The COVID-19 pandemic and the post-pandemic world have forced governments and healthcare providers to consider new ways of delivering healthcare. With the responding rise of virtual care services, we are seeing a patchwork of ever-changing rules across the provinces and territories. Many different stakeholders, including physicians, patients, and even the Competition Bureau of Canada, are calling for uniformity, reduced barriers, and increased access to virtual care.
Prior to the COVID-19 pandemic, private virtual care services outpaced publicly funded options for virtual care. This is because virtual care was generally considered an uninsured service, allowing physicians to charge privately for the provision of these services, including through private business to consumer and business to employer models. However, in response to COVID-19 many jurisdictions (including Ontario), amended their billing rules to enable physicians to bill the public healthcare system for virtual care. Since physicians are prohibited from charging for the provision of insured services or engaging in any “extra-billing”, private virtual care providers were forced to shift their business models to ensure compliance with changing regulatory frameworks.
On Dec.1, 2022, these temporary COVID-19 billing codes expired in Ontario and were replaced by a new virtual care funding framework, based on the Physician Services Agreement between the Ministry of Health and the Ontario Medical Association. Under this framework, physicians are permitted to bill OHIP 100 per cent of the in-person fee for some video visits but only if they have an ongoing or existing physician-patient relationship, such as seeing the patient in person at some point in the last two years. However, if the patient has not been seen in person by the physician, physicians may only charge $20 for a video visit and $15 for a telephone visit. This discrepancy in funding per visit disrupted many of the business models of virtual care providers. To continue to operate, providers have had to reconsider how they offer their services.
While there is currently not a consistent licensing approach across the provinces and territories, it appears we may slowly be getting closer to pan-Canadian licensure.1 On May 1, 2023, the Council of Atlantic Premiers recently implemented a new physician register.2 The register allows physicians who have their primary practice in an Atlantic province and who hold a licence issued by one of the four Atlantic provinces to practice in any of the four Atlantic provinces without any additional licensing requirements. Additionally, Quebec has updated its licensing requirements under its Professional Code to allow physicians legally authorized to practice outside of Quebec the right to provide virtual care to patients located in Quebec on a limited basis, upon issuance of a special authorization, subject to restrictions.3
On May 18, 2023, Royal Assent for Your Health Act, 2023 (Ontario) (the Act) was also received. The Act introduces as-of-right licensing, which would allow healthcare professionals who are licensed in other provinces and territories in Canada to practice in Ontario, without needing an additional approval or licence, subject to certain conditions. When the Ontario Provincial government first announced as-of-right licensing, it appeared as though it would have broad applicability and would allow for the expansion of services such as virtual care to Ontarians by healthcare professionals licensed elsewhere in Canada. However, proposed regulations under the Act released on June 9, 2023 indicate that this may not be the case. Instead, the proposed regulations restrict the applicability of as-of-right licensing by making it only available as a temporary measure to certain healthcare professionals who have applied for licensure in Ontario and who only provide professional services in or on behalf of an Ontario public hospital, the University of Ottawa Heart Institute, or a long-term care home. Stakeholders should continue to monitor the status of the Act and the proposed regulations for any changes, as many sections of the Act have not yet been proclaimed in force and the Provincial government is seeking feedback on the proposed regulations until July 9, 2023.
In this growing landscape, physicians, companies, and others looking to provide virtual healthcare services should consider the following tips and best practices:
- make sure virtual care is appropriate for the patient given the nature of the consult, the patient’s condition, and the limitations of technology in that context;
- make sure they are covered through their insurer and confirm the patient’s location will not impact their coverage;
- be aware of the governing standards and guidelines concerning virtual care, including privacy and security, consent, documentation, and online prescribing;
- track out-of-province virtual care encounters and justifications for providing such care when necessary;
- inform themselves of the local resources where the patient is located to ensure continuity of care;
- maintain detailed and up-to-date records for all virtual care encounters in the same way in-person interactions would be documented; and
- always keep in mind their obligations when charging for uninsured services and/or setting fees for their services, as there are both legislative and regulatory college requirements that dictate how health care providers should charge for their services and how they can be compensated.
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Special thanks to articling student Bailey McMaster for her assistance with this article.
1 Pan-Canadian licensure is defined as the ability for physicians with full licences to practise independently without restrictions or for medical resident trainees registered in any Canadian jurisdiction to practise or train in any other Canadian jurisdiction without having to acquire more than one license or pay additional licensing fees.
2 Premiers Discuss Health, Immigration, Labour and Housing Priorities – The Council of Atlantic Premiers. (2023, February 20). Council of Atlantic Premiers.
3 Special authorization – Telemedicine and other activities. (2022, March 29). Collège Des Médecins Du Québec.