The COVID-19 pandemic and the post-pandemic world have forced governments and healthcare providers to consider new ways of delivering healthcare. With the responding rise of virtual care services, we are seeing a patchwork of ever-changing rules across the provinces and territories. Many different stakeholders, including physicians, patients, and even the Competition Bureau of Canada, are calling for uniformity, reduced barriers, and increased access to virtual care.
Prior to the COVID-19 pandemic, private virtual care services outpaced publicly funded options for virtual care. This is because virtual care was generally considered an uninsured service, allowing physicians to charge privately for the provision of these services, including through private business to consumer and business to employer models. However, in response to COVID-19 many jurisdictions (including Ontario), amended their billing rules to enable physicians to bill the public healthcare system for virtual care. Since physicians are prohibited from charging for the provision of insured services or engaging in any "extra-billing", private virtual care providers were forced to shift their business models to ensure compliance with changing regulatory frameworks.
On Dec.1, 2022, these temporary COVID-19 billing codes expired in Ontario and were replaced by a new virtual care funding framework, based on the Physician Services Agreement between the Ministry of Health and the Ontario Medical Association. Under this framework, physicians are permitted to bill OHIP 100 per cent of the in-person fee for some video visits but only if they have an ongoing or existing physician-patient relationship, such as seeing the patient in person at some point in the last two years. However, if the patient has not been seen in person by the physician, physicians may only charge $20 for a video visit and $15 for a telephone visit. This discrepancy in funding per visit disrupted many of the business models of virtual care providers. To continue to operate, providers have had to reconsider how they offer their services.
While there is currently not a consistent licensing approach across the provinces and territories, it appears we may be slowly getting closer to pan-Canadian licensure.1 On May 18, 2023, Royal Assent for Your Health Act, 2023 (the Act) was received. The Act introduces as-of-right licensing for healthcare professionals. Importantly, the entire Act has not yet been put into force and many sections, including those pertaining to as-of-right licensing, are awaiting proclamation. Once proclamation is received , as-of-right licensing would allow healthcare professionals, including physicians, who are licensed in other provinces and territories in Canada to practice in Ontario, without needing an additional approval or licence. This would allow them to provide virtual care to Ontarians wherever they are located. Although not as expansive as Ontario's as-of-right licensing, the Council of Atlantic Premiers recently implemented a new physician register on May 1, 2023. The register allows physicians to practice in any of the four Atlantic provinces without any additional licensing requirements.
In this growing landscape, physicians, companies, and others looking to provide virtual healthcare services should consider the following tips and best practices:
- make sure virtual care is appropriate for the patient given the nature of the consult, the patient's condition, and the limitations of technology in that context;
- make sure they are covered through their insurer and confirm the patient's location will not impact their coverage;
- be aware of the governing standards and guidelines concerning virtual care, including privacy and security, consent, documentation, and online prescribing;
- track out-of-province virtual care encounters and justifications for providing such care when necessary;
- inform themselves of the local resources where the patient is located to ensure continuity of care;
- maintain detailed and up-to-date records for all virtual care encounters in the same way in-person interactions would be documented; and
- always keep in mind their obligations when charging for uninsured services and/or setting fees for their services, as there are both legislative and regulatory college requirements that dictate how health care providers should charge for their services and how they can be compensated.
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Special thanks to articling student Bailey McMaster for her assistance with this article.
Footnote
1. Pan-Canadian licensure is defined as the ability for physicians with full licences to practise independently without restrictions or for medical resident trainees registered in any Canadian jurisdiction to practise or train in any other Canadian jurisdiction without having to acquire more than one license or pay additional licensing fees.
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