Dr. Amit Sharda poses for a photograph at his home in Markham, Ont., on Saturday, September 7, 2019, (Christopher Katsarov/The Globe and Mail)Christopher Katsarov/The Globe and Mail
Businesses in Ontario that specialize in home-doctor visits say that the Doug Ford government’s recently announced cuts to house-call premiums are putting their companies at risk.
When doctors visit patients at home, they can bill OHIP (the Ontario Health Insurance Plan) for more money than for an office visit. Several businesses make money by liaising between doctors willing to do house calls and patients who request them, collecting a portion of the OHIP money.
But as of Oct. 1, 2019, doctors will be able to collect house-call premiums only for patients who are frail and elderly or housebound.
The Ontario government and the Ontario Medical Association (OMA), a group representing doctors, revealed a list of 11 changes to OHIP on Aug. 22 meant to cut down on medically unnecessary procedures. The cost-cutting effort was ordered by arbitrator William Kaplan, who ended a long-running contract dispute between the Ontario government and OMA.
Faced with losing a substantial part of their client base next month, business owners say they’re scrambling to adapt and that the change does a disservice to patients.
Tom Burko, a physician who owned and operated MedVisit for about 30 years, says the measure could worsen waiting times at walk-in clinics and hospitals.
“It’s not compassionate. It’s not efficient. Patients’ health will deteriorate until they make their way to an emergency room,” he said.
MedVisit was bought by Australian company National Home Doctor three years ago and the company’s Canada president, Carl Aube, says the company does about 100,000 house calls a year in Ontario. The company serves the Greater Toronto Area and is the largest house-call provider in the province.
It’s an important service that helps bridge gaps to getting health care, Mr. Aube said. Demand is high after hours and on weekends when family doctors’ offices and walk-in clinics tend to be closed, he said.
Doctors will still be able to bill for procedures they perform while on a house call, according to Travis Kann, spokesman for Ontario Health Minister Christine Elliott. But they’ll receive the same amount as if the procedure was performed in a clinic.
Ontario doctors can bill between $21.70 and $77.90 a visit for patients who come to their office, depending on the services they provide. When they do a home visit, they can bill between $109.05 and $191.55, depending on the time and day of the week, under current rules.
“Removing premium payments for house calls that are delivered for convenience rather than necessity helps to ensure that frail, elderly or housebound patients requiring a health-care service at home receive the care they need more quickly,” Ontario Ministry of Health spokesman Mark Nesbitt said in a statement.
Esme Fuller-Thomson, interim director of the Institute for Life Course and Aging at the University of Toronto, said it’s unfortunate to see house-call premiums for regular patients go. She used MedVisit herself when two of her three young children were sick and vomiting.
But she’s pleased coverage remains for people who are frail, elderly and housebound – people she says need in-home care the most.
Dr. Burko and his colleagues at National Home Doctor have asked for a meeting with the Ontario Health Ministry to clarify the new criteria for house-call premiums.
He knows patients recovering from strokes or dealing with conditions such as muscular dystrophy will be considered housebound, but what about a younger person with a broken leg? Or a single mother with several children who would have trouble travelling to an emergency room?
Mr. Kann at the Ministry of Health said deeming a patient housebound is at a doctor’s discretion.
The move away from paying premiums for house calls on non-complicated patients also has smaller businesses thinking about how they can adapt. Amit Sharda, a chiropractor based in Markham, Ont., has poured the past two years and about $100,000 into developing an app he thinks could be the “Uber of house calls.”
It’s called MedHouseCall, and participating physicians turn the app on when they want to see patients and set a geographic range they’re willing to travel to. Patients have started downloading the app and Mr. Sharda was in the process of bringing doctors on board when the provincial announcement came down.
Now, Mr. Sharda says he’ll need to “pivot.” He’s not sure whether to tighten his focus to patients who are frail, elderly and housebound, or move to a fee-for-service model.
“Everyone’s [house call] business model is going to be taking a big, big hit,” he said. “We can expect reductions in call volumes by 50 per cent or probably more.”
But some family physicians The Globe and Mail spoke with questioned whether house-call businesses were necessary, since family doctors should already be making house calls to patients who need them – and premiums still exist for those patients.
Cathy Faulds, a family doctor in London, Ont., said house calls should be part of the services every family physician provides. She questioned the quality of care from house-call businesses, since those doctors may not follow up with a patient like a family doctor would.