OMA Section on Rheumatology Report

Wearing a mask in public, social distancing and bubbling have become the new norm to help keep us safe. However, out of everything bad, comes something good. Due to the spread of the coronavirus, human activity has slowed down reducing the carbon footprint on our planet. While COVID-19 continues to threaten mankind, Mother Earth is healing. Personally, in the past several months, I have driven my car far less and stepped up my walking. I am grateful for the healthy lifestyle change.

The Canadian Association of Physicians for the Environment launched its CMA-endorsed Healthy Recovery report last week. It shows that between now and 2050, environmentally-minded decisions can save over 100,000 lives and create over a million jobs, in Canada alone, all while improving the health of the planet.

OMA’s newest MIG (Medical Interest Group) is Green is Health. Their objective is to discuss how environmental health affects medical health, and how in medical practice we have the capacity to affect the environment.  You can sign up for the emails at greenishealth@gmail.com.

On that positive note, let me bring you the latest OMA news.

1. IMPACT OF COVID ON PHYSICIAN’S INCOMES (analysis by OMA economist)

• OMA Economics, Policy and Research (EPR) department examined the economic impact of the COVID-19 pandemic on physician payments.
• They used Ministry of Health data to prepare a report that examines the effect of COVID-19 on Ontario physician payments.
• Fee For Service (FFS) billings (professional and technical fees and shadow billings) declined by about 21% in March of 2020 relative to March of 2019, by about 49% in April of 2020 relative to April of 2019, and by about 46% in May of 2020 relative to May of 2019.
• Over March to May 2020 combined, this represents about a 37% reduction in FFS billings.
• Specifically, impact on average total payment per physician for Rheumatology: March-May -27.9%, March -16.5%, April -34.8%, May -34.4%.
• Most affected specialty Ophthalmology -51.2%, least affected specialty Nephrology -2.0%.
• The OMA will be using this data as part of negotiations and discussions with the Ministry, as it strongly reinforces the claims the OMA has been been making for months that there has been a significant decrease in physician billings during the COVID-19 pandemic. Physicians continue to carry their steep business/office overheads despite the dramatic drop in case volumes.
• See table below showing the impact on average total payment per physician, by OHIP specialty group from March to May 2020.

 

 

2. CHANGES TO ADVANCE PAYMENT PROGRAM “REPAYMENT” SCHEDULE

• The OMA Board unanimously rejected the Advance Payment Program April 22, 2020, after asking the government repeatedly for appropriate relief for physicians – namely infrastructure costs and income stabilization.
• Nevertheless, this top-up to 70% of a physician’s normal billings was imposed upon us by government.
• The OMA considered the approach by Government nonsensical as instead of not having enough money to pay your overhead in May and June, physicians won’t have enough to pay our overhead when the government starts to recover payments in February 2021.
• The OMA advocated for grants rather than loans because doctors will not be able to make up for the deficit when the pandemic ends.
• Patient volumes continue to be much lower than usual for most physicians honouring public health recommendations on social distancing, keeping patients at home and out of the office. Those physicians who are seeing patients face-to-face are dressing in PPE, and sanitizing examination and other common office areas, increasing overhead cost and reducing efficiency.
• The Ministry’s first installment of the Advance Payment Program should have been on your May RA.
• The Ministry has recently advised the OMA of the following changes: Elongating the recovery period from five to six months and delaying the start of repayment from November 2020 to February 2021.

• Comparison of Original vs. Revised Advance Payment Program

Program Details	Advance Payment RAs	Recovery RAs
Original	May 2020 to July 2020	November 2020 to March 2021
Revised	May 2020 to July 2020	February 2021 to July 2021

• Recovery of advance payment amounts are still planned to be evenly divided across the recovery period, and the advance payments received are interest-free.
• The total amount of the advance payments will be recovered in six equal instalments against future OHIP payments from February 2021 to July 2021.

For example, a provider received the following advance payments:

• May 2020 RA: EMERG ADVANCE PAYMENT (COVID19) $5000
• June 2020 RA: EMERG ADVANCE PAYMENT (COVID19) $6000
• July 2020 RA: EMERG ADVANCE PAYMENT (COVID19) $7000

The total of advance payments made to the provider is $18,000. $18,000 divided by six is $3,000. Starting on the February 2021 RA, the provider will see a deduction of $3,000 per month ending with the July 2021 RA.

Please see infobulletin #4765 http://www.health.gov.on.ca/en/pro/programs/ohip/bulletins/4000/bul4765.aspx 

 

3. FEE CODE CHANGES AS OF APRIL 1, 2020

• By now, you should all be aware of the Arbitrated Award 2017-2021 Physician Services Agreement (PSA) year 4, fee code increases for Rheumatology starting April 1, 2020.
• Fee code recommendations for Rheumatology and all sections April 1, 2020 OHIP Schedule of Benefits fee changes are available on the OMA website here.
• I hope all of you saw April 1, 2020 fee code increases reflected on your remittances starting from May 2020.
• For year 4, since the new fees are programmed in the OHIP computers, we can bill them as we go, and not have to go through a long retroactive pay process as for years 1-3.
• Yes, it is true. You have NOT yet received Year 3 retroactive payments and they are probably not coming until February of 2021!

