Charles Darwin said, “It is not the strongest of the species that will survive, nor the most intelligent that survives. It is the one that is most adaptable to change”.
COVID-19 has taught us that as a society, we must change our behaviors and our practices to overcome this pandemic. Physicians in particular have scrambled to transition to new ways of seeing patients (virtual care) to protect the vulnerable in society while simultaneously trying to protect our families and ourselves, all while dealing with financial strains trying to keep our businesses afloat. The OMA has been integral in advocating for physicians during COVID-19 in constant discussions with government to ensure adequate supply of PPE, cover infrastructure costs and income stabilization for physicians and immediately implementing temporary OHIP fee codes for telephone and non-OTN video visits.
There have been 71 general OMA updates and 45 OMA President’s updates to members since January 2020 compared to 12 OMA updates and 20 OMA President’s updates in 2019. To help you navigate through this daunting onslaught of OMA emails, please allow me to summarize the highlights and acquaint you with important OMA news. This document may serve as a go to for many resources you may find helpful to your practice.
- UPDATE ON OMA LEADERSHIP/ELECTIONS AND OMA GOVERNANCE
- Our new OMA President, Samantha Hill was installed at OMA’s first virtual Spring Council meeting on May 3, 2020 to begin her 1-year term. She is a cardiac surgeon at SMH and a McGill graduate (2003). Dr. Hill succeeds Dr. Sohail Gandhi as OMA President. Please welcome Dr. Adam Kassam, as your OMA President-elect. Dr. Kassam graduated Phi Beta Kappa from Cornell University. He obtained an MD from Dartmouth Medical School while also completing a Master’s in Public Health from Columbia University. He previously served as OMA Chair of the Section of Physical Medicine and Rehabilitation.
- OMA Rheumatology Slate: OMA Section Chair Dr. Carter Thorne, Vice-Chair and delegate, Dr. Julie Kovacs, secretary and District 11 delegate, Dr. Philip Baer.
- OMA Board voted to reduce itself in size from 25 physicians to 11 (8 physicians, 3 non-physicians).
- OMA Council voted to restructure itself into a General Assembly that is only half the size of the current Council.
- These OMA Governance changes were made to make the OMA nimbler and more responsive to member’s needs.
- VIRTUAL CARE CODES
- In November 2019, Health Minister Christine Elliott announced an expansion of virtual video visits through OTN. This meant that physicians, including all specialists, could now deliver direct-to-patient video visits and could bill the government for these services. Video visits are not paid out of the OHIP pool of funds (it is a separate pot of money).
- Currently, the only software that qualifies for government funding is OTNinvite. OTNinvite allows doctors to use any webcam enabled device, to “visit” a patient in any setting, so long as they have a webcam enabled device. To register as an OTNinvite physician, and become eligible to bill for this, go to OTNhub.ca click here.
What you need to get started:
- ONE ID Credentials
All applicants are required to have a ONE ID account from eHealth Ontario. - Visit the CPSO website and directly register for a ONE ID in minutes. Click here to: Get your ONE ID from CPSO.
- An OTNhub account
Use your ONE ID to sign up for an OTNhub account. Health care providers working at organizationsmay be able to access OTN services instantly through express sign up if you are affiliated with a hospital. Physicians in private practice without a hospital affiliation/privileges should go to the private practice sign up portal which is extremely backed up and may take months.
- TEMPORARY FEE SCHEDULE CODES K083
- 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 the MOH Bulletin 4755 Here http://www.health.gov.on.ca/en/pro/programs/ohip/bulletins/4000/bulletin_4000_mn.aspx
- FEE CODE CHANGES AS OF APRIL 1, 2020
- As you are all aware, for the first time in the history of Ontario, physicians were given an Arbitrated Award in the 2017-2021 Physician Services Agreement (PSA).
- The Kaplan Board of Arbitration agreed that we must deal with the issue of relativity.
- The official OMA model for relativity is CANDI. The government refused to accept CANDI. The official MOH model for relativity is RAANI. The OMA feels that there are serious, significant, and unresolvable issues with RAANI, and we refused to accept it. The Arbitrator (acting in this case as a mediator), worked with both sides, and came up with the Hybrid model, and the Hybrid model will be used for all 4 years of the current PSA.
- As a result of the award and the Hybrid process, the Section on Rheumatology was awarded a 7% normative increase for year 4 of the fee allocation process
- The Medical Services Payment Committee (MSPC) which is a bilateral committee — (half OMA and half MOH, who had to agree, otherwise unresolved issues would go back to arbitration) was tasked with the responsibility of implementing the normative increases for every section.
