Phone calls, video conferences and remote monitoring. In just a few short months, these tools for virtual care have become part of many physicians’ day-to-day practice. With virtual care becoming part of this “new normal,” medical associations in the Atlantic provinces are coming together to examine the best path forward.
“We will never go back,” said Robert Thompson, executive director of Newfoundland and Labrador Medical Association. “This is part of the future.”
Spurred by this shift, the New Brunswick Medical Society, Newfoundland and Labrador Medical Association, Doctors Nova Scotia, and the Medical Society of Prince Edward Island commissioned consultancy firm Deloitte to examine how virtual care operates, including virtual care fee codes and remote patient monitoring.
“Virtual care became an effective method of providing care to patients during the pandemic, and the level of uptake and satisfaction pave the way for expanding its use,” explained Dr. Ann Collins, a New Brunswick physician and President of the CMA.
Funded by the Canadian Medical Association, the study aims to answer questions such as how physicians should bill for interactions with patients over instant messaging or email, and the benefits of video and telephone consults. The final recommendations will be shared with all participating associations.
“The neat thing about the four Atlantic provinces is that we are four small provinces, we’re geographically in the same boat, and we experience similar things,” explained Dr. Robyn MacQuarrie. “We are trying to gather information and come up with a plan.”
When the COVID-19 pandemic started, jurisdictions across Canada rapidly implemented temporary billing codes so that doctors were compensated for virtual care. Many of these codes have now been extended to the end of 2020.
Yet long-term strategies for virtual care are still under discussion.
Thompson said one key issue he wants to address is how to compensate physicians for text messages and email exchanges with patients.
“It’s a challenge,” he said. “It uses physician time and care.”
Remote patient monitoring creates other questions about compensation. Patients participate in their care by measuring their own vital signs such as body temperature or blood pressure, and doctors interpret the data.
“That data will get sent to the physician, so you could be monitoring 50 patients with cardiac issues,” Thompson said. “The main type of work you’re doing is monitoring.”
While this type of care is not yet widespread, it is important to think about the compensation issues now, he added.
As a region already grappling with physician recruitment and retention, even before the pandemic the Atlantic provinces were planning to examine how it could help improve access, particularly for patients in rural areas forced to drive long distances for care.
“With COVID-19, naturally the desire not to be in offices and stay socially distanced, that’s the main driver. But a lot of patients also just want the convenience,” Thompson said. “With this study, we will have a common base of information that will help us talk to each other about what is working in our own jurisdictions.”
Dr. David Bannon, president of the Medical Society of Prince Edward Island, said the pandemic has “forced a shift” in healthcare.
“The pandemic showed us the importance of being nimble and responsive to meet patient needs. We want to carry that forward,” he said. Since the pandemic began, support for virtual care amongst the public has grown. A national poll conducted for the CMA in May 2020 found those who connected with their doctor virtually during COVID-19 reported a 91% satisfaction rate. Dr. MacQuarrie reports a similar response in Nova Scotia, where she said she’s had “overwhelmingly positive” feedback from patients about their virtual care experiences.
The CMA’s funding for this Atlantic virtual care study builds on its ongoing work to scale up virtual care across Canada, by creating a task force, policy recommendations, how-to guides and patient resources.
Learn more at cma.ca/virtual-care.