This gender-affirming clinic in Toronto closes today as lower virtual-health fees set in

Connect-Clinic, a virtual clinic in Toronto that provides gender-affirming hormones and referrals for surgery, will close Thursday because of recent cuts to virtual-only medicine, an outcome that one MPP is calling “shameful.”

“The minister of health has the ability and the power and the resources to (fund the clinic) and she’s chosen not to,” New Democrat MPP Kristyn Wong-Tam told the Star, referring to Health Minister Sylvia Jones. “She’s choosing not to support and provide gender-affirming lifesaving health care for the trans and non-binary community.

Dr. Kate Greenaway, the founder and lead physician of Connect-Clinic, said the new fees for virtual-only clinics such as hers aren’t enough to keep it going.

“All the doctors and our clinical staff are just devastated,” said Greenaway. “Everyone is so sad.”

The clinic, which has seven doctors, has seen about 2,000 patients since it opened.

The new virtual fees are part of a Physician Services Agreement (PSA), negotiated by the government and the Ontario Medical Association, which takes effect Dec. 1.

The agreement, the first to include specific OHIP payments for virtual medicine, says virtual-only services such as Connect-Clinic can bill $20 for a video visit and $15 for a phone appointment.

In contrast, family physicians who see patients in person as well as virtually can bill in full for a video appointment and at 85 per cent if it’s by phone. The OMA says the most common visit fee code billed by family physicians for an in-person appointment is $36.

The government made the move to discourage the type of virtual-only websites that became popular during the pandemic when it was difficult to see a family physician in person.

The government has said “virtual care is intended to complement in-person care, not replace it. This approach has resulted in meaningful changes for virtual care that ensures a positive patient-physician relationship is fostered.”

The ministry didn’t address new questions sent by email Wednesday asking if it would consider funding the clinic.

Wong-Tam asked Jones the same thing in the legislature this week.

Jones said, among other things, that the government wasn’t forcing virtual clinics to close but that the new PSA will ensure that Ontarians have equal access to family physicians in person.

Connect-Clinic was founded in Toronto as a video clinic in 2019 and was originally funded by the government through the Ontario Telemedicine Network (OTN). It helps people from across the province.

A physician could bill $67 to OTN for a typical 20-minute appointment, or more when it was a first-appointment consultation, and patients would connect to a doctor through a video system in an approved OTN setting such as a pharmacy, hospital or community organization anywhere in the province.

When virtual doctor appointments took off out of necessity during the pandemic, OHIP began covering virtual fees, paying for video and phone appointments as it would for in-person. Patients could connect to doctors from anywhere, including their home.

When the new PSA was released, Greenaway thought the clinic could continue for a time assuming fees for existing patients were paid at the old rates. The clinic stopped adding names to the 2,000 or so it had on its wait list.

But a clarification from the OMA on Friday made clear to Greenaway that the new fees will apply to existing patients as well as new ones, which means the clinic can’t continue to operate.

“That was a new clarification, because previously we’ve been told we could see anyone we’ve done a complete assessment or intake on in the previous 24 months,” said Greenaway, meaning doctors believed they would continue to be paid in full for existing patients.

“Our previous plan was that we would continue to see existing patients while we figured out what our next steps were,” said Greenaway. “But we can’t do that. We can’t afford to keep the clinic running in that way.

“We’re still working on our advocacy,” she said. And “for the moment, we’re going to continue the patients on their prescriptions and deal with any urgent issues. We’re not going to stop dealing with their urgent care.”

The Ministry of Health noted, for an earlier story about Connect-Clinic, in an email that it has “taken additional steps to provide funding for team-based care such as Community Health Centres (CHCs) and Family Health Teams (FHTs) to improve access to primary care including for trans Ontarians.

“Many primary care teams run programs as part of their LGBTQ+ services and offer specific clinics for trans populations which provide interdisciplinary primary care services, including mental health services for their clients,” according to the email.

Dr. Danyaal Raza, who is on the board of Canadian Doctors for Medicare and an assistant professor/family doctor with the University of Toronto, said he was “disappointed” by the government’s response to the clinic’s situation.

“The upcoming billing changes are, overall, an important tool to ensure appropriate use of virtual care,” said Raza in an email.

“However, there still may be an opportunity for safe, virtual-only care that can be assessed on a case-by-case basis,” said Raza. “This is particularly true for patients who experience barriers to care because of factors like geography or expertise.”

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