 

4. RESOLUTION OF VIRTUAL CARE CODES (K083, E078, K481)

• Effective March 14, 2020 MOH introduced a Temporary Fee Schedule Code K083, covering telephone and non-OTN virtual care visits for specialists
• Effective May 1, 2020, physicians could submit claims for Temporary Fee Schedule Code K083 for services provided on or after March 14, 2020.

Please see OHIP Bulletin 4755 http://www.health.gov.on.ca/en/pro/programs/ohip/bulletins/4000/bulletin_4000_mn.aspx

• July 9, 2020, the OMA announced the resolution of some issues around the Phase I codes including an E078 victory! 
• OHIP Bulletin 4764 was posted on August 7, 2020 and is available via this link:OHIP Bulletin

• After months of discussion between the OMA (and ORA) and MOH, a resolution was reached with the government on the E078 billing code issue! The OMA position was that physicians should be reimbursed the same fee for the telephone (K083) or non-OTN video visit as an in-person visit. The Ministry position initially was that premiums such as E078 should not be eligible for payment with the new virtual care K-codes.

• The MOH has reversed its position and Specialist premiums E078 will be paid with K083 (assuming all requirements in the Schedule of Benefits are met).

• Effective immediately, any claims for specialist payment, for services rendered after March 14, 2020 but not yet billed, should be submitted using the K083 code (Specialist consultation or visit by telephone or video payable in increments of $5) inclusive of the value of all the eligible premiums (such as E078) and service codes.
• If physicians have already submitted claims for services under K083 for which “premiums” were eligible but not billed, a new code will be launched to allow for retroactive payment.
• Unfortunately, this will require OHIP computer programming, with the usual delay, with the intention being to aim for the October 2020 RA. (A separate INFOBulletin will announce this-but nothing announced as of Oct. 2, 2020). 
• An equivalent “management fee” will also be implemented to pay physicians for eligible management fees (specifically, K481 for Rheumatology – Rheumatoid arthritis management by a specialist – annual management fee)
• Management fees are NOT payable in K083 units. (A separate INFOBulletin will advise on the process and code to submit such claims). 
• Agreement on adjusting these temporary virtual care codes recognizes the on-going COVID-19 pandemic and the fact that physical distancing continues to place limits on the ability to provide face-to-face care.

 

5. NEGOTIATIONS UPDATE

• While the Negotiations Task Force (NTF) has spent much of its time engaging with government on COVID-19 related issues, the NTF is now ramping up to prepare for the next round of Physician Service Agreement negotiations in October 2020.
• The NTF requested input from each OMA Section, Medical Interest Group (MIG) and Forum leads on their negotiation priorities.
• Rheumatology negotiations priorities were submitted to the OMA.
• In addition to consulting with constituency leads, a negotiations survey was sent out to ALL OMA members (survey closed August 10) to have the opportunity to provide YOUR priorities for the next PSA negotiations so the OMA can better advocate on your behalf.
• I hope you all had a chance to complete the survey!
• We are excited to have Dr. Jane Purvis on the OMA Physician Service Committee which can only help as we negotiate our next Physician Service Agreement (PSA).

 

6. PPE

• The OMA has put together a preferred vendor list for PPE.
• These are companies whose products have been vetted (so many subpar or fraudulent companies surfaced over the last several months).
• Details are available in a recent Member Alert.
• The MOH and Ontario Health (OH) co-announced that the new Pandemic PPE Transitional Support Program (PPTTSP), will provide PPE to all community-based physicians free of charge.
• The program is transitional, the Ministry reserves the right to alter the terms, and a standard provincial formula will be applied to determine quantities of each item per allocation.
• Providers can make requests through Ontario Health (OH) regional online Remedy Intake Forms.
• Please note, Ontario Health requires providers to include the following information the final field of the remedy form that says “please include any additional comments”:
• The number of patient-facing clinical staff and learners in the practice/organization,
• The number of non—clinical staff in the practice/organization, and
• The number of patients the practice services
• You will not receive your PPE allocation unless this information is submitted. Ontario Health has informed the OMA that the form will be updated to provide specific prompts and fields for this information in the near future.
• The following types of PPE can be requested through this process: Surgical masks, gloves, gowns, hand sanitizer, face shields and disinfectant wipes.
• If you require N95 masks for aerosol/generating medical procedures, you must complete a separate intake form. Your OH region will follow-up to understand the rationale for your request.
• In addition, MOH requests providers continue to update their PPE inventory levels twice a week. This is an eligibility requirement to receive PPE through the new PPTTSP program.  OH explains you will not receive your PPE allocation if this information is not submitted.  The OMA understands that this is an onerous task and have communicated this to the government.  The government requires this information to aid in planning procurement and distribution of PPE, especially given their new PPE allocation strategy

Access the Remedy Intake Form (for Ontario Health North, Toronto, Central and East)

Access instructions for how to complete the Remedy Intake Form

Access the Ontario West Intake Form (select the link for your subregion)

• Read more about the details and how to apply in a recent Member Alert.

