Urgently enable all Ontarians to video, call, or message their family doctor!

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Dear Minister Elliott,

First of all, we thank you for your pandemic leadership. We are in a fight against a common enemy, and stand united in our commitment to the health of Ontarians. 

We write to advocate for your proactive leadership in an issue that severely impacts most of Ontario’s 14,000 family physicians, and by extension hundreds of thousands of Ontarians.

For a number of reasons, the temporary COVID-19 virtual care codes are problematic for both capitated and non-capitated family practices. 

In a pandemic, a wide array of virtual care options are needed to keep the people of Ontario safe and healthy. Every Ontarian deserves to have care by video, call, or message from their physician. To this end, several of our members have communicated with provincial leaders regarding expanding the current OTN monopoly on OHIP billing codes. Provincial leaders have shared that this expansion will be phased, and ultimately still several months away. We know this delay to be unacceptable for three main reasons.

1. Equitable care to the most vulnerable Ontarians.

The OTN monopoly harms our most vulnerable patient populations. Those capitated physicians who would normally provide diabetes care, HIV primary care, chronic pain, palliative care, and other critically important care for Ontario’s most at-need, are forced to choose between,

  • using an OTN platform, 
  • bringing patients into the office in-person amidst a pandemic.

2. The unacceptable performance of the OTN platform.

We also draw your attention to the current OTN eVisit platform. We have many reports from our members of the eVisit platform being intolerable for clinical work, whether it is by slow loading time, patients not having the connectivity, hardware, or ability to operate the platform, or simply poor OTN server bandwidth and associated crashes.

We have reports from members that the OTN platform fails in up to half of patient encounters for the above populations. Not only does it have the above technical challenges, it is also not integrated into our clinical workflows.

The OTN platform is therefore clinically unacceptable in day-to-day practice, and unsuitable for Ontario’s pandemic care needs.

3. Virtual care is essential care.

Ontario's physicians continue to do comprehensive diabetes, palliative, and other chronic disease care for our most at-need populations. They take a pay cut by doing this care over non-OTN platforms. They also continue to communicate by video, phone, and messaging with patients, families, and caregivers.

On one hand, capitated physicians cannot bill their regular “out-of-basket” codes over platforms outside of the OTN platforms, so though they often provide complex care, the value paid is 15% of the virtual care codes.

On the other hand, non-capitated physicians are limited to three virtual care codes to somehow capture the variety and complexity of care they provide at rates below what they are usually paid.

They continue out of our deep sense of commitment to our patients, but this sacrifice is unsustainable to the longevity of our care through the pandemic.

We hope that you consider expediting both of the following policies that have been previously agreed upon by the Virtual Care Working Group:

A. Expand the number of platforms for video visits beyond OTN that are eligible for funding under existing OHIP codes.

B. Expand the modalities of virtual care beyond video visits that are eligible for funding under existing OHIP codes to include modalities such as phone, email, and text messaging.

Ontario’s family doctors stand committed to the health of Ontarians. We hope you stand behind us, and expedite your plans to expand virtual care for all Ontarians. The equity, access, and sustainability of primary care through Ontario’s pandemic depend on your immediate leadership.

 

Sincerely,

Your elected primary care leaders from throughout Ontario.

Dr. Dominik Nowak
Dr. Adam Stewart
Dr. Aly Abdulla
Dr. Nadia Alam
Dr. Sohal Goyal
Dr. Lori Di Santo
Dr. Darija Vujosevic
Dr. Roxanne Trangmar
Dr. Iram Ahmed
Dr. Caterina Mastrogiacomo
Dr. Marie-Claude Christine Gagnon
Dr. Michael Kates
Dr. Clay Hammett
Dr. Allan Studniberg
Dr. Harry O'Halloran
Dr. Rob Annis
Dr. David Schieck
Dr. Gordon Schacter
Dr. Christine Seidler
Dr. Crystal Cannon
Dr. Clover Hemans
Dr. Donna Mahoney
Dr. Lian Peter