{"id":16002,"date":"2021-01-18T20:52:31","date_gmt":"2021-01-19T01:52:31","guid":{"rendered":"https:\/\/www.ontariohealthcoalition.ca\/?p=16002"},"modified":"2021-01-31T21:01:16","modified_gmt":"2021-02-01T02:01:16","slug":"private-virtual-health-services-are-booming-in-a-policy-vacuum","status":"publish","type":"post","link":"https:\/\/www.ontariohealthcoalition.ca\/index.php\/private-virtual-health-services-are-booming-in-a-policy-vacuum\/","title":{"rendered":"Private virtual health services are booming in a \u2018policy vacuum\u2019"},"content":{"rendered":"

(January 17, 2021)<\/p>\n

By: Theresa Boyle, YorkRegion.com<\/p>\n

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When over-the-counter medication failed to quell a sudden and intense allergic reaction, the Toronto senior turned to her computer in search of a remedy.<\/p>\n<\/div>\n

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A quick Google search brought her to the website of Maple Corp., one of the country\u2019s largest providers of virtual health care.<\/p>\n<\/div>\n

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In no time at all, she was communicating, via secure text messaging, with a family doctor who gave her a prescription for a nasal spray. The doctor also recommended that she try to get out of a dog-sitting arrangement, which appeared to bring on the allergic reaction.<\/p>\n

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The virtual visit cost the patient $49.<\/p>\n<\/div>\n

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Such transactions are\u00a0occurring at record rates<\/a><\/span>\u00a0during the\u00a0pandemic<\/a><\/span>, which has seen a surge in the use of virtual health-care services.<\/p>\n<\/div>\n

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While it\u2019s widely accepted that\u00a0growth in virtual care is long overdue<\/a><\/span>, defenders of public medicare question the expanding role of private providers in a publicly funded health system.<\/p>\n<\/div>\n

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As demand for services from companies such as Toronto-based Maple soars, so too does scrutiny.<\/p>\n<\/div>\n

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Critics charge that private providers don\u2019t always act in the best interests of patients and taxpayers, or operate within the provisions of the Canada Health Act.<\/p>\n<\/div>\n

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There is no doubt that virtual care will play an increasing role in the delivery of health services, they acknowledge. But they also argue that the pandemic is exposing shortcomings of the nascent sector and underscoring the need for policymakers and legislators to ensure it is better integrated into Canada\u2019s publicly funded health system.<\/p>\n<\/div>\n

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Charging patients for care that should be publicly insured is a case in point, they contend.<\/p>\n

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Natalie Mehra, executive director of the Ontario Health Coalition, takes issue with private providers charging patients for online consultations, especially when the Ontario government recently created billing codes to allow doctors to bill OHIP for virtual care, albeit by video or phone, not by text.<\/p>\n<\/div>\n

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\u201cThey are violating the core tenets of public medicare in Canada and it has got to be stopped,\u201d she says.<\/p>\n<\/div>\n

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The Canada Health Act requires that medically necessary services provided by doctors be covered by provincial health insurance plans.<\/p>\n<\/div>\n

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\u201cCharging patients out of pocket for it would mean that the Canada Health Act would be meaningless if that were allowed to continue,\u201d Mehra argued.<\/p>\n<\/div>\n

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Over at Maple, business is indeed booming. Since the start of the pandemic, more than a million new patients have been served by the company, and consultation volumes have tripled, said CEO Dr. Brett Belchetz.<\/p>\n<\/div>\n

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\u201cOn our busier days, we process several thousand visits \u2026 with the majority of that volume occurring in Ontario,\u201d he said.<\/p>\n<\/div>\n

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Belchetz takes exception to criticism of the growing role that firms such as his are playing. For-profit companies are already widely involved in the provision of health services across Canada, he noted.<\/p>\n<\/div>\n

