Patients who rely on virtual care now facing fees in Ontario: health-care platform founder

Amid a growing shortage of family doctors and increasing pressure on Canada’s hospital systems, recent funding changes have slashed access to virtual care in Ontario — forcing some patients to choose between a potentially unnecessary emergency room visit and paying out of pocket for care that used to be free, according to the founder of one virtual care platform.

That platform, called Rocket Doctor, says cuts to funding have had a dramatic impact on its ability to provide services to patients.

The platform operates in B.C., Alberta and Ontario, but it has been asking Ontario patients to pay out of pocket ever since the province stripped funding to physicians offering virtual care in December. Another virtual care platform, Kixcare, switched to a paid format in response to the funding change as well.

Dr. William Cherniak is an emergency care physician and the founder of Rocket Doctor, where patients can connect to a doctor online through partnerships with hospitals for various primary care issues, such as consultations, prescriptions or lab work referrals.

“I think the government has a very difficult job to do to try to sort out where to allocate funds in the health-care system, but I think one of the things that happened, specific to our program, is as a Canadian technology company, we enable physicians to practice medicine virtually, and then help them co-ordinate that into a system of care.” Cherniak told CTV’s Your Morning on Thursday.

“And when those cuts happened in December, dropping reimbursement by 50 per cent for family emergency physicians who had not seen a patient in person … it made it so that they really couldn’t provide the same standard of care virtually.”

Funding used to be fairly even whether a doctor was conducting in-person or virtual appointments during the pandemic, with Ontario doctors able to bill the government up to $80 per visit.

But now Ontario doctors will only receive $20 for a video visit and $15 for a telephone visit, unless they have seen a patient in person at least once within the last two years.

If they have an in-person history, they will receive full funding for future virtual visits with that patient, a change that cripples platforms that offer the equivalent of a virtual walk-in clinic.

“The OMA believes the best care is inside the patient-doctor relationship,” the Ontario Medical Association said in December when the change went into effect. “Virtual care is fully funded by OHIP under this new agreement when there is this ongoing relationship.”

The move is intended to ensure that virtual care doesn’t replace comprehensive care, according to officials, but other experts say it leaves behind patients who have difficulty accessing a family doctor.

More than a third of Canadians who don’t have a family doctor said in 2022 that they had been searching for more than a year. In Ontario alone, nearly 1.8 million don’t have a family doctor, and research published last fall projects that if current trends continue, that number could balloon to three million by 2025.

• Read more: More than 170K Ontario patients lost family doctors in first 6 months of pandemic, study finds

One of the ways virtual care fills a gap in the health-care system, Cherniak said, is by addressing situations where a person is unsure if they need to rush to the hospital or not.

“Folks may not be fortunate enough to have their own family doctor, and so they’ll use emergency departments as really the safety net, to try to access some level of care,” he explained. “(Or) you may have a family physician, but you may have some sort of event that happens to you that you’re not sure, through no fault of your own, if it’s an emergency or not. And perhaps you can’t see your family doctor in a few days, and so folks come to the ER with that fever, pain, trying to sort out what’s going on on an urgent basis.”

A 2014 study from the Canadian Institute of Health Information found that 20 per cent of patients who visit emergency rooms across Canada could have been treated elsewhere.

For those who don’t have access to a family doctor or who can’t access theirs quickly, free virtual health-care also provides a quick diagnostic.

“You can log in and you can chat with a care co-ordinator who can help you understand first if, you know, you have crushing chest pain, stroke symptoms, a broken arm, okay yes … the ER is for you, but it’s a refill on a medication or a different condition that could be managed with virtual care, then we can use a physician on the platform to help you out,” Cherniak said.

There are other options to get advice on the necessity of an ER visit. In Ontario, a free telephone service has been connecting patients with nurses to receive advice for years, but has been plagued with long waits at times. The service, which was renamed from Telehealth Ontario to Health Connect Ontario in 2022, was clogged up for days on end early in the pandemic, showcasing the need for more than one option for remote health care.

