Sunday House Call, #735, April 19, 2020: A common sense Ontario physician’s services fee code solution is twisted by the Ontario Government into a new chapter of Catch-22. “We are paying our physicians. But there’s a catch.. “You can’t use the fee codes.”
The Government of Ontario has expressed gratitude for the services of all health care professionals. It is indeed disheartening and discouraging that the words do not match its actions nor its ability to listen to the issues. These issues are hampering our ability to provide care to patients and yes, to preserve our practices.
The issue is straightforward; since mid March, the pandemic public health guidelines has restricted patients’ access to their doctor’s office or medical centre. Therefore, your doctor cannot use the usual billing codes for in-office appointments. They must use the virtual medicine codes that are set at the identical office visit fee of either $23.75 or $36.85 depending on the duration of the telephone call.
In addition, there are other important commonly used fees that are not provided for in the present virtual billing codes. Thus the total drop in income is estimated to be 30 to 100 per cent depending on how the practice is paid.
The Government’s decision to not pay physicians for their services until mid June or July, because they cannot program their computers to accept the five extra virtual medicine fee codes, risks the closure of your doctor’s office and for some, permanently. Doctors have the same expenses as other small businesses.
Unlike the provinces of Newfoundland, Nova Scotia, PEI, Saskatchewan, and Manitoba where physicians are receiving payment for virtual care and maintaining a functional health care system, Ontario is systematically destroying primary care services by their inaction.
There is a simple remedy to this issue but the bean counters in the Ministry of Health would rather collect data on the use of these virtual codes (that cannot be used) rather than ensure that your doctor is available to care for you and your family.
The Ontario Government announced a plan to the media to correct this problem that is convoluted and amounts to a payback loan. We do not want a loan. We need working fee codes. The plan has been covered by Brian Lilley in the newspaper.
It is not surprising that their solution was leaked before presenting the details to us first.
As OMA President Dr. Sohail Gandi wrote in an April 18 update to members “It’s just part of a political game they play to try to make themselves look good. “See how reasonable we’ve been.” “We’re offering such a good deal.” That sort of thing. It’s part of the game of politics.”
This is not the time for politics.
Physicians are alarmed about the coming demands on our health care system when pandemic restrictions ease. With each passing week tens of thousands of medical management decisions and its impact on patient care are delayed. In an article I wrote for Bourque.com (http://bourque.com/dworkin3.html), I noted we will need every physician’s office and diagnostic centre working at full capacity. Even so, demand will exceed capacity.
How to correct this problem? Use the regular fee codes that doctors have used for decades. They are identical to the virtual medicine codes thus revenue neutral. Until the Ministry has programmed their computers, this would help physicians preserve their practices. The billing infrastructure is in place for this to work now. No extra programming, no “deals”, just a bit or common sense in this chaotic environment.
However, the Ministry will not do this because they want to collect data on the virtual medicine codes that we cannot submit. The reasons behind this data collection will be investigated in more detail in the near future.
It seems to me that what is important now is ensuring that medical practices remain open to patients and not trying to add another chapter to Joseph Heller’s Catch-22. It is demoralizing when the need to count codes trumps a one second solution to preserve practices to provide patient care now and for the coming deluge.