call, and have secured a rent deferral to make up for lost revenues.

But, he said, even with those measures, the clinic will still face a $30,000 monthly deficit without additional funds from the government.

CBC News asked the Ministry of Health about income stabilization for fee-for-service health-care providers.

The ministry acknowledged it's receiving a large number of requests. It did not include a response to those questions in its response.

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