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\u201cFrom public-private partnerships that run some of our largest hospitals, to laboratory companies and diagnostic imaging centres, private, for-profit businesses provide the backbone of much of our publicly funded health-care system.\u201d he said. \u201cThere is no reason why virtual care shouldn\u2019t involve the private sector in a similar manner.\u201d<\/p>\n<\/div>\n

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Belchetz wants Maple to play an even bigger role in the delivery of health care and would like to see more public coverage for services that companies such as his are capable of providing, he said.<\/p>\n<\/div>\n

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\u201cWe would love to see more coverage across the country for broader services, as well as provincial remuneration for cross-provincial care. A national physician licensure for telemedicine would also be a major step forward,\u201d he said explaining that this would allow physicians in well-serviced provinces such as Ontario to care for patients in underserved areas such as the Maritimes and the North.<\/p>\n<\/div>\n

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Last March, the Ontario government introduced a handful of temporary billing codes, known as \u201cK-codes,\u201d to enable doctors to provide routine health-care services by video and telephone. These codes are intended to help with social distancing during the pandemic.<\/p>\n<\/div>\n

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Not included were visits done by secure text messaging, a service Belchetz said patients prefer and one that Maple offered even pre-pandemic.<\/p>\n<\/div>\n

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That meant Maple could charge the woman with the dog allergy $49 for an appointment done by text even though OHIP would pay $36.85 for such a visit if done by phone or video under one of its new codes.<\/p>\n<\/div>\n

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Maple does offer video and phone services, but Belchetz acknowledged it often defaults to text.<\/p>\n<\/div>\n

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\u201cOur broadly available online GP consultations don\u2019t always qualify for OHIP\u2019s K-codes \u2026 due to the core components of our platform,\u201d he said, adding that 70 per cent of Maple patients decline video and phone appointments when they\u2019re able to, opting instead for secure messaging.<\/p>\n<\/div>\n

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Doctors affiliated with Maple charge provincial health insurance plans if possible, but when it comes to providing non-publicly covered services, Maple gives patients what they want, he said.<\/p>\n<\/div>\n

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\u201cIn any consultation where an Ontario doctor sees an Ontario patient by video or phone and no significant component of the visit is conducted by secure messaging, our doctors will bill the K-codes and not bill privately,\u201d he explained.<\/p>\n<\/div>\n

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\u201cMaking that the default scenario isn\u2019t what the vast majority of our patients want, however. Instead, they want to be connected at speeds that can only be achieved with cross-provincial coverage, and once connected, most prefer to discuss their concern via secure text message versus phone or video,\u201d he added.<\/p>\n<\/div>\n

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Belchetz said he would welcome public funding for text messaging.<\/p>\n<\/div>\n

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A recent article in the CMAJ \u2014 \u201cPrivate virtual care thriving in a legal grey zone\u201d \u2014 said confusion and convenience may explain why Canadians are still paying privately for virtual-care services even though the public system covers variations of the same service.<\/p>\n<\/div>\n

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In other words, it\u2019s likely many Ontarians are unaware that virtual visits are now publicly covered if done by phone or video but not by text. And even for those who are aware, they may prefer to pay out of pocket for the convenience of a service they can access immediately, 24 hours a day, seven days a week.<\/p>\n<\/div>\n

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In her recent annual report, Ontario Auditor General Bonnie Lysyk said that the province, and all of Canada, for that matter, have historically been slow to expand their virtual-care services. Private virtual care has proliferated to fill the gaps, particularly during the pandemic, she said.<\/p>\n<\/div>\n

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\u201cWe found multiple private virtual health-care companies that charge patients in Ontario for a range of services, such as access to medical advice, prescriptions, medical notes, and lab work requisitions. \u2026 They offer differing pricing and service packages, such as approximately $50 to $100 depending on the time of day, or membership plans for unlimited visits ranging from a few hundred dollars to over $1,000 per year. Patients either pay out of pocket or through private insurance plans,\u201d she wrote.<\/p>\n<\/div>\n

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Lysyk expressed a number of concerns about the growing presence of private providers in the sector, including:<\/p>\n<\/div>\n

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