- The timelines were tight as the MOH insisted they had to have a decision by December 18, 2019, in order to program their computers for April 1, 2020.
- In July 2019, the MSPC sent letters to all Section chairs outlining this process. In August 2019, the MSPC surveyed members of each Section to see what fee codes were in need of change. On September 20, the Section chairs were sent the survey results, and asked to provide input by October 14 (as mentioned the timelines were tight-3 months).
- The Section of Rheumatology provided feedback, to assist the MSPC with their recommendations.
- 5 Sections received zero allocation – i.e. no overall increase to their budgets (cardiology, diagnostic radiology, gastroenterology, ophthalmology, and radiation oncology).
- The specific changes approved by MSPC for Rheumatology show fee increases between 2.20-8.32% (8.32% increase for a new consultation).
- 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 May and June 2020 remittances.
- Unlike the year 1 and 2 binding arbitration awards, 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 and tedious retroactive pay process as we had in prior years.
- By the way… Year 3 retroactive payments are probably not coming until February of 2021!
- TEMPORARY FEE SCHEDULE CODE K083
- Effective March 14, 2020 MOH introduced Temporary Fee Schedule Code K083, a telephone and non-OTN virtual visit code for specialists, but we were asked to hold off on sending in our billings until the OHIP computers were re-programmed.
- Effective May 1, 2020, physicians were finally allowed to submit claims for Temporary Fee Schedule Code K083. Claims for services provided on or after March 14, 2020 can now be submitted. MOH Info Bulletin 4755
Please see the OMA Bulletin Here: https://ontariorheum.ca/wp-content/uploads/OHIP-bulletin-4755-re-submitting-K083-code.pdf
6. CONFUSION RE: E078 AND K083
- The OMA position is 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 is that premiums such as E078 should not be eligible for payment with the new virtual care K-codes.
- No resolution to date.
- Dr. Baer and Dr. Purvis strongly advocated for Ontario’s rheumatologists, holding meetings with OMA President Sohail Gandhi, OMA CEO Allan O’Dette and the Negotiations Committee and the Ministry
- OMA see this issue as a priority and supports fully the payment of E078 for all virtual visits, including telephone and non-OTN video visits, and the Negotiations Committee and OMA legal strongly put this in front of the ministry.
- OMA prefers to reach a negotiated settlement rather than trigger arbitration where while they feel we have a strong case, in the hands of an arbitrator, a win is never guaranteed.
- OMA thinks they will have a sense by the end of June whether their negotiations with government will prove unsuccessful.
- The OMA at that point could consider going the rights arbitration route.
- Bottom line is it is therefore up to each of you whether you wish to bill either:
i) K083 with E078 (e.g. A483/E078 is 25 units, A481/E078 is 22 units, A484/E078 is 19 units) since this combination is being paid by the MOH but could still be clawed back or subject to audit
OR
ii) Bill K083 without E078 (e.g a usual A483 is 16 units, A481 is 15 units, A484 13 units).
- Again, the Ministry’s position is to bill K083 without E078
- SOME PHYSICIAN’S HAVE REPORTED DIFFICULTY BILLING K481 ON THE SAME DAY AS SPECIALISTS’ TELECONFERENCE VIRTUAL CARE CODE K083.
- As you know, K481 is a specific code to Rheumatologists for management of RA
- K481 is limited to one per patient per year and is only eligible for payment if the physician has rendered a minimum of 3 consultations/assessments in the 12-month period for which K481 is claimed
- K481 does not need to be billed on a visit day and can be billed independently on a different non-visit/appointment day as long as tender joint count (TJC), swollen joint (SJC), physician and patient global assessment of disease activity, patient pain score, HAQ or SF36 scores, pooled measure of RA disease activity (DAS 28, SDAI or CDAI) are recorded and all other above criteria are met
- IMPACT OF COVID ON PHYSICIAN’S INCOMES (analysis by OMA economist)
- 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%.
- CLAIM SUBMISSION REJECTIONS– SPECIALIST CONSULTS
- As many specialists are aware, the Ministry of Health experienced challenges with the medical rule associated with additional consults by the same provider to the same patient, but with a different diagnosis within the same year. The OMA strongly advocated for a fix for this and there is now a solution in place
- Please resubmit the claims that came with the error code “AC1 – Maximum reached – resubmit alternate FSC.”