During the pandemic, virtual care took off, with many physicians shifting to offering video or phone calls instead of in-person appointments.

The goal was to ensure access to care remained in place without increasing COVID-19 transmission, but many experts found that virtual care also opened up more access to health care for those in remote areas or with disabilities.

A Canadian study published in January by the peer-reviewed journal BMC Primary Care found that the expansion of virtual care spurred by the pandemic helped remove long-standing barriers to access for many patients, including those who rely on public transportation and those who can’t take time off of work easily.

“There’s been a thousand patients that have been seen (through Rocket Doctor) the last number of months, and they’ve been effectively prevented from an unnecessary ER visit,” Cherniak said.

But that progress is now roadblocked in Ontario, he says.

Prior to the December funding change, speaking to a doctor virtually through Rocket Doctor’s platform cost the same amount for patients in British Columbia, Alberta and Ontario: nothing. The services were fully funded.

Today, if you navigate to the page on Rocket Doctor’s website for accessing a doctor in B.C., you are simply instructed to fill out your information to get matched with a doctor free of charge.

But clicking on the option to access a doctor in Ontario loads a very different page, prompting patients to select either a payment of $55 to have a single live chat with a doctor, or various health-care packages ranging from $50-$107 a month to access their services on a continuing basis.

Underneath these payment options, the website states: “As a result of decisions made by the Ontario Medical Association (OMA) and the Ontario Ministry of Health, virtual primary care and urgent care services are unfortunately no longer a service that patients can access for free on Rocket Doctor.”

It then links to a petition started last fall urging the Ontario government to reexamine its reasoning behind these funding changes, and to pause the changes until then. More than 31,000 people have signed.

Rocket Doctor isn’t the first virtual care platform to be affected by the Ontario funding changes. In the fall, Kixcare, a company that offered 24/7 virtual access to pediatric health-care experts, announced it would be shutting down its urgent care services and began charging families a monthly $29 fee to access health practitioners.

Alana Kayfetz, a parent who had previously obtained fully covered medical care for her two-year-old son through Kixcare, told CTV News Ottawa that Ontario’s decision to strip funding to virtual care felt “really weird and backwards.”

Dr. Harley Eisman from Kixcare told CTV News Toronto that the 75 per cent reduction in government funding being paid to doctors meant it wasn’t “a tenable option” for them to continue providing access to public health care.

Cherniak believes that Ontario’s funding needs to take into account the particular situations of patients when deciding whether to fully fund virtual care or not.

“There can be nuance added to these changes to make it so a) if a patient doesn’t have a family doc, the physician can be fully reimbursed, or b) if they have a more acute condition that would’ve gone to ER, we can fully reimburse the doctor for doing that work,” he suggested. “Hopefully that will help to keep these programs going.”

In a letter sent last week to the Ontario government and other provincial governments, federal Health Minister Jean-Yves Duclos said he was “very concerned with the recent increase in reports of patient charges.”

“Canadians pay for their health-care services through their tax dollars, and should not be asked to pay again by way of patient charges when they need to access those services,” the letter read.

The federal government weighed in Friday on the increase in out-of-pocket payments across Canada, threatening that future federal funding could be clawed back if provinces allow patients to be charged for medically-necessary services.

But it’s unclear if this move will address funding changes like Ontario’s slashing of funding for purely virtual care.

• Read more: Ontario could see federal health-care funding deducted if patients are charged for care

Cherniak is hoping that there will be no further cuts to virtual care access, and that other provinces will embrace funding virtual care.

“I think it’s important to note that across Canada, you know, Alberta, British Columbia, fully fund virtual care, and so folks are able to access services in that way,” he said.

“Hopefully where we’re going to find ourselves is just continuing to engage more and more technology to ultimately improve equitable access to care and just make healthcare better. I mean, that’s my goal.”