COVID is superspreading convenient health care
Twentieth-century health care required patients to book an appointment—well in advance—and then meet their doctor in-person at the doctor’s office or hospital. The status quo worked well for physicians, who have many demands on their time. Patients generally received good care, but, it now seems, probably not in the most efficient fashion.
In Canada, population density is low and specialized care is concentrated in a few centres of expertise so a visit to the doctor often involved a whole day or even an overnight stay. When I was a practising cardiovascular surgeon in Calgary it was not uncommon for patients to drive hours from rural Alberta or even British Columbia to visit me in the hospital for a follow-up appointment. There they would learn their aorta was stable, receive reinforcement of advice they had already been given and schedule further follow-up testing. In many cases, maybe even most cases, they didn’t actually have to be there in person.
Even when I started medical school more than 25 years ago, telehealth services existed in Canada. But most physicians did not take to virtual visits. The incentive structure didn’t encourage it. Reimbursement for telephone or videoconference consultations was either poor or non-existent. The technology was cumbersome. Virtual meetings took many of us out of our comfort zones and doing a proper physical exam and developing rapport with patients was difficult.
But then COVID-19 struck and everything changed. Due to legislated social distancing, physicians have been forced to use virtual care, typically in the form of videoconferencing. Several new user-friendly digital platforms have become widely available and governments have introduced new fee codes on a temporary basis to incentivize remote care.
For example, in Alberta, prior to COVID, a phone call to discuss the results of diagnostic testing paid $20 (and doctors could use that particular fee code up to 14 times per week). Due to the pandemic, however, new codes were created including for "telephone advice during a viral epidemic," which pays $20 with no limits on the number of times it can be used per week, and “comprehensive consultation via teleconference or secure videoconference,” which starts at around $80—effectively the same amount as an in-patient consultation. As a result, doctors in Alberta are not financially penalized for seeing patients virtually rather than in-person.
Not surprisingly, many patients prefer the convenience of a 20-minute chat with their doctor without having to go to the hospital. What’s more interesting is that colleagues in various medical subspecialties have also expressed their satisfaction with this way of providing care. They say it’s an efficient use of their time, care can be delivered virtually without compromising outcomes and, maybe most importantly, patients like it. People often wonder how the world will change as a result of COVID-19. One difference is that the pandemic has markedly reduced physicians’ aversion to virtual visits and accelerated what was previously a very gradual trend toward virtual care.
Going forward, Canadian health-care authorities must revisit rates of reimbursement for virtual visits. Fee codes instituted on a temporary basis during COVID will need to be made permanent and possibly be increased if virtual appointments become the new normal. Canada’s public health-care system—and the regulations that define it—must also evolve as we embrace the digital health revolution and, as a result, provincial and national barriers evaporate in our new virtual world.
Once we decide virtual care doesn’t compromise outcomes and is beneficial for patients, we’ll immediately face another set of problems involving payment models for out-of-province treatment. The Canada Health Act, which influences almost all aspects of our health-care system, has little relevance for a patient waiting for care in rural Manitoba who uses an app to consult with a specialist in B.C. (or even outside the country). As a general guideline for novel solutions, we can lean on four key goals from the Institute for Healthcare Improvement, an organization committed to advancing the quality of care: improve outcomes, improve the patient experience, improve the clinician experience and decrease costs.
Shopify CEO Tobias Lutke has said that COVID-19 has brought 2030 a decade early. Both physicians and patients have now had positive experiences with virtual visits. The federal government has already announced funding for virtual-care strategies to help manage COVID demands. Now is the time to capitalize on the consequences of COVID and make sure our laws, regulations and financing rules don’t prevent this unexpected win-win for patients and physicians.