OMA Section on Rheumatology Report

It is disheartening that we are now one and a half years since the start of the COVID-19 pandemic and into a “fourth” wave affecting a third school year. During the pandemic, Ontario doctors have had to overcome PPE, medication, ventilator, and ICU bed shortages. Doctors have a duty to work regardless of the circumstances. However, doctors also have a right to protection. It is unconscionable that recently anti-vaccine protesters gathered outside of hospitals and other health-care institutions where doctors deliver and sick patients receive care. Doctors form a critical part of an effective response to the COVID-19 pandemic. Pandemics can’t be managed without public cooperation, nor can they be managed without doctors. During the pandemic, as always, doctors have stepped up, and have taken on more, never missing a beat, leading by example, educating, advocating, masking, gowning, vaccinating, negotiating, adapting to virtual care while on the front lines continuing to deliver essential healthcare services. Doctors endure.

I remain concerned about the wellbeing of physicians across the province over the past 19 months. The wellbeing of physicians is tethered to the health of communities. Physician burnout is a pervasive issue impacting the profession and exacerbated by the pandemic. In a white paper released by the OMA in August 2021, the OMA Burnout Task Force reports that almost three-quarters (72.9%) of members surveyed said they experienced some level of burnout in 2021, up from 66% from the previous year.  It is my sincere hope, in negotiating our next Physician Service Agreement (PSA), that the government recognizes and considers the diligent efforts and sacrifice Ontario doctors make every day for their patients, most undeniably heightened by the COVID-19 pandemic.

I invite you to find a comfortable seat and catch up on some exciting and enlightening OMA news. You may also come across some links you may wish to bookmark for future reference.

1. TEMPORARY COVID-19 PHYSICIAN VIRTUAL CARE FUNDING EXTENDED

• OMA Negotiations Task Force (NTF) successfully negotiated an agreement with the Ministry of Health (MoH) to extend K-codes that fund virtual care and other COVID-19 related funding to September 30, 2022.
• OMA Negotiations Task Force (NTF) successfully negotiated an agreement with the Ministry of Health (MoH) to extend.
• This agreement was approved by the OMA. Board of Directors and approved by Cabinet July 27, 2021.
• This funding extension, effective Oct. 1, 2021, will maintain:
• All existing virtual K-codes (telephone and virtual assessments and visits), including virtual palliative care services and the GP psychotherapy premium virtual care.
• Assessment Centre sessional fee codes (H409/H410).
• Physician hospital and community funding:
  • Revised temporary EDAFA agreement.
  • Hourly rates in ICUs and wards.
  • COVID intubation team 30 per cent premium for resuscitation with intubation.
  • Non-clinical assignment compensation.
  • Infectious Diseases FTE top ups.
  • Thirty per cent complexity modifier for aerosol-generating medical procedures.
  • Hourly rates for residents.
• Surgical backlog funding; premiums on after-hours elective surgeries and procedures.
• The previous agreement was slated to end Sept 30, 2021.
• Expiration of that agreement without a new replacement agreement could have resulted in the end of previously negotiated and agreed to COVID funding, including virtual K-codes.
• Additional details about the COVID funding extension agreement are provided on the OMA COVID-19 Billing and Compensation webpage.

If you have questions, please email info@oma.org

  2. NEW TRACKING CODES

• The ORA sent out an email to its members September 29 as a reminder of the upcoming new “tracking codes” K300 and K301 and “how to” instructions on adding the new codes manually to the Accuro system (Link: How to add codes).
• As part of the recent COVID funding extension agreement, beginning October 1, 2021, the MOH and OMA have agreed to capture whether K-code services are provided by phone or video.
• This will be done via a requirement to submit one of two tracking codes K300 (video) or K301 (phone) to be used with K083.
• B203 continues as a tracking code only to use for the “OTN” platform. Usual OHIP fee codes for consults and visits apply.
• Regardless of the virtual care platform used (B203 for OTN/K300 or K301 for non-OTN), you must add a line containing a tracking code to your claim to get paid.
• K300 and K301 (just like B203), since they are “tracking codes”, have no fee attached to them. Tracking codes allow the MOH to know which doctors are using video (OTN or other video platform) or telephone when treating their patients virtually.
• Never use B203 with K codes (specifically K083, K300 or K301) at the same time because the claims will be rejected.
• Please refer to Ministry OHIP Bulletin 210904 for more information (Link: Bulletin 21094).

