A recent Access to Information Request has revealed new details about the provincial government’s contract with Fonemed, the company that designed and administers the province’s 811 HealthLine, and also provides access to nurse practitioner (NP) virtual care appointments.
The NLMA voiced concerns two years ago, when the NP virtual care appointments were added to the 811 HealthLine – that it should include both family doctors and nurse practitioners, should focus mainly on unattached patients, and should be connected with in-person care when necessary. This contract with Fonemed has since been renewed in 2022 for a five-year period.
In recent days we have obtained a copy of the new agreement between the Government and Fonemed. We were hoping to see a specific cost for the 811 virtual care appointments, but instead the contract has a single rate for all HealthLine services. Therefore, we are asking the Department to break out this cost for our review.
Nonetheless, the data in the contract allows for some preliminary observations. The contract provides $31,362,525 over a five-year period from March 1, 2022 to February 28, 2027.
The contract specifies that the $31 million will cover up to 72,000 service calls from residents in Newfoundland Labrador. This translates to approximately $82 per call as the average price for all HealthLine services in the first year of the contract, which gradually increases yearly up to approximately $92 per service call in the final year of the contract.
If the program receives more than 72,000 calls in a given year, the government will pay Fonemed approximately $58 to $66 per additional call.
These numbers were certainly surprising for the NLMA. MCP currently pays about $37.00 for a standard in-person visit at a family physician’s clinic and $47.00 for a virtual care visit with a family physician (following the recent MOA signing). The number of patient visits that family physicians are permitted to offer virtually are also capped at 40 per day.
Like Fonemed, a family doctor’s clinic also operates as private businesses with their own staff, equipment and overhead. Many have also invested in electronic medical record systems that can improve quality of care.
Family physicians in the province are already feeling overstretched and undervalued, so we will continue to seek an explanation from government of the large discrepancy between physician rates and what is being paid for non-physician virtual care.
On a related point, a separate Request for Proposals for a provincial Virtual Primary Care and Virtual ER program was issued by government earlier in 2022. This contract has not yet been awarded. This new service appears to address the issues we raised with the government about the 811 virtual care line.
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