Introduction

The Ontario Medical Association (OMA) has reached a new Physician Services Agreement (PSA) with the provincial government. The agreement covers the time period from April 1, 2021, to March 31, 2024. Dr. Adam Kassam, president of the OMA, says the agreement will allow doctors to keep focusing on patient care and support the healthcare system’s recovery from the pandemic.

In this article, we'll take a closer look at some of the key changes included in the agreement, and explore their potential effects on physicians and how they operate their practices. We'll focus on the agreement's impact on virtual care and how we can help doctors maximize their revenue potential and opportunities.

PSA Key Changes

The new agreement includes a number of changes. Managed entry into Family Health Organizations has begun, with applications being received as of April 1. Applications are also being received for new on-call groups, including Hospital On-Call and Community Palliative Care groups. There have also been funding increases and programmatic changes implemented for the Parental and Pregnancy Leave Benefit Program, and the work is underway for many of the new and continuing committees and working groups. The agreement also introduces a new permanent virtual care framework.

The impact of these changes on clinics across the province is still being assessed. However, it is clear that the agreement will have a significant impact on how clinics operate.

The OMA outlines some high-level changes as follows:

• “A permanent framework for virtual care by telephone and video, when appropriate. Both patients and physicians have found virtual care to be effective, efficient and convenient during the pandemic.”
• “Provisions for more family doctors to join Family Health Organizations, groups of physicians who work together to give patients better access to primary care services.”
• “Improved parental leave benefits, which will allow early and mid-career physicians to spend more time with their families and help address both work-life balance and physician burnout.

A New Virtual Care Model

In addition to the changes to fees mentioned above, the PSA also discusses a new "Virtual Care Model" extensively. The plan is to integrate virtual care into the Ontario health care system.

Virtual K-codes are going away, with permanent codes taking their place. There are some premiums that can be added to virtual visits, with more information to come from the Ministry. The PSA's virtual care provisions come into effect on October 1, 2022. In the meantime, the existing temporary virtual care fee codes remain in effect.

This could include, but is not limited to:

• “A dedicated virtual care team at each LHIN to help coordinate patient care across the care continuum.”
• “The use of new technology, such as virtual health records, to support the delivery of care.”
• “The expanded use of video conferencing to connect patients with their care team.”

What do these changes mean for clinics?

Under the new Virtual Care Model, physicians will be paid based on their participation in team-based care arrangements. These arrangements will include a variety of health professionals, such as nurses, pharmacists, and dietitians. This team-based approach is intended to provide patients with more coordinated and personalized care.

While this new agreement sets an aspiration that primary care physicians will see 60% in-person, it is unclear what the current reality looks like or how this will change over time.

There are some challenges that may arise as the model is implemented. One challenge is that the Virtual Care Model requires a significant investment in new technology. This includes virtual health records, video conferencing, and other forms of telecommunication. These investments may be difficult for some clinics to make, especially those that are already struggling financially.

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The changes included in the Physician Services Agreement will have a significant impact on how clinics operate. In particular, the new Virtual Care Model will require clinics to adapt their workflow and staffing to accommodate the team-based approach to care.

Clinics will also need to be aware of the revised rules around billing and payments, as these may affect how they submit invoices and receive payments from the province. Finally, clinics should expect an increase in patients seeking care, as the agreement includes provisions for more family doctors to join Family Health Organizations.

Rostered patients

With the new codes for virtual services starting later this year, physicians will get paid different rates for telehealth appointments depending on whether there is an ‘existing’ relationship between patient and doctor.
These changes may impact clinics that currently offer a lot of walk-in telehealth appointments. This is because, unless the patient has an existing relationship with a physician at that clinic, these appointments will not generate the same fee as under the previous Virtual K-codes. It should be noted that when a referral has been received from a family doctor, specialists may see patients via video to bill a service.

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To track patient rosters and ensure accurate data, clinics may find it useful to leverage patient intake forms to capture consent to roster patients while booking.

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Online booking

To modernize the booking process for primary care, all FHOs will ‘endeavour’ to have an online booking system available for their patients by March 31st, 2023 and are encouraged to communicate their progress with Ontario Health.

All other primary clinics are still encouraged to adopt an online booking system and communicate their process too.

There are various benefits of online booking for both patients and providers, including increased efficiency for clinics and more convenience for patients.

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Our online booking solution can help you research and select the right solution for your clinic. You may be eligible for funding from Ontario Health when adopting an online booking system.

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