The issue of payment for the provision of virtual care faces challenges at two levels. First, across provincial/territorial (PT) boundaries, the portability criterion of the Canada Health Act only covers emergency care for persons temporarily outside their home jurisdiction; other care requires prior approval in order to be publicly insured.
However, the largest barrier to the widespread adoption of virtual care between physicians and their patients in routine office-based practice is the current interpretation and application of the billing regulations in PT health insurance plans within jurisdictional boundaries. The preamble to several of the PT billing guides specifies that the physician must either personally carry out or have direct supervision over any act or procedure in order for it to be billable to the PT insurance plan. As a result, PT physician payment systems are still based primarily on face-to-face encounters between the patient and physician. Some provinces do provide payment for telemedicine when both the physician and the patient are in a designated telemedicine facility on the same province.
- What updates would you recommend be made to provincial/territorial health insurance plans to support physicians providing virtual care to their patients?
- What updates would you recommend be made to the portability provisions of the Canada Health Act to support physicians providing virtual care to patients across provincial/territorial boundaries?