Addictions docs, Ontario govt. reach virtual care deal after outcry from physicians
Ontario's doctors have reached a deal with the province over how much addictions physicians will be paid for virtual care after they raised an outcry over previously planned changes they said would have put 30,000 patients at risk of losing lifesaving opioid treatments, The Canadian Press has learned.
Details of the deal were not available but an internal email from the Ontario Medical Association -- which represents the province' doctors -- to addictions physicians said the agreement would resolve concerns that a drastic cut in funding for virtual care could leave patients without access to treatment.
"An agreement in principle between the Ministry and the OMA bargaining teams has been reached," Dr. Chris Cavacuiti, who leads the OMA's addictions section, wrote in the email sent late last week that was obtained by The Canadian Press.
"The final outcome will result in the status quo for our practices in terms of delivering and billing for video services."
The issue arose after the Ministry of Health and the OMA, which represents the province's doctors, reached a "physicians services agreement" in February, part of which dealt with upcoming changes to Ontario's virtual care program.
At the time, both sides agreed to hammer out details on lingering issues, one of which was the unintended consequences of the changes.
The changes were to take effect Oct. 1 but were delayed to Dec 1. because the province could not make the necessary computer system changes in time.
Addictions doctors said the agreement would cut a $15 virtual care premium paid to doctors per virtual visit.
They argued that meant many physicians may no longer be able to afford to provide treatment for those needing certain opioid therapies.
The doctors emphasized that the main issue was many in the field rely heavily on treating hard-to-reach patients through virtual means, particularly for opioid agonist therapy that involves getting patients on methadone and buprenorphine treatments, which help curb relapses and avoid overdoses.
There are about 600 addictions doctors who specialize in that therapy -- about 200 of them use virtual care.
Internal Ontario Medical Association emails and documents obtained by The Canadian Press show that by early September, the province refused to make any exceptions to the physician services agreement for addictions doctors,
"The OMA has repeatedly advised the ministry that proceeding with (the physician services agreement) implementation as scheduled, without addressing these unintended consequences, would adversely affect access to equitable health care and the well-being of several vulnerable cohorts of Ontarians," association board chair Dr. Cathy Faulds wrote in an email on Sept. 7 to members.
Addictions section head Cavacuiti, who declined to comment when contacted, wrote on Sept. 20 to his colleagues saying that the changes meant about 30,000 patients who rely on virtual care for opioid agonist therapies were at risk of losing to the treatments.
The changes, he wrote, would have hit doctors differently depending on how they practice. For those with a roster of patients, funding would have been reduced by 17 per cent, from roughly $193 per patient per month to $160 per patient per month, based on OHIP data.
For those who work in a team or clinic setting where patients can receive care from anyone, the province will slash funding by 79 per cent, from roughly $198 per patient per month to $40 per patient per month.
"Programs and providers clearly cannot sustain a 17% loss of funding, let alone an 80% loss of funding," Cavacuiti wrote.
The OMA did not provide specifics on the new deal reached with the province, saying that "discussions and the implementation of the ratified agreement continue."
"Continued access to high quality addiction medicine services has always been a priority and by working together through the implementation process we are confident there won't be any interruption in these needed services," it wrote in a statement.
A spokesperson for the Ministry of Health did not comment specifically on the deal but said "all medically necessary virtual care services, including initial patient visits by telephone, will continue to be insured under OHIP."
The issues raised by the addictions doctors came as the province works to change how and what doctors can bill for in virtual care. Some of those changes include lowering payments to doctors for virtual appointments and incentivizing in-person rules around linking patients with a doctor.
The tensions between the addictions doctors and the government also arose as opioids continue to ravage the province.
More Ontarians have died from opioids each year since 2011, according to data from the Office of the Chief Coroner. Overall, the mortality rate for opioid toxicity more than doubled between 2017 and 2021, when 2,883 people died, or about eight people per day.
Some addictions doctors said word of a deal on virtual care was welcome.
"It's definitely a relief," said Dr. Nikki Bozinoff, an addictions physician at the Centre for Addiction and Mental Health in Toronto.
Addictions doctors have long pioneered virtual care, especially through the phone, to treat those who are dependent on opioids, she said. It especially helps to reach those who do not have a home or live in a shelter and other vulnerable populations.
"There's existing data from the U.S. for example, that telephone visits, or virtual care more broadly, led to improved retention in treatment and significant decreases in overdoses," she said. "We need to expand this way of delivering care."
Dr. Meldon Kahan, medical director of META:PHI, a clinic that helps patients with addictions, said he was ecstatic at the news.
"I'm very happy at this outcome," he said. "But it caused a lot of stress and uncertainty and it looked like a lot patients were being left out in the cold."
This report by The Canadian Press was first published Oct. 6, 2022.
CTVNews.ca Top Stories
'I just can't believe that it took so long': Body found in wreckage 3 months after deadly fire
A man accused of arson in a January Old Strathcona apartment fire is expected to be charged with manslaughter after a body was discovered in the burned building late last month.
No proof man lied to brother about number of kittens born in litter, B.C. tribunal rules
A man was denied a $5,000 payout from his brother after a B.C. tribunal dismissed his claim disputing how many kittens were born in a litter.
Quebec police hand out hundreds of tickets to Hells Angels and other bikers before 'first run' meeting
Quebec provincial police handed out hundreds of fines to Hells Angels members and other supporting motorcycle clubs who met for their 'first run' in a small town near Sherbrooke, Que.
Feds hope to table foreign interference legislation next week: LeBlanc
Democratic Institutions Minister Dominic LeBlanc says he plans to table legislation this week to help the federal government address foreign interference, but he wouldn't say whether the proposal will include a foreign agent registry.
Auston Matthews skates ahead of Game 7, status unclear with season on the line
Auston Matthews was back on the ice with his teammates Saturday.
Snakes almost on a plane: U.S. TSA discovers a bag with small snakes in passenger's pants
According to an X post by the Transportation Security Administration, officers at the Miami International Airport found the small bag of snakes hidden in a passenger's trousers on April 26 at a checkpoint.
A Chinese driver is praised for helping reduce casualties in a highway collapse that killed 48
A Chinese truck driver was praised in local media Saturday for parking his vehicle across a highway and preventing more cars from tumbling down a slope after a section of the road in the country's mountainous south collapsed and killed at least 48 people.
Russia puts Ukrainian President Zelenskyy on its wanted list
Russia has put Ukrainian President Volodymyr Zelenskyy on its wanted list, Russian state media reported Saturday, citing the interior ministry’s database.
Work stoppage possible as WestJet issues lockout notice to maintenance engineers' union
A lockout notice issued by WestJet to a union representing aircraft maintenance engineers could result in a work stoppage next week.