3. EXPANDED ELIGIBILITY FOR 3^RD COVID-19 VACCINE DOSES

• Based on recommendations from the chief medical officer of health and health experts, Ontario is offering third doses of the COVID-19 vaccine to select vulnerable populations to provide sufficient protection based on a suboptimal or waning immune response to vaccines and increased risk of COVID-19 infection.
• The ORA is pleased with the government’s decision to protect our immunosuppressed patients with a third dose of the vaccine.  
• The Ministry of Health expanded the list of immunocompromised individuals who qualify for third doses a minimum of 8 weeks after their second dose.

• The ministry also indicated that eligible patients will be contacted by their health-care provider, such as their primary care provider, specialist or hospital specialty program.
• Initially, a referral letter from their provider was required to receive their third vaccine dose.

• The ORA and OMA strongly advocated for their members and reached out to the Ministry to obtain further clarification. We requested that instead of a physician letter, a patient attestation be considered (as was the case for the 1^st and 2^nd COVID-19 vaccine doses).

• The Ministry has released their new policy on accessing 3rd doses of the COVID-19 vaccine. Specifically, it states: “Prescriptions/ medication bottles for the below immunosuppressant medications can be presented for third doses as needed.”
• Letters from physicians should no longer be required for patients taking any of these medications to access 3rd doses of the vaccine.
• https://health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/vaccine/COVID-19_vaccine_third_dose_recommendations.pdf

• Patient attestation will suffice.

• Those now eligible for a third dose are:
  • • patients with solid tumors or hematological cancers on active treatment
    • transplant recipients (including solid organ transplant and hematopoietic stem cell transplants), and chimeric antigen receptor (CAR)-T-cell recipients
    • patients with moderate or severe primary immunodeficiency (for example, DiGeorge syndrome, Wiskott-Aldrich syndrome)
    • patients with stage 3 or advanced untreated HIV infection and those with AIDS
    • recipients of any of the following immunosuppressive therapies: anti-B cell therapies (monoclonal antibodies targeting CD19, CD20 and CD22), high-dose systemic corticosteroids, alkylating agents, antimetabolites (eg. MTX, Imuran), TNF inhibitors and other biologic agents that are significantly immunosuppressive.   
    • Third doses will continue to be offered to residents of high-risk congregate settings, including long-term care homes, higher-risk retirement homes and First Nations elder care lodges a minimum of five months following the second dose.

  A complete list of eligible medications are available via this link: Read the ministry’s guidance document on third-dose eligibility.

4. COVID-19 VACCINE EXEMPTION NOTES 

• Given how rare eligible COVID-19 vaccine exemptions are, the CPSO now directs that any notes for exemptions need to clearly specify the reason the patient is exempt and the effective time period for the medical reason.
• The OMA has updated its toolkit and sample doctors’ note for providing medical exemptions to prompt physicians to indicate the specific medical reason for it.
• Access the toolkit on COVID-19 vaccine medical exemptions.
• The Ministry of Health recently announced several additional valid medical exemptions including youth with a history of myocarditis unrelated to the COVID-19 vaccine and individuals who had a severe reaction to their first dose that resulted in hospitalization, persistent or significant disability/incapacity.
• Both groups should be evaluated by a specialist to determine whether they can safely receive the vaccine.
• Individuals actively receiving monoclonal antibody therapy or convalescent plasma therapy for the treatment or prevention of COVID-19 qualify for a time-limited medical exemption while they are actively receiving therapy.
• As a reminder, those with an allergy to one or more of the vaccine ingredients or severe allergic reaction or anaphylaxis following the first dose and those with a diagnosis of myocarditis/pericarditis after the first dose of Pfizer or Moderna continue to be eligible for exemptions.
• Read the ministry’s guidance on valid medical exemptions to the COVID-19 vaccine.

5. COVID-19 VACCINATION POLICY TEMPLATE

• The OMA has created a template for mandatory COVID-19 vaccination policies that you may use with your staff.
• To protect vulnerable patients and staff in high-risk settings, Ontario’s chief medical officer of health issued a directive mandating hospitals, ambulance services and home and community care service providers to have a COVID-19 vaccination policy for employees, staff, contractors, students, and volunteers no later than Sept. 7.
• While the directive does not currently apply to community-based physician practices, the OMA continues to advocate for mandatory vaccination of health-care workers within these settings and has encouraged all physicians to consider following it for safer workplaces and health-care settings.
• If you are implementing a mandatory vaccination policy, you may also wish to contact and retain an employment lawyer prior to enacting it and/or if you have an employee who is refusing to comply.
  Access the COVID-19 vaccination policy template.

