Virtual health-care clinic says it's in trouble after medicare billing rate reduction

A New Brunswick-based virtual health-care clinic says it has been forced to scale back its services after the rate it could bill medicare was cut by almost a third. 

The co-founders of eVisitNB are calling on the province and the New Brunswick Medical Society to establish billing rates more aligned with the style of care offered at the new virtual clinic during a time when physical distancing is key and tens of thousands don't have access to primary care.

Dr. Hanif Chatur, who co-founded the company with Dr. Jonathan Clayton in January, said recent changes to the fee code structure — the hierarchy of rates physicians can charge Medicare per visit — has already cost them doctors and it's a "matter of weeks" before they run out of cash.

The Department of Health and the medical society unveiled New Brunswick's first fee code for virtual visits in mid March, just prior to the COVID-19 emergency declaration.

It was a flat $45 rate for any kind of consultation, and it was good news for eVisitNB because it was not medically insured and patients were paying out of pocket. Chatur, an emergency room physician from Woodstock, said this allowed them to attract more care providers and expand the company. 

Patients can book online appointments with New Brunswick-based medical doctors, mental health therapists and certified diabetes educators. The website lists 27 care providers, but Chatur said numbers have dwindled following changes made to the original virtual fee code.

He said they are down to 10 physicians from their peak of 20. That's led to a considerable reduction in weekly visits — down to 200 from the 600 a week before the changes.

Fee code changes

The province and medical society agreed on a fee scale that closely mirrors that of in-person visits. That means specialists can bill at a higher rate than family doctors, who can charge more than a one-off, walk-in clinic-style consultation.

The question was where does eVisitNB fit on the scale? In the eyes of the province and the society, it was a virtual walk-in clinic.

For Chatur, it was a major blow. The family doctor rate is $47.50 and the walk-in rate is $29 — about two thirds the initial $45 rate.

"eVisit New Brunswick is a great benefit and has been a great benefit to our health system, particularly during a pandemic," said Anthony Knight, CEO of the New Brunswick Medical Society, "but the level of responsibility placed on the physicians who see patients in New Brunswick is simply different than that which a family doctor would provide in their clinic or office."

The distinction lies around the continuation of care, Knight said. Physicians at walk-in clinics don't need to worry about comprehensive record-keeping, monitoring test results and taking responsibility for a patient's care if they're hospitalized.

A health department spokesperson echoed Knight, saying the agreement increased the number and types of fee codes.

"This should result in an increase in virtual care and better services for the patients of the province," said Bruce Macfarlane, communications director with the Department of Health. 

"With respect to eVisitNB, a company which provides software services for physicians, the reduction in fee would only be for those physicians who do not maintain a medical record and ensure follow-up and ongoing care for the patients they see. Those types of one-off visits would be reimbursed at the same rate as a traditional walk-in clinic."

'We really occupy the space in between'

As of the end of February, 39,677 New Brunswickers were registered with Patient Connect NB as needing a family doctor, according to the Department of Health, and Chatur said eVisitNB provides some family doctor-style services for those people.

He said there needs to be a rate to reflect that they do "quarterback" care for some New Brunswickers without access to primary care.

"I understand the logic that medicare applied and I respect that," Chatur said.

"They only had one of two places to put us, but we really occupy the space in between. All we ask is for a re-establishment of that code so that we can continue to do what we're doing, which is to attract amazing providers, compensate fairly and ensure all New Brunswickers are getting the same access to virtual care, not only during business hours but essentially for most of the day."

Knight said it's a popular service, but it will likely need to change its business model.

Running out road

The company had been operating at a loss since the changes because they opted to pay the health-care providers the same $45 rate in order to maintain its level of offerings.

"Eventually we're going to run out of funds. There's going to be a moment … where we will have no resources to pay the providers at the same level they were paid before," Chatur said in late May.

On Tuesday, he said the company is now applying the lower fee as directed by medicare for patients not attached to a physician.

The providers keep 100 per cent of the fees paid by medicare and are not charged for operating on the virtual platform. 

"We hope to be able to continue to provide virtual care in some capacity to New Brunswickers for at least the next 3 months," Chatur said in an email Tuesday.

Positive polls

A recent poll commissioned by the New Brunswick Medical Society indicated 77 per cent of respondents support continued use of virtual care once the pandemic is declared over. 

The Narrative Research poll, which surveyed 400 adults in May, suggested four in 10 New Brunswickers had a virtual care appointment during the COVID-19 pandemic.

"And while there is overwhelming support to maintain virtual care access, a large majority of respondents stated they would not pay for virtual care if it was not covered by medicare," the accompanying release from the society stated.

It said it's committed to growing and enhancing access to virtual care in New Brunswick.

A company survey indicates nearly three quarters of all eVisitNB patients avoided a trip to the emergency room because of the virtual consultation.