When the COVID-19 pandemic forced people to isolate while also requiring vaccinations, drive-thru vaccination clinics became an effective and efficient go-to solution, according to Public Health and health care authorities at the time. Now OHIP is saying health care professionals who hold such clinics off-site or with medical student participation won’t be paid for the work. Kingstonist file photo.
The Frontenac Doctors clinic has cancelled its planned drive-through vaccine clinic this weekend because the Ontario Health Insurance Plan (OHIP) won’t cover its expenses. Unfortunately, that is just the beginning of the government-run health plan’s unsympathetic cost-saving measures, according to local health care providers.
The Frontenac Doctors’ drive-thru COVID-19/influenza vaccination clinic was planned for Saturday, Oct. 26, 2024, in the St. Lawrence College parking lot in Kingston. However, the over 600 patients scheduled to attend will now have to visit the Frontenac Doctors clinic at 189 King Street West for their shots, because OHIP refuses to compensate the doctors for work done outside the four walls of their building or by medical students in training. At the same time, the government-run health plan is also attempting to claw back payment for the thousands of vaccines administered in similar circumstances during the throes of the pandemic.
Dr. Elaine Ma, lead physician with Frontenac Doctors, spoke to Kingstonist about the unfortunate circumstances.
“During COVID, [doctors] were asked by our Medical Officer of Health, [Dr.] Kieran Moore, to operate off-site vaccine clinics and work as quickly as possible. And then, during [the peak of the Omicron variant], we were asked to really ramp up distribution. Physicians billed for their services, as we were told we could do,” she said.
“However, OHIP has now pulled out a 2001 bulletin memo that says you can’t bill for the work of medical students, and you can’t bill if you’re not within the four walls of your office.”
Therefore, all those clinics must now be paid for by the doctors who ran them, Ma explained.
OHIP INFOBulletins are communications from the Ministry of Health that inform doctors about changes in payment, policy, program, or software. Ma said OHIP is now citing a 2001 INFOBulletin that states physicians can only bill work which was delegated to “employees who have Canada Revenue Agency deductions and only within the four walls of our office.”
Ma said the clinic’s plan for Saturday had been in the works for months. The plan was to distribute vaccines in the most convenient and safe way possible for over 600 of their patients.
“But because we would need to use medical students to help, we had to cancel. Otherwise, we would literally be paying out of pocket to vaccinate,” she said. “Our stance is that students function as employees under the Employment Standards Act definition of ‘learner.’”
Ma pointed out that a vaccination clinic is a learning opportunity for medical students. In fact, the doctors had so many interested medical students offering to help with the clinic that they had already begun to turn some away.
Moreover, she emphasized that if doctors can’t bill for work performed by medical students, the students will no longer be able to practise their skills. Denying coverage for the work of medical students, she said, “has huge repercussions, because basically that means that people aren’t going to want to train medical students if they not only have to do the work of training medical students, but then not get paid for doing what they would normally get paid for.”
Further, Ma said, doctors would likely never “go back to doing vaccine clinics inefficiently; it just doesn’t make any sense.”
On top of this, OHIP is trying to apply the memo retroactively to all of the vaccines doled out during the pandemic, effectively arguing that the COVID-19 vaccines given during the pandemic did not meet the letter of the law when it comes to the definition of “employees” or “office.” Ma explained, “They have asked for a refund for the money.”
OHIP isn’t even even factoring in that the work was done at the behest of the province, Ma said.
“Nobody has ever argued that work wasn’t done,” she stated.
The Kingston-based doctor said she has spoken with Premier Doug Ford, who told her he was upset about the policy — “He says that work was done; it should be paid” — but that is cold comfort.
“OHIP, on the other hand, is saying, ‘The same work was done, but we found the technicalities, and therefore we don’t have to pay you; therefore, give back all the money.’… They’re saying, ‘Well, it’s the law, and we don’t pay for things to fall outside of that.’”
It is disheartening, Ma said, that OHIP seems to have found “a 20-year-old loophole” that technically says they can request that money back.
Ma never intended to make this a news story, she said. She always assumed the province would figure out the right course of action once the pandemic chaos slowed down.
“I never wanted to come forward publicly. People have asked me for two years since this review has been going on, and I never wanted to go public because I wanted the right thing to happen,” she expressed.
There were only two options, Ma said: “Charge OHIP or charge patients… [I had to] make that decision [to cancel the clinic] because we aren’t going to charge our patients. That isn’t right.”
She said, “It was yesterday when we had to make the decision that… we are not in a position to be able to pay to vaccinate our patients… We wouldn’t be able to bill for any of the supplies or equipment. Cancelling was the most upsetting thing to me.”
On top of the disappointment of being unable to give her patients the vaccines they need, Ma said it has been a stressful situation for the past two years.
“About a year after we started giving vaccines, but after really all the clinics in spring of 2022, OHIP started asking questions… I got the initial request and didn’t think much of it. I just sent them back the information, and they said, ‘No, that’s not OK,’” she said firmly.
Ma said OHIP is arguing that she “made a lot of money in a few days” by running the clinics this way, but that they’re not taking into account that it took months to do the work.
“The work is not just vaccinating,” she explained. “It was entering everything [during] COVID, all the pre-work, all the post-work. But they’ve painted it as [if] I’ve made so much money in a few days. It has nothing to do with how much we agreed to pay for vaccines. It has 100 per cent to do with ‘You shouldn’t get paid that much,’ And so now it’s become a bigger and bigger thing for two years.”
The battle culminated this past week, said Ma, who spent much of the the week in Toronto defending her case before OHIP at a hearing.
“It became very apparent that OHIP was not interested in vaccines, and it became very apparent that they are 100 per cent firm [that a] physician cannot delegate and bill for treatments given outside their four walls,” she said.
This is a developing story with more to come.