First Teladoc virtual ER opening in New-Wes-Valley this week
N.L.'s contract with virtual-care provider will cost $22M over 2 years, says government
Teladoc Health's first virtual emergency room is scheduled to open this week, at the Dr. Y.K. Jeon Kittiwake Health Centre in New-Wes-Valley, with the company's services expected to expand to virtual primary-care physicians in the coming months.
The two-year contract will cost $22 million, Health Minister Tom Osborne said Monday morning, and there's an option to renew the contract for a third year.
"This virtual-care service will complement existing services, improve access to the overall delivery of health care, add services to people where needed, where they are in need of a family physician," Osborne said at a news conference.
"For emergency rooms or urgent-care centres, this virtual-care solution will keep facilities open and ensure patients have a place to go when needing care."
Stephen Greene, N.L. Health Services' chief information officer and vice-president of digital health, says patients will arrive at a participating emergency room and first see an in-person clinician and then connect with a virtual doctor.
The clinician will conduct an assessment and then they'll work with the doctor on a diagnosis and treatment, he added. If needed, he said, patients will be transferred to a full-service hospital.
The first emergency room will open in New-Wes-Valley this week and later expand to four other locations, though Osborne said those sites haven't been determined yet.
Osborne said the clinician doesn't necessarily need to be a nurse practitioner — they could be an advanced-care paramedic, among other health-care providers, he said.
The second part of Teladoc's contract covers virtual primary care.
In the coming weeks, said Osborne, 15,000 people who are on the Patient Connect N.L. or another wait-list with a valid medical care plan number will be getting letters to inform them they're eligible to sign up for the service.
Osborne said it will be a phased approach that will expand to more people in the coming months. The first cohort could see a virtual doctor in December.
Virtual care to stay
Teladoc doctors will be paid in line with what doctors in the province get for similar services, but Osborne wouldn't say whether the contract will cost the provincial government more than hiring doctors itself.
"The value of this, it is probably priceless, really," he said, adding it's a new way for people in rural areas to receive care. "And I would argue that, you know, providing this service is worth every dollar."
Osborne said it's challenging to recruit physicians to work in rural communities that are shrinking and have an aging demographic.
"I do see virtual primary care being a tool that will be used into the future. The continuity of care by a family care team is what we are aiming for, for every individual in the province. But virtual will have a role to play," said Osborne.
Pat Parfrey, deputy minister of health transformation, said he believes virtual care is the future and people have to embrace it.
"There are engagements with physicians that do not necessarily have to be face to face, and sometimes they're impossible face to face, for isolation reasons," said Parfrey.
The pandemic has shown that virtual care is doable and will have to be extended to tertiary care, he added.
No poaching clause
In late October, the Newfoundland and Labrador Medical Association's president, Dr. Gerard Farrell, voiced concerns that the virtual-care system would result in a "splintering" of the health-care system into public and private streams.
Osborne dismissed fears of privatization of the health-care system, saying a doctor's office is also a private company that is paid publicly.
In a statement, NDP MHA Lela Evans said she's concerned the government's handling of virtual care will create inequalities for vulnerable people like seniors and people with disabilities, as well as those living in rural areas.
"I fear that what should be a well-thought-out temporary stopgap measure to improve the reach of public health while government deals with its inability to retain health-care workers is going to become status quo," said Evans.
"It was concerning to hear government officials say that virtually delivered care is better care with nothing to back up that claim."
Osborne said the Teladoc contract prohibits the company from poaching doctors already working in the province but he acknowledged the provincial government can't dictate where doctors work.
He also said retired doctors could work for Teladoc and doctors already working for the health authority can carry out the work in their off hours.
The virtual doctors will be in Canada and have to be registered with the College of Physicians and Surgeons of Newfoundland and Labrador, members of the NLMA and licensed in the province, he said.
Question of cost
A Newfoundland doctor who unsuccessfully bid on the contract said he was surprised to see how much the winning bid cost
Dr. Todd Young — who put in a bid through his company Medicuro — said he supports anything that improves the province's health-care services but there are certain aspects of the winning contract that stood out to him, like the cost and how the services are being rolled out.
Teladoc is a good company, said Young, but his own bid cost $3.5 million a year, one-third of the Teladoc contract, and would have stayed within the province.
But rather than looking at what's expensive or cheaper, Young said, people need to look at its value.
"What are we getting for the value of our dollar? And how is it structured such that it meets the goal of excellence for health care for people in our province?" he said.
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With files from Mark Quinn