6. INFECTION PREVENTION AND CONTROL BEST PRACTICES

• Public Health Ontario released a summary of infection prevention and control (IPAC) best practices for acute respiratory illnesses, such as COVID-19, influenza, and other communicable diseases in community-based practices.
• The recommendations have changed as they relate to COVID-19.
• Medical equipment/items in contact with patients’ intact skin and used on multiple patients (ie. arm rests, exam table surfaces, stethoscopes, and BP cuffs) require cleaning and low-level disinfection after each use.
• For patients on droplet and contact precautions, equipment and surfaces that the patient contacted should be cleaned with a low-level disinfectant after the patient leaves.
• High-touch surfaces and items, such as doorknobs and telephones, should be cleaned and disinfected at least once daily and more frequently as needed.
  Read Public Health Ontario’s IPAC best practices

7. EAP REQUESTS TRANSITIONING TO MOH SPECIAL AUTHORIZATION DIGITAL INFORMATION EXCHANGE (SADIE) PORTAL JAN 1, 2022 

• The Ministry of Health continues to modernize the Exceptional Access Program (EAP) and transition away from fax-based processes by December 31, 2021.
• Effective Dec. 31, the Ministry will no longer accept EAP request submissions by fax from Ontario prescribers, and only digital requests will be honoured.
• By January 1, 2022, all EAP requests must be submitted using the Ministry of Health’s Special Authorization Digital Information Exchange (SADIE) portal.
• SADIE is the digital portal for submitting Exceptional Access Program (EAP) requests for Ontario Drug Benefit recipients.
• Why use SADIE?
• Delegates can submit requests to the EAP!
• Accessible wherever and whenever prescribers work – SADIE is available 24×7 on your computer, tablet, or smart phone.
• Smart forms that streamline submissions for any drug by asking questions specific to the patient’s circumstances.
• Designates can prepare an EAP request for a prescriber to review and submit. (Prescribers can allow delegates to create and submit requests to the EAP on their behalf. Delegates can use SADIE if the prescriber they work with has designated them on GO Secure and SADIE).
• Faster decisions and a reduction in requests for additional information.
• Same day approvals for many requests submitted through SADIE.
• To support ORA members in the transition to SADIE, ORA held a virtual SADIE demonstration led by Ted Durst from the Ministry of Health September 21, 2021.
• A recording of this Town Hall is available to members at https://ontariorheum.ca/ under Your Membership, Resources for Members.

• SADIE info website is https://www.health.gov.on.ca/en/pro/programs/sadie/default.aspx

Email address: SADIE@ontario.ca

8. HEALTH CARD RENEWALS REINSTATED

• The province lifted renewal requirements on expired Ontario health cards when the COVID-19 pandemic started in March 2020 but is now reinstating them.
• Ontario residents have until Feb. 28, 2022, to renew expired health cards and accessible parking permits.
• Patients can visit ServiceOntario in person or online to renew health cards.
  Read more on OHIP INFOBulletin 201107 for current information on health card validation

9. OMA FEE-SETTING PROCESS

• The Medical Services Payment Committee (MSPC) is a bilateral committee with equal representation from the OMA and Ministry of Health.
• The OMA-MSPC will begin undertaking preparatory work for a bilateral fee-setting/allocation process, which is anticipated following a new physician services agreement (PSA).
• The OMA is undertaking work to establish a fee-setting process.
• The Section of Rheumatology (along with every section, medical interest groups (MIGs) and forum leaders) will be invited to make “fee submissions”, which are due in early November.
• MSPC will then review all submissions and engage sections/MIGs/fora in further discussions starting in early 2022.
  Learn more about the fee-setting process and timelines.

10. UPDATE ON ADVANCE PAYMENT PROGRAM

• The OMA Board unanimously rejected the Advance Payment Program April 22, 2020, after asking the government for appropriate relief for physicians – specifically, infrastructure costs and income stabilization, however, the APP was imposed on Ontario physicians by government.
• The government planned to start to recover payments in February 2021.
• The first recovery of the COVID-19 Advance Payment Program was applied to your April 2021 Remittance Advice.

