Virtual clinics can’t all be lumped together

Setting rules around how health care is provided is necessary, but often troublesome and controversial — think of all the ink spilled debating public versus private care and who pays for what.

Many smaller funding policies that can still have a big impact play out within Ontario’s massive health-care system. One of them has caught up thousands of Peterborough patients who can only get online care.

The issue is how much a doctor who “sees” a patient virtually gets paid for that visit. For the past four years, doctors at the local Virtual Care Clinic here have been collecting, on average, $37 a visit.

For more complex care, such as diagnosing heart issues and other serious medical concerns, their fee can be as high as $65. Complicated diagnoses take more time.

It’s been a necessary and effective complement to the standard but overwhelmed system where patients go see their family doctor when they aren’t feeling well. In Peterborough city and county, roughly 13,000 “orphan patients” don’t have a family physician.

But recent rule changes about to go into effect for the virtual clinic — and for a smaller one operating out of a private pharmacy — will cut payments to a flat $20 per visit.

The change is well intentioned, and probably necessary to correct one funding issue. Apparently a number of virtual clinics that opened during the COVID-19 pandemic treat nothing but “coughs and colds” patients and generate big profits from high volumes.

Local doctors who provide full-service care for patients from their virtual clinics believe the new rules, which went into effect for them Thursday, are designed to curb the high-profit clinics.

The official Ministry of Health position is that limiting payment for all virtual visits is intended to get patients back to seeing doctors in person more routinely, considered necessary to get the best health-care result.

Both factors are in play.

Samuel Berman, director of the Virtual Care Clinic, is no doubt right that some “coughs and colds” clinics were created with an eye on the easy money.

It is also true that some family doctors who provide full service out of their offices have been reluctant to go back into work and continue to see most patients virtually.

They can return to their offices and not feel the effect of reduced virtual payments, which works for both them and their patients.

“Orphan patients” don’t have that option. If the local virtual clinic shuts down in February because doctors won’t accept a nearly 50 per cent reduction in their compensation, those patients have no alternative.

As Berman says, that’s bad for everyone. Someone who could get needed heart surgery or treatment as the result of a virtual diagnosis will be more likely to end up in hospital with a heart attack, horrible for the patient and costly for the system. Peterborough-Kawartha MPP Dave Smith is looking for a “creative solution” to the impending closure, one that would require virtual clinics to see patients in person at least once every two years, the province’s minimum standard for effective care.

When patients have a family doctor that makes sense, and maybe something is possible to apply the same standard for orphan patients and virtual care.

But until that happens, it makes no sense to cut those patients off from the only doctor they have.

Negotiate away, but until an agreement is reached let doctors like those at the Virtual Care Clinic continue to provide service their patients need, and deserve, at a fee schedule that makes it possible.

It makes no sense to cut those patients off from the only doctor they have