There’s been a recent update to the Ministry of Health’s Virtual Care Program (previously called the Telemedicine Program). Telemedicine was originally introduced as a way to treat remote patients, or in remote areas that lacked physicians. Nowadays, it’s becoming a more convenient type of medical care; it means less waiting time for patients and a more efficient way to quickly clear up minor, but not urgent, conditions. Therefore, the Ontario Medical Association (OMA) and OHIP have decided it's time to modernize and improve Ontario’s approach to virtual care. While this is an on-going project, they have recently implemented two major changes:
- Enabling Direct-to-Patient Video Visits so that patients can receive a video visit from their location of choice (e.g. in their home on their own device).
- Modernizing Virtual Care Compensation to reflect the maturation of virtual care technology and to align with compensation for in-person care.
1. Enabling Direct-to-Patient Telemedicine Video VisitsThere are two types of video visits that you can use to speak with patients, a hosted video visit or, the newly introduced direct-to-patient video visit.
Hosted VideoA Hosted Video Visit is when you speak with a patient who is currently at a patient host site. A patient host site is an organization that provides patients with an on-site location with videoconferencing technology and, in some cases, clinical support services (nursing support, diagnostics through peripheral devices). Since a hosted Video Visit is limited (as it still requires your patient to go to an organization) OMA and OHIP have recently introduced direct-to-patient video.
Direct-to-patient VideoA direct-to-patient video visit is when you speak with a patient who is either at their home or any other location besides a patient host site. This includes situations where your patient schedules and manages the encounter independently using their own technology, or where an organization provides support resources (e.g. access to technology). In order to be eligible for payment for direct-to-patient telemedicine video visits, you need to register with the ministry’s Virtual Care Program. To register fill out the OHIP Virtual Care Physician & Dentist Registration Form and email it to firstname.lastname@example.org or fax to 416-354-8280. Membership is free if you receive 50% or more of your earnings from OHIP. Keep in mind, you’re only eligible for direct-to-patient telemedicine video if you are:
- A specialist;
- A GP physician has been designation by the OMA-Ministry GP Focused Practice Review Committee;
- A primary care physician that is in a patient enrolment model (PEM) and you’re delivering care to a rostered patient.
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General Requirements for all Telemedicine Video Visits
(hosted video and direct-to-patient video visit)Whether you have a hosted video visit or a direct-to-patient video visit you must meet the following general requirements for video visits:
- Be registered with OTN,
- Be physically located within Ontario during the call,
- You and your patient must be present the whole time during the call in an approved OTN video solution,
- Set the location (SLI) of your claim to ‘Ontario Telemedicine Network.’
- Select a billing code along with the applicable Virtual Care Program B-code (e.g. B099A, B100A, B200A); and
- Do not include fee codes for services excluded from the Virtual Care Program (see list below ‘excluded fee codes’).
Requirements for Hosted Video VisitsThere are no additional requirements for Hosted Video Visits beyond the general requirements for all Video Visits provided above.
Requirements for Direct-to-Patient Video VisitsIn addition to the general requirements above, to be eligible to bill direct-to-patient video visits you must also meet the following requirements:
- For Video Visits to be delivered they must be deemed to be appropriate according to your professional judgement and in the best interest of their patient [See CPSO telemedicine policy].
- Your patient must consent to receive a video visit.
Additional GP Focused Practice Designated Telemedicine Requirements:
- You have to have been designated by the OMA-Ministry GP Focused Practice Review Committee;
- You must be providing the video services within the scope of your designation (e.g. addiction medicine, pain management).
- You cannot provide Direct-to-Patient Video Visits for routine primary care.
Addition al Primary Care Direct-to-Patient Video VisitsAt this time you’re only eligible to bill direct-to-patient video visits in primary care if:
- You’re in a patient enrolment model (PEM);
- You’re delivering care to a patient rostered to the same PEM practice.
2. Telemedicine Virtual Care CompensationThe following fee codes are eligible for payment from November 15, 2019 – March 31, 2020:
Direct-to-Patient Video Visit:B099A: $0.00 Tracking Code You need to add a fee code and then the tacking code (B099A) to your claim. This aligns your compensation with in-person care since you'll be compensated for the same amount whether you see your patient in-person or on video. It also let’s OHIP know it’s a direct-to-patient video visit.
Hosted Video Visit:B100A: $35.00 First Telemedicine Patient B200A: $15.00 Subsequent Telemedicine Patient B101A: $35.00 First Cancelled/Missed Telemedicine Patient B201A: $15.00 Subsequent Missed/Cancelled Telemedicine Patient B102A: $35.00 First Technical Difficulties Abandoned Patient B202A: $15.00 Subsequent Technical Difficulties Abandoned premium ***More Virtual Care Program codes will be released on April 1, 2020.
Telemedicine Premiums RemovedTelemedicine premiums were first introduced over 10 years ago when you were required to travel to an OTN telemedicine studio in order to conduct a video visit. However, since now you can easily access telemedicine visits from the comfort of your office - or even your smartphone - the need for telemedicine premiums are no longer needed. Therefor, telemedicine premiums are slowly being phased out. Below are the current conditions when telemedicine premiums still apply:
In TransitionIf you can demonstrate that there will be a significant negative impact to patient access to care due to impacts of the premium removal on your existing virtual care service, you can send feedback to OMA from November 15, 2019 to January 17, 2020. This feedback will then go to the Virtual Care Working Group (created earlier this year between the Ministry, the OMA, OntarioMD and OTN) and they will further explore expansion of virtual care in Ontario.
Hosted Video Visits:If you’re using Hosted Video Visits because your patient lives in a rural area then you’ll continue to get a $15 premium per completed video until March 31st, 2021. Remember that rural patients are identified as patients living in communities with a Rurality Index of Ontario score of >=45.
Rural PhysiciansIf you’re a rural physician based on the OMA’s RIO Postal code lookup then for now your premiums will remain the same. Except changes sometime in 2020.