• As previously communicated, the recovery of the next five instalments starting in May 2021 has been paused until further notice.
• Details, including options for earlier, voluntary repayments, are provided in OHIP INFOBulletin 210103. https://www.health.gov.on.ca/en/pro/programs/ohip/bulletins/redux/bul210103.aspx

11. OMA GOVERNANCE TRANSFORMATION

• Elected colleagues and OMA staff came together virtually in the last ever OMA Fall Council meeting November 28 and 29.
• Dr. Julie Kovacs and Dr. Philip Baer attended.
• OMA has worked to achieve Governance transformation to enable OMA to evolve into a world-class medical organization since 2016 and received approval at Fall Council.

• The OMA’s governance transformation journey over the last two years has focused on how to ensure members are at the center of the OMA’s work.

• The OMA has undergone significant transformation and reform since 2017. ​
• A new Board was elected in 2017​ and a new CEO (Allan O’Dette) appointed in 2018​.
• Under the new OMA governance, the smaller, skills-based Board was reduced from 26 to 11 (8 physicians and 3 non-physicians), with professional directors who will ensure a more nimble and effective organization.
• You, the OMA membership for the first time directly elected the skills-based Board of Directors and the President-elect.
• The previous OMA Council (250 delegates) was sunsetted and a new Priority and Leadership Group (PLG) of delegates (reduced to 125 delegates) was established to reflect the broad diversity of the profession.
• All sections have at least 1 allocated delegate. The number of delegates representing a section is proportional to the size of the section. Smaller sections have a single delegate representing them, while larger sections such as internal medicine, family practice, pediatrics and psychiatry have several delegates.
• The PLG is made up of:
• 5 Networks (MEDICAL –37 delegates allocated, SURGICAL –23 allocated, PRIMARY CARE –27 allocated, DIAGNOSTIC –7 allocated AND REGIONAL NETWORKS representing the 11 geographic districts -22 allocated).
• 2 Fora (Academic and Rural): 3 Delegates per Forum = 6 Total Priority and Leadership Group
• 2 residents and 1 medical student delegates.

• Further, there are 3 panels to help shape the OMA’s priorities – Issues and Policy, Compensation, and Advocacy. Each panel has seven members.
• The OMA held their AGM (May 28-30, 2021), and Dr. Julie Kovacs attended.
• Adam Kassam was installed as the OMA’s 140^th and youngest president, the first physiatrist and first Ismaili Muslim in the association’s history.
• OMA’s new General Assembly took effect May 29, 2021.
• Since May 2021, when OMA members and elected leaders formally came together, the OMA has made strong progress. Nearly all 125 delegates have been appointed to the PLG.
• July 8, 2021, Dr. Carter Thorne stepped down as OMA Chair, Section on Rheumatology.
• Julie Kovacs, previously OMA Vice-Chair and delegate Section on Rheumatology agreed to step in as Chair and will continue as the delegate for the Section on Rheumatology (Medical network) as part of the new PLG.

• 21 members have been appointed to the Compensation, Issues and Policy, and Advocacy panels.

• I would like to extend our congratulations to Dr. Jane Purvis for her appointment to the OMA’s new General Assembly Issues and Policy Panel for a two-year term beginning immediately and concluding in 2023. Dr. Purvis is also one of 2 delegates representing OMA geographic district 6.

• Dr. Veronica Legnini has been elected as chair and Dr. Atul Kapur as vice-chair of the General Assembly Steering Committee.
• Learn more about the General Assembly. 

12. PRIORITY AND LEADERSHIP INAUGURAL MEETING (SEPT. 29, 2021) 

• Under the new OMA governance framework, the Priority and Leadership Group (PLG) of 125 delegates from elected leadership from all sections, districts, and fora met at an inaugural priority-setting virtual meeting Sept. 29, 2021.
• Julie Kovacs and Dr. Jane Purvis attended.
• The Priority and Leadership Group’s main function is to set priorities for the organization that are achievable and aligned to the OMA’s strategic plan, helping to modernize the organization as well as healthcare in Ontario.
• The priorities that came out of this first PLG meeting will be presented to the OMA Board for approval later in the fall.
• Zayna Khayat, PhD and renowned health futurist with a background in health-system strategy and innovation, delivered a keynote address.
• Delegates also elected the 3 remaining members of the General Assembly Steering Committee.

