Addiction Documents, Government of Ontario. reach virtual care agreement after protests from doctors

Ontario doctors have reached an agreement with the province on how much addiction doctors will be paid for virtual care after they protested previously planned changes that they said would have put 30,000 patients at risk of missing out on treatments. with life-saving opioids, 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’s doctors, to addiction doctors said the deal would resolve concerns that a drastic cut in funding for virtual care could leave patients without access to treatment.

“An agreement in principle has been reached between the Ministry and the WCO negotiating teams,” Dr. Chris Cavacuiti, who heads the WCO’s addictions section, wrote in the email sent late last week. which was obtained by The Canadian Press.

“The end result will result in the status quo of our practices in terms of delivery and billing of video services.”

The issue arose after the Health Ministry and the OMA, which represents doctors in the province, reached a “medical services agreement” in February, part of which dealt with upcoming changes to the virtual care program. from Ontario.

At that point, both sides agreed to work out details on persistent issues, one of which was the unintended consequences of the changes.

The changes were supposed to take effect on October 1, but were delayed until December 1 because the province was unable to make the necessary changes to the computer system in time.

Addiction doctors said the deal would reduce a $15 virtual care premium paid to doctors per virtual visit.

They argued that meant many doctors may no longer be able to pay for treatment for those who need certain opioid therapies.

Doctors stressed that the main problem was that many in the field relied heavily on treating hard-to-reach patients through virtual means, particularly for opioid agonist therapy that involves patients receiving methadone and buprenorphine treatments, which They help stop relapses and prevent overdoses.

There are about 600 addiction doctors who specialize in addiction therapy; about 200 of them use virtual care.

Internal emails from the Ontario Medical Association and documents obtained by The Canadian Press show that, in early September, the province refused to make exceptions to the medical services agreement for addiction doctors.

“The WCO has repeatedly warned the ministry that continuing to implement (the health services agreement) as scheduled, without addressing these unintended consequences, would negatively affect access to equitable health care and the well-being of several vulnerable cohorts of West Africans. Ontario,” the association’s board said. the president, Dr. Cathy Faulds, wrote in a Sept. 7 email to members.

Addiction section chief Cavacuiti, who declined to comment when contacted, wrote colleagues on Sept. 20 saying the changes meant some 30,000 patients who rely on virtual care for opioid agonist therapies were running the risk of missing treatments.

The changes, he wrote, would have affected doctors differently depending on how they practice. For those with a patient list, funding would have dropped 17 percent, from about $193 per patient per month to $160 per patient per month, according to OHIP data.

For those who work in a team or clinical setting where patients can receive care from anyone, the province will cut funding by 79 percent, from about $198 per patient per month to $40 per patient per month.

“Programs and providers clearly cannot bear a 17% loss of funds, let alone an 80% loss of funds,” Cavacuiti wrote.

The WCO did not provide details on the new agreement reached with the province, saying “discussions and implementation of the ratified agreement continue.”

“Continued access to high-quality addiction medicine services has always been a priority, and by working together during the implementation process, we are confident that there will be no interruption in these necessary services,” he 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 phone visits, will continue to be insured by OHIP.”

The issues raised by addiction doctors arose as the province works to change how and what doctors can bill in virtual care. Some of those changes include reducing payments to doctors for virtual appointments and incentivizing in-person rules to link patients to a doctor.

Tensions between addiction doctors and the government have also flared as opioids continue to wreak havoc in the province.

More Ontarians have died from opioids each year since 2011, according to data from the Office of the Chief Medical Examiner. Overall, the death rate from opioid poisoning more than doubled between 2017 and 2021, when 2,883 people died, or about eight people a day.

Some addiction doctors said the news of an agreement on virtual care was welcome.

“It’s definitely a relief,” said Dr. Nikki Bozinoff, an addictions physician at the Center for Addiction and Mental Health in Toronto.

Addiction doctors have long pioneered virtual care, especially over the phone, to treat those dependent on opioids, he said. It especially helps to reach those who are homeless or living in a shelter and other vulnerable populations.

“There is existing data from the US, for example, that phone visits or virtual care more generally led to better treatment retention and significant reductions in overdoses,” he said. “We need to expand this way of providing care.”

Dr. Meldon Kahan, medical director of META:PHI, a clinic that helps patients with addictions, said he was excited about the news.

“I am very happy about this result,” he said. “But it caused a lot of stress and uncertainty and it seemed like a lot of patients were being left out.”

This report from The Canadian Press was first published on October 6, 2022.

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