Psychiatrists left out of virtual care plan

Doctors Nova Scotia expects the province will fix the gaping hole it created when it set up billing procedures to allow for virtual appointments with physicians.

But some Nova Scotian psychiatrists, whose patients are at risk of falling into that dismal hole, say the fact that they, and their patients, were left out in the first place is indicative of the low priority the government continues to place on mental health.

Last week, in a move to slow the spread of the Coronavirus, the province had MSI establish a fee code that allows doctors to bill for telephone or videoconference appointments with patients. The $38.65 fee is considered appropriate for family docs, who generally take about 10 minutes with most patients, and for follow-up calls with many specialists that can usually be done quickly, as well.

But that fee doesn’t work at all for fee-for-service psychiatrists, who will spend an hour or more with many of their patients, whether the appointment is face to face or virtual.

The failure to provide a reasonable fee for psychiatric care seems contrary to the objectives Premier Stephen

Mcneil and Dr. Robert Strang, the province’s chief medical officer of health, have clearly articulated every day since the crisis began.

The measures implemented by the province – and given the full force of law with the declaration of a provincial state of emergency Sunday – are designed to slow the rate of infection and thereby relieve some of the inevitable pressure the health system will feel as the virus becomes more widespread.

If the rate of infection increases rapidly, “the stress it will place on our health system will be crippling,” Mcneil said Sunday.

Vulnerable patients, unable to connect with their psychiatrists, are at high risk for a mental-health crisis. That risk is elevated by the stress of isolation and uncertainty, two omnipresent characteristics of dealing with COVID-19.

Nova Scotians facing mental health crises will end up in hospital emergency rooms, applying the very pressure on the system that provincial officials are trying to mitigate. The province’s failure to adequately provide for virtual psychiatric care is counterproductive to its own critical objective.

Virtual health care is the medical equivalent of working from home. Unlike others who are working from home, psychiatrists are being asked to do it while absorbing a pay cut in the order of 85 per cent.

“All across Canada, provinces have made it possible for psychiatrists to safely treat their patients by telehealth during the pandemic,” said one Nova Scotia psychiatrist. “In fact, many provinces allow telehealth for psychiatrists as part of the regular provision of psychiatric care.”

But Nova Scotia has no billing provisions appropriate for psychiatric care unless it is conducted face to face.

“This discriminates against patients with mental health problems and the psychiatrists who treat them,” said one fee-for-service psychiatrist. (The identity of the psychiatrists interviewed are being protected at their request.)

The provincial Department

of Health and Wellness (DHW) wasn’t able to shed much light on the omission. Asked if it was oversight, the department replied a few days later with this:

“We continue to take measures to further prevent the spread of COVID-19 and increase capacity within the health system in Nova Scotia. These efforts include new options for virtual care for doctors and pharmacists using telephone and secure videoconferencing. We know that certain specialists may need to adapt to these unique circumstances to provide virtual care. We are working to find a solution that will continue to allow them to meet the needs of the Nova Scotians they care for.”

For starters, and for the duration of the crisis, provincial bureaucrats might want to put aside their practised non-committal talking points in favour of some straight answers. They have a template for that in the way the premier and Dr. Strang have been communicating Covid-19-related issues for more than a week.

In a letter to physicians sent out last week, Doctors NS president Gary Ernest identified psychiatric care as one of the gaps in the province’s virtual care plan, and he said DNS is working with the Health Department to plug those gaps.

Over the weekend, a DNS official said it seems likely that the government is about to fix the most glaring gap, related to psychiatric care.

Fee-for-service psychiatrists say the $38.65 now available isn’t enough to cover their overhead. Their practices are not sustainable at that revenue level.

The normal wait time to see a psychiatrist in Nova Scotia starts at about four months and is generally longer, except in emergency cases.

In a province where the provision of mental-health services is at a premium every day, the province’s failure to provide a reasonable fee to ensure fee-for-service psychiatrists keep working is incomprehensible.

We already have an infectious disease crisis. We should expect the province to do all it can to avoid, or at least limit, a mental-health crisis at the same time.