Funding rheumatology care before and after the pandemic

The ORA have prepared a response to the issue about OHIPs stance on cutting the income of community clinics .

https://ontariorheum.ca/wp-content/uploads/May-4-ORA-Membership-E078.pdf

Patients should be concerned.

These cuts will directly affect delivery of patient care to our most vulnerable patients across the province. It is not only our office which is affected.

Why are we planning to re-locate the office?

Background

  1. Community physicians’ offices rely entirely on OHIP fees generated by patient visits to pay for all expenses including their lease, equipment, and staff salaries. These are not fees to doctors, they are the revenue for a business. A remarkably high percentage of income is used to simply keep an office running.  (That is why every no show has such an effect on offices). If a doctor chooses to buy additional equipment or employ a nurse, for example, this is an expense and is not funded by the government.
  2. Doctors have no pensions. That has to be planned from these fees too.
  3. We chose to run an office staffed by a multi-professioinal team, and equipped with ultrasound, infusion suite , microscopy. An innovative modern approach which OHIP has never been equipped to properly fund. This model of care has been shown to improve patient outcomes. Whilst unfunded we felt this was a worthwhile investment.
  4. OHIP recognises the complexity of looking after patients by adjusting the fee to the medical diagnosis of the patient, so that, for example, complex patients on immunosuppressive therapy are able to be safely cared for. This is to recognise the added time it takes to look after a complex patient safely.

OHIPs shameful decision

After the pandemic started the official government stance was that where possible physicians should run virtual clinics i.e. phone or video clinics. The correspondence included the statement:

“The intent is for physicians to be reimbursed the same fee for the telephone or video visit as an in person visit. As such if a premium was eligible for payment then it still will be…”

The ministry developed a cumbersome and complex system of recording the visits, and then announced that they were no longer going to honour the original agreement of equivalency. They justified this with the statement

“It is recognized that many patient encounters conducted remotely will involve a lower degree of assessment than the comparable “in person” encounter. “ 

This decision affects those patients  MOST IN NEED of virtual care – patients on immunosuppressive medications. It disincentivises virtual care and seemingly randomly picks certain disease groups.

OHIP is  wrong,. Virtual visits require the same level of care in ensuring the safety of patients. There are added nuances of managing fears over being immunosuppressed during the pandemic, dealing with drug shortages, hard of hearing patients, language barriers, and managing drugs where lab testing has become less frequent or impossible.

When OHIP reached their conclusion, did they consider the impact on patient care?.

Our advice is to be guided by arthritis patients groups and the Ontario Rheumatology Association – follow their websites and if you are concerned – which you should be – write to your MPP