 

7. CORONAVIRUS (COVID-19) UPDATE

• The government is continuing its gradual, staged approach to reopening Ontario, restarting the economy and easing the necessary restrictions that were put in place to contain the spread of the COVID‑19 outbreak, as outlined in A Framework for Reopening our Province.
• July 17, 2020, the Government moved into stage 3.
• The OMA recently issued a public statement calling on the provincial government to rethink opening indoor bars, which generated significant media attention across the province.
• https://www.healthing.ca/diseases-and-conditions/coronavirus/omas-five-pillars-are-a-safety-plan-for-ontarios-reopening
• Back to School Podcasts: The OMA Spotlight on Health podcast interviewed five public health physicians from across the province, discussing their roles in preparing schools and answering important questions for parents/guardians.
• MOH Screening Tool for Children in School and Child Care
• As we have ventured inside, with the cooler weather and the return to school, COVID cases are on the rise.
• New COVID-19 modelling was released by the Ontario government on September 30, 2020
• New COVID-19 cases in Ontario are doubling approximately every 10 to 12 days.
• According to the provincial government, when there are less than 150 COVID-19 patients being treated in intensive care in Ontario hospitals, the province can maintain non-COVID capacity and all scheduled surgeries.
• According to government, once that number rises above 150 it becomes harder to support non-COVID-19 needs. Once it exceeds 350 people, it becomes “impossible” to handle.
• Rapid testing is not yet approved for use in Ontario. Health Canada has approved ID Now, a point of care test for COVID-19, with up to 95% accuracy, that delivers results within 15 minutes.
• As a result of the efforts of the OMA working with the Ontario Chamber of Commerce, Mar 16, 2020, Premier Ford announced that sick notes are not necessary during the COVID-19 period.

• OMA COVID-Related Doctor’s Notes Toolkit
• COVID-19 Provincial Testing Guidance Update
• For patients, the OMA  launched a patient facing website, virusfacts.ca. This website contains useful information for patients on what they should do if they are concerned about COVID-19 and reference numbers to call.

 

8. COVID-19 Alert App 

• During the COVID-19 pandemic we do know that rapid and thorough contact tracing is essential in moving forward safely.
• If you haven’t already downloaded the App, the OMA would like you to consider doing so and encourage your social networks and patients to do the same. The COVID Alert app will work best if widely adopted.
• For those who can’t/won’t use the App, the OMA has a pocket journal to track movements and interactions daily; it’s far easier and more thorough than trying to recall 14 days’ worth of activity.

 

9. Updated COVID-19 Patient Assessment Tool

• An updated COVID-19 Patient Assessment Tool was developed by the OMA
• It is being continuously revised based on the Ministry’s decisions and summarizes guidance on testing and clearance for COVID-19.
• OMA held a town hall addressing some of the common questions and concerns around ramping up health care and office visits. You can watch the session online.

 

10. UPDATE ON OMA LEADERSHIP OMA

• OMA President, Dr. Samantha Hall (who started her term May 3, 2020) is spending a great deal of time on outreach to MPPs, to educate and establish relationships that enable the OMA to better advocate for all its individual members.
• To date, the OMA has completed almost 50 meetings with MPPs, with more scheduled.
• On September 26, 2020, the OMA hosted a virtual Physician Leaders’ Day.
• Council Delegates including Dr. Kovacs and Dr. Baer attended to discuss the challenges and advantages of the proposed governance changes planned for the new year.
• The OMA on the advice of SuccessMap Consulting Group, intends to drastically slash the number of its Board and General Assembly members, to make the OMA an organization better suited to respond swiftly to physician’s needs.
• As well, Kim Tran led a timely thought-provoking interactive session on Equity, Diversity, and Inclusion.

