Doctors face two-month wait for phone consult pay
Physicians say clinics might close because billing codes not activated
Doctors are getting increasingly frustrated after learning they might not be paid for months.
The problem affects thousands of physicians who bill for individual services, from family doctors to specialists.
The issue comes down to a glitch in the electronic billing system that won’t accept billings for telephone consultations.
The province told physicians on March 14 that five new billing codes were being introduced to cover phone visits during the COVID -19 outbreak. But the codes haven’t been activated yet.
The province says it expects to start processing claims in early May — which means doctors won’t be paid until June. Doctors say they still have to pay for expenses such as rent, staff, diagnostic equipment and electronic record-keeping. And they have to balance medicine and running a business.
“None of us understands why it takes so much time to add five billing codes, or why we can’t use the old codes,” said Dr. Keely Giles, an Ottawa family physician. “There’s no clarity.”
Some doctors have had to lay off staff. Some are dipping into their own savings or making other financial arrangements.
“Maybe we’ll have to get a line of credit,” said family physician Dr. Gabriela Lewin. “Maybe we’ll have to close. It will leave the 5,000 patients in our clinic without a physician.”
Family physician Dr. Nili Kaplan-Myrth said she doesn’t want her patients to think she would abandon them, but she doesn’t know what will happen. “It might be total ruin.”
An online survey conducted by the Ontario Medical Association attracted responses from about 5,000 doctors. Just over half said they were laying off staff and 49 per cent said they were thinking of closing their clinics completely, said OMA president Dr. Sohail Gandhi.
“If we close clinics for three months, it’s a catastrophe. When they start ramping up health care again, there will be no place to go but the hospital.” Doctors are pressing for some form of income stabilization so they can keep their lights on, said Gandhi.
“I think the government needs to do the right thing and be fair. If they say you can bill on March 14, you shouldn’t have to wait.”
Dr. Paul Hacker, an Ottawa physician who provides palliative care in the community, said the overhead on his practice is low, so it’s not in jeopardy. But he’s worried about the effect the pay delay will have for the entire system.
“We don’t want to be alarmist, but there is a real crisis in the making. You can’t solve this by focusing only on hospitals and acute care,” he said. “Hospitals are absolutely essential. But the real battle is happening in the community. And it is not being valued very highly.”
Kaplan-Myrth said her understanding in mid-March was that she would be able to do all of her consultations with patients by phone, and the billing codes would be ready.
That hasn’t happened. She has a very small supply of personal protection equipment and it has to be carefully managed to be used only for patients with essential needs, such as vaccinations for infants.
“I have been on the phone with patients seven days a week, following up on those who have COVID symptoms and all of the other primary care things I have to do,” she said. “We just need to know there will be income stability for doctors. We need to know we can keep on practising.”
Meanwhile, many physicians report that their patient volumes have fallen significantly.
Doctors don’t want patients exposing themselves to possible infections in waiting rooms. And patients don’t want to be out of their homes unnecessarily, said Ottawa nephrologist Dr. Adam Cohn. It’s also hard to get X-rays and blood tests.
Cohn, who also works as an emergency room consultant, used to see patients in his office three days a week. That’s down to half a day a week.
The pay delay has been an unnecessary stressor for physicians, he said.
“Everyone is stepping up to the plate. The money issue is secondary, but it is a problem,” he said.
“It could be figured out with the stroke of a pen. It would count for a lot of goodwill.”
Giles said her patient volume has fallen by 30 per cent. She works one or two shifts a week at the Brewer arena COVID-19 testing centre.
She also said she doesn’t know when she will be paid for that work. Giles is not complaining. She said she knows a lot of people are not being paid, and she will eventually be paid.
In a statement, a spokeswoman for Ontario Health Minister Christine Elliott said the province introduced the new billing codes to help doctors provide care over the phone and support the goal of keeping people at home in isolation.
Since the new codes were introduced “there has been considerable uptake, demonstrating a clear need,” said the spokeswoman.
Virtual care has its limitations, said Hacker.
“There’s more to palliative care than making people comfortable. People rely on us to be there. And we want to be there,” he said. “I’m concerned about people who are slowly deteriorating at home. Even with our best efforts, they’re not getting the care they need. Eventually, it will come home to roost.”