Earlier this month, the Ministry of Health and the Ontario Medical Association announced a Proposed Physician Services Agreement (PPSA). The proposed OMA Physician Services Agreement has now been ratified and includes changes that will impact physicians and change how practices operate.
What are the changes to the OMA Physician Services Agreement?
There are many changes in the OMA Physician Services Agreement, but we’ve focused on summarizing several key areas and highlighting potential impacts. The OMA summarizes several high-level changes as follows:
- “A permanent framework for virtual care by telephone and video, when appropriate. Both patients and physicians have found virtual care to be effective, efficient and convenient during the pandemic.”
- “Provisions for more family doctors to join Family Health Organizations, groups of physicians who work together to give patients better access to primary care services.”
- “Improved parental leave benefits, which will allow early and mid-career physicians to spend more time with their families and help address both work-life balance and physician burnout.”
Other changes include:
- Clinics are encouraged to have 60% or more of their weekly patient encounters in-person
- FHOs & primary care clinics will endeavour to implement online booking
- Fee-for-service limits move to the individual level rather than being pooled in the group
- Virtual K-codes are going on away Oct 1, 2022, with permanent codes for virtual services taking their place
What could be the impact of the Physician Services Agreement on your clinic?
Beyond the changes listed above, these are other areas where changes may impact your clinic.
Rostered patients
With the new codes for virtual services starting later this year, physicians will get paid different rates for telehealth appointments depending on whether there is an ‘existing’ relationship between patient and doctor.
An existing relationship is when either:
- a patient is on that physician’s roster
- a patient has seen that family doctor within the last 24 months
When there is an existing relationship, doctors will receive:
- Full value for a video visit
- 85% of the full value for phone visits
However, when there is no existing relationship prior to the telehealth appointment, the PSA dictates that video visits pay $20 and $15 for a phone visit.
These changes may impact clinics that currently offer a lot of walk-in telehealth appointments. This is because, unless the patient has an existing relationship with a physician at that clinic, these appointments will not generate the same fee as under the previous Virtual K-codes. It should be noted that when a referral has been received from a family doctor, specialists may see patients via video to bill a service.
To track patient rosters and ensure accurate data, clinics may find it useful to leverage patient intake forms to capture consent to roster patients while booking.
Virtual care
In addition to the changes to fees mentioned above, the PSA also discusses a new Virtual Care Model extensively. The goal is with ‘integrating virtual care into the Ontario health care system’ in mind.
While this new agreement sets an aspiration that primary care physicians will see 60% of in person. It also states that physicians should choose which aspects of their practice are appropriate for telehealth.
Overall, these changes may impact how some physicians operate compared to the height of the COVID-19 pandemic by transitioning back to a lower ratio of telehealth appointments.
However, the PSA also presents an opportunity for primary care physicians to formalize their virtual care offering, especially as the fee structure incentivizes video appointments.
To prepare for the proposed OMA Physician Services Agreement, consider checking if your existing telehealth provider is or will be OTN certified before October 1, 2022.
For WELL EMR Group customers, you can research and select a new long-term telehealth solution that integrates seamlessly with your EMR through the apps.health marketplace.
Online booking
To modernize the booking process for primary care, all FHOs will ‘endeavour’ to have an online booking system available for their patients by March 31st, 2023 and are encouraged to communicate their progress with Ontario Health.
All other primary clinics are still encouraged to adopt an online booking system and communicate their process too.
There are various benefits of online booking for both patients and providers, including increased efficiency for clinics and more convenience for patients.
For OSCAR Pro customers, our guide to online booking systems will help you research and select the right solution for your clinic. You may be eligible for funding from Ontario Health when adopting an online booking system.
Billing
This is where the proposed agreement has perhaps the most complex impact on physicians, with various changes to billing included in the PSA. The changes to the Virtual K-codes are one area, however, there are others.
Our partners at DoctorCare have helped summarize many of the billing changes in the new PSA and how the agreement will impact family physicians in Ontario.
| Deliverable | Impact | Date | |||
|---|---|---|---|---|---|
| FHO Managed Entry | Increase of 40 new spots per month available | April 1, 2022 | |||
| Minimum size for new FHO groups increases to six | April 1, 2022 | ||||
| Minimum size for existing FHO is six | April 2023 | ||||
| Compensation Increase | Monthly lump-sum payments for Year 2 of 2.01 percent (compounded value of Year 1 and Year 2 increases) | April 2022 | |||
| After Hours Requirements | Changes to After Hours obligations, effective three months after ratification | July 2022 | |||
| FHO Weekly Patient Access | The metric is 88 patient encounters/week (pro-rated for 1300 enrolled patients) with at least 60% being in-person visits | July 2022 | |||
| Virtual Care | Virtual K-codes are going away with permanent codes taking their place | Oct 1, 2022 | |||
| Preventive Care Bonus | Bonus updates to account for patient’s co-morbidities | April 1, 2023 | |||
| Fee-for-service Hard Cap | Limits will be moved to the individual level, rather than being pooled in the group. | April 1, 2023 | |||
| Billing Submission & Reconciliation | Claims for services rendered must be submitted within 3 months versus 6 months, with no time limit to fix errors. | April 1, 2023 |
Do you need help understanding how the PSA will impact your billing?
To help support doctors with the changes to the PSA, DoctorCare is offering a free consultation. This complimentary session will help guide you through the full billing changes outlined in the new agreement.
This offer expires on April 30, 2022.
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