13. NEGOTIATIONS UPDATES

• Mediation with the Ministry of Health resumed Sept. 11, 2021, with sessions scheduled throughout the fall and into December 2021.
• The parties have also agreed to dates in January, February and March 2022 for arbitration hearings should that prove necessary.
• Our Physician Services Agreement (PSA) concluded March 31, 2021 (7 months ago).
• The next PSA will be retroactive to April 1, 2021.
• The OMA has brought forward a number of priorities in mediation, including: global fee increases, continuation and expansion of virtual care, establishing relativity across all domains (intersectional, intrasectional and across gender), modernization of the Schedule of Benefits, medical liability protection reimbursement, increased access to existing and creation of novel alternate funding plans, financial support for physicians in this and future pandemics or emergency situations, and enhancing access to the FHO model.
• A large gap remained between the parties heading into mediation.
• Rheumatology continues to be represented at monthly Negotiation Updates by Dr. Julie Kovacs and Dr. Jane Purvis (Physician Service Committee).

14. CPSO VIRTUAL CARE POLICY CONSULTATION

• With the increase in vaccination uptake, an appropriate balance of in-person and virtual care should be provided to meet the needs of patients.
• The Ministry of Health recently released updated primary care guidance and the CPSO provided new information on striking the right balance between providing in-person care and virtual care.
• The OMA is preparing a submission to the CPSO on its updated virtual care policy and advice to the profession.
• As part of its consultation, the CPSO is interested to know if the policy and advice document adequately explain meeting the standard of care when virtual care is provided, when it would be in a patient’s best interest to provide virtual care, and in-person care, privacy and security requirements, obtaining informed consent, and licensing requirements when providing virtual care to Ontario patients.
  Email your input by Friday, Oct. 15 to inform the OMA’s response.
  Access the CPSO policy and advice document and provide the CPSO with direct feedback

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

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

See below for OMA modules or webinars that may be of interest to you:

OntarioMD (OMD) and the OMA have launched a comprehensive new Virtual care Module. Explore the new Virtual Care Privacy and Security Online Training Module.

eConsult and eReferral webinar series. Ontario eServices Program is hosting a series of webinars throughout October and November.
Learn more and register for the eConsult and eReferral fall 2021 webinar series.

Speaking out as a hospital-based physician. Join the OMA, a panel of communication, legal experts and a physician for an upcoming webinar intended to help hospital-based physicians understand their rights and responsibilities, Thursday, Oct. 14 from 8-9 p.m.
Register for the webinar on speaking out as a hospital-based physician.

Practice advice for early career physicians. Are you new to practice? Join the OMA for a two-part webinar series on Thursday, Oct. 14 and Thursday, Oct. 21 from 6-9 p.m. to learn about practice management in your early years of practice. This two-part series will cover a broad range of topics including practice structures, digitally enabling your practice, financial management, personal and professional insurance, contracts, managing referrals, and more.
Register for the Getting Started for Early Career Physicians webinar.

See below for OMA’s exclusive member discounts on various goods and services:

Save on PPE. Surgo Surgical Supply medical equipment, medical supplies, medical printing, medical apparel, and a complete line of office supplies. Learn more about the exclusive discount offered to OMA members and other special promotions.

Dragon Medical Dictation Canada. Receive a $200 rebate when you sign up for a one-year subscription for Dragon Medical One Cloud Version.  Dragon Medical is offering free 30-day trials for all OMA members. Learn more about Dragon Medical Dictation Canada.

Discounts available from VIA Rail Canada.  OMA members are entitled to a 15% discount on the best available fare. This discount applies to OMA members and up to three additional passengers. Learn more about VIA Rail discounts.

Keeping travel costs down.  Local Hospitality offers an exclusive worldwide travel discount program where you can save up to 20% below market on any hotel or car – anywhere, anytime.

Getting back to the gym. OMA members are eligible for preferred membership rates at Goodlife Fitness Learn more about the offer and join Goodlife today.

Special savings on UpToDate^® subscriptions. UpToDate^® is an evidence-based, physician-authored resource, Learn more on how you can get special discounts on your subscription.

Stay safe and be kind.