A virtual care platform connecting patients with doctors in Ontario has cut back on services and seen a mass exodus of physicians after changes to fees for virtual appointments kicked in this week.
The founder of Rocket Doctor said Friday that the changes mean some patients might find it harder to access care, while the reduction in virtual appointments could place more pressure on an already strained health-care system.
“What we’ve built here is an incredible tool that folks that have limited access to care are using to prevent unnecessary ER and walk-in clinic visits, which is reducing burden on our in-person health-care system,” Dr. William Cherniak said in an interview.
“It’s very sad to see access to care has been dramatically reduced for so many people.”
The province reached an agreement with the Ontario Medical Association earlier this year that, as of Thursday, reduced fees paid to doctors for many virtual visits.
While fees for one-off visits were previously set at $37 for minor assessments and up to $60 for longer sessions, the changes cut those to $15 for phone calls and $20 for video sessions.
Cherniak said the billing changes have had a big effect on platforms like his, which serve as virtual walk-in clinics.
Rocket Doctor said on its website that it had to cease appointments for family and emergency doctors as well as pediatricians under OHIP through its platform as of Thursday. The service said it will continue to help patients access specialist care, which was spared from similar fee cuts through an agreement with the province in October.
The fee changes resulted in 85 per cent of Ontario doctors leaving or discontinuing their services on Rocket Doctor, Cherniak said.
Rocket Doctor previously had 20 to 25 physicians collaborating to provide care to between 500 and 600 patients daily, Cherniak said, but on Friday had one doctor providing care to roughly 20 patients or less.
The platform allows doctors who may also work elsewhere to allocate spare hours to see thousands of patients virtually across the province. Cherniak said billing changes make it harder for physicians to justify using those spare hours to see more patients at a far lower fee.
“In the optimal world, everybody in Ontario would have a family physician and that family physician would be available to see them at all hours of the day, every day of the week. But we know that simply isn’t the case,” he said.
“We’re going to force patients now who don’t have access to drive to emergency departments or drive to walk-in clinics to go back to the status quo, where they just don’t have access to care at all. It’s very unfortunate for the province.”
Half of the patients seen on Rocket Doctor do not have a family physician, Cherniak said. Over 30 per cent said they would have gone to an emergency department had the platform’s services not been available and half would have gone to a walk-in clinic, he added.
The platform also offered greater access to physicians for patients in rural areas, as well as those with chronic conditions that present barriers to in-person visits, Cherniak said.
Meanwhile, the CEO of Maple, a virtual health platform offering care across Canada, said his service has seen a rise in users after the Ontario changes resulted in cuts by other providers.
Dr. Brett Belchetz said Maple hasn’t been directly affected by the fee changes because its business model was set up in 2015 – before the pandemic brought in a huge rise in virtual care – and uses a combination of fees paid by patients, insurance plans and some provincial coverage to provide service.
“We’ve seen quite a dramatic increase in the demand for our service over the last few weeks leading up to this billing code change as a result of, I think, a shortage of other options for patients to seek in the virtual realm,” said Belchetz.
He said the repercussions of the billing changes will likely strain the physical health system further.
“There’s no question, there’s a crisis in access to care that exists right now,” said Belchetz. “There’s a real desperation amongst the patients that we have never really seen before.”
The Ministry of Health said it learned of the benefits of virtual care throughout the COVID-19 pandemic and the new agreement it reached with the Ontario Medical Association ensures virtual care will become permanently integrated within the OHIP-insured framework.
“Virtual care is intended to complement in-person care, not replace it,” the ministry said in a written statement. “This approach has resulted in meaningful changes for virtual care that ensures a positive patient-physician relationship is fostered.”
The Ontario Medical Association said it is beneficial for patients to access care through doctors they have a relationship with.
“OMA believes in the importance of providing virtual care in the setting of an ongoing physician-patient relationship,” it wrote in a statement.
The OMA said virtual care now accounts for 26 per cent of health-care visits, while 74 per cent are in person.
“We think it is important to encourage the patient-physician relationship, which results in better patient care,” it said. “This continuity of care leads to better outcomes and a better patient experience.”
The OMA noted that more than one million patients in the province don’t have a family doctor and said it was advocating for measures like faster licensing of internationally educated physicians to help address the doctor shortage.
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