- If you submitted claims on or after February 1, 2020 for an additional specialist consultation, MOH is correctly adjudicating the claims in accordance with the changes to the Schedule of Benefits effective October 1, 2019.
- If you submitted claims between November 1, 2019 and January 31, 2020 with service dates on or after October 1, 2019 for an additional specialist consultation, by the same provider, for the same patient, but for a clearly defined unrelated diagnosis within the same 12-month period and that were previously rejected as noted in the providers’ error report during this time frame, these claims can now be resubmitted.
- If you have already resubmitted an alternate FSC and you are eligible for payment for a consultation, please submit a Remittance Advice Inquiry to have the claims appropriately adjudicated by your claim’s office.
- Stale dating will be extended to August 31, 2020 to allow re-submission of services that were denied due to this error
- For further details refer to Ministry of Health INFOBulletin #4744: http://www.health.gov.on.ca/en/pro/programs/ohip/bulletins/4000/bul4744.aspx
- Or contact the Service Support Contact Centre: 1-800-262-6524 or SSContactCentre.MOH@ontario.ca
- CORONAVIRUS (COVID-19) UPDATE
- Jan. 25, 2020 A man in his 50s arrived in Toronto from Wuhan, China, the epicenter of the outbreak, admitted to Sunnybrook Hospital and becomes the first “presumptive” case of the new coronavirus in Canada.
- You can read the daily OMA COVID-19 Updates here.
- The OMA is in constant discussion with government and advocating strongly for members in several ways:
- Having the government ensure the supply of PPE (as was done during SARS in 2003)
- Immediately implementing a temporary OHIP fee code for telephone consults for patients who are at risk for COVID-19 so they don’t have to come to the office
- Implementation of off-site screening tests
- Asking the government repeatedly for appropriate relief for physicians – namely infrastructure costs and income stabilization
- The OMA has had daily contact with the government at senior and staff levels. The Board unanimously rejected the offer of advance payment, as it failed to address the problem, even though the government has since imposed it.
- Since then, the OMA has been advocating for appropriate financial relief during the COVID-19 pandemic.
- On Friday, May 8, the OMA launched the Protect Health Care Infrastructure education campaign, allowing members to send a pre-populated email to Premier Ford, and Minister Elliott.
- A MPP Kit is available on our website to support you with outreach to your MPPs. It includes tips for holding successful discussions, a script for phone calls, and an email template to set up an introductory meeting.
- The OMA is collecting information about revenue loss.
- Ensuring income mitigation if physicians are asked to self-isolate.
- 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.
- The OMA is recommending that you refrain from non-essential visits and use telephone and non-OTN video visits (available to everyone) or OTN video visits (available if you have signed on to OTNInvite) where possible.
- There are of course some people we must see in person.
- Patients should call your office when they arrive, and then wait outside and they can be phoned or texted to come in when we are ready. This improves Social Distancing.
- A video on #socialdistancing is here.
- A quick video with five tips for COVID-9 is here.
- A video on how to wash your hands is here.
- MOH ADVANCE PAYMENT PROGRAM
- Despite the OMA Board unanimously rejecting the government COVID-19 Advance Payment Program April 22, 2020, government imposed the Advance Payment Program,
- The Ministry’s first installment of the Advance Payment Program should be indicated on your May RA.
- Please check whether you have received it.
- As you know, the OMA does not support this as a solution to the current income crisis and will advocate for its members until a more satisfactory solution is found.
- By the way…The Ministry intends to start recapturing these funds in November 2020, so budget accordingly.
- SICK NOTES
- 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.
- FEDERAL SUBSIDY PROGRAMS
- Canadian Emergency Wage Subsidy (“CEWS”)
- Temporary Wage Subsidy for Employers (“TWS’)
- Canadian Economic Response Benefit (“CERB”)
- 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
PHYSICIAN BURNOUT
- 52% of all physicians have at least one symptom of burnout, and 27% are clinically burnt out.
- Physician burnout is one of the OMA’s top priorities for 2020.
- The Burnout Task Force is exploring the issue in depth and will be making recommendations on system-wide issues that contribute to burnout.
- They will also make recommendations to prevent burnout, advocate to government and other stakeholders and co-ordinate with national and provincial organizations
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. 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 OHIP Billing Resources and OMA Quick Reference Guides at www.oma.org/sections/billings-and-agreement
Online educational modules on billing, patient care, practice management and retirement planning are available through the OMA Education Network at:
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