 

11. GENDER EQUITY AND PAY GAPS

• In 2018, the Canadian Medical Association published a damning review of gender equity in medicine.
• Female family doctors earned 84 cents on the dollar compared to their male counterparts.
• Female specialists earned 63 cents on the dollar compared to their male counterparts.
• Women were five times more likely than their male colleagues to experience opposition to career advancement and three times more likely to experience disrespectful or punitive actions.
• Women were significantly underrepresented in leadership positions, such as hospital leadership, medical association leadership, etc.
• At the OMA Council meeting in May 2019, the following members’ period motion was carried: “That the OMA initiate a thorough study of the sources and magnitude of physician gender pay gaps in Ontario.”
• At the fall 2019 Council meeting, a subsequent members’ period motion was passed: “That the OMA move from research and analysis of the gender pay inequity, underemployment and unemployment of physicians to possible solutions that address these issues by the next Council in spring 2020.”
• OMA staff have completed a preliminary report outlining a gender discrepancy in pay and billings and illustrating significant differences in how male and female physicians are compensated in a number of different practice areas and specialties
• OMA Gender Pay Gap Report can be viewed here.
• As a direct result of this report, the Board passed motions directing findings, data and analyses to be used to further the OMA’s priorities in addressing relativity and in strategy development for the 2021 negotiations; to develop a communications strategy to highlight the gender pay gap and its impact; and to look at trends in income in addition to other available data to address potential health human resources shortages.
• The OMA is the first Canadian provincial/territorial medical association to address this issue.

 

12. CPSO Consultations: Have Your Say

• CPSO have proposed 4 open policy consultations (below) and would like your thoughts.
• Links are provided below to view the current policy and advice documents and post your comments on the online discussions pages.
• Draft Policy: Delegation of Controlled Acts dedicated consultation page
• Draft Policy: Professional Responsibilities in Medical Education dedicated consultation page
• Draft Policy: Third Party Medical Reports dedicated consultation page
• Current Policy: Telemedicine dedicated consultation page
• Physician feedback deadline November 16, 2020.

 

13. OMA President’s Tour

• This year, the President’s Tour which aims to increase transparency and member engagement will be in 2 phases and will likely all be virtual.
• The first phase will be a leader-to-leader outreach via Assembly town halls, to better engage with executives of OMA Sections, MIGs, and Fora, divided by the four assemblies (Medical, Surgical, Diagnostic, General and Family Practice). Dr. Kovacs participated in the Medical Assembly town hall October 1, 2020. Dr. Hill was joined by OMA CEO Allan O’Dette, Board Chair Dr. Tim Nicholas, President-Elect Dr. Adam Kassam, and the respective Assembly Directors, and engaged in discussion about how the OMA is: Preparing for the next round of negotiations to get the best possible deal for doctors; Advocating for issues that are important to you and the profession; Transforming to provide better value and services for your membership dues; and, prioritizing diversity, equity and inclusion.
• The second phase will look more like the traditional President’s Tour, reaching out to members in each District, and providing an opportunity for meaningful discussions.
• Stay tuned for upcoming dates.

 

14. FEDERAL SUBSIDY PROGRAMS REMINDER

• Canadian Emergency Wage Subsidy (“CEWS”)-ongoing to 2021
• Temporary Wage Subsidy for Employers (“TWS’)-ended as of mid-June 2020
• Canadian Economic Response Benefit (“CERB”)-ended as of late Sept. 2020

• MNP (one of Canada’s leading national accounting, tax, and business consulting firms) developed a physician-friendly guide to the various supports and incentives being made available by the federal government.
• This is an extremely valuable resource for identifying avenues of support that will immediately benefit you and your practice. Please follow the link below and open the pdf called “Details of federal support programs (PDF)”.

https://www.oma.org/member/section/search/covid-19-managing-your-practice-during?type=topics

 

OMA Fall Council is scheduled for November 27-29, 2020.

We will continue representing the Section on Rheumatology at Medical Assembly teleconferences and Assembly meetings, as well as all regular and special OMA Council Meetings.

New! COVID-related continuing professional development (CPD) and learning opportunities are now available. Follow this link for a list of COVID-CPD activities eligible for Maintenance of Certification (MOC) Program credit (Section 1 and Section 3).

You can monitor the MOHLTC website under the Health Professionals tab for new developments: http://www.health.gov.on.ca/en/pro/. There are links to OHIP Physician Bulletins: http://www.health.gov.on.ca/en/pro/programs/ohip/bulletins/ and to updates regarding the OPDP formulary, including new EAP listings:
http://www.health.gov.on.ca/en/pro/programs/drugs/eap_criteria.aspx

You may also keep up on OMA issues by reading the Ontario Medical Review (OMR), the OMA monthly magazine available in print and on the OMA website: www.oma.org

Provided is a link to prior OHIP Bulletins http://www.health.gov.on.ca/en/pro/programs/ohip/bulletins/4000/bulletin_4000_mn.aspx

Online educational modules on billing, patient care, practice management and retirement planning are available through the OMA Education Network at:

https://learn.oma.org

As well, an online Privacy and Security Training Module is now available from OntarioMD:

https://www.ontariomd.ca/products-and-services/privacy-and-training-resources

Be safe and stay kind.