N.L. paying telehealth company more than twice what it pays doctors for consultations

The association representing doctors in Newfoundland and Labrador is looking for answers after it discovered the province agreed to pay a private telemedicine company more than double what it pays family doctors for consultations.
The Newfoundland and Labrador Medical Association found a contract between the provincial government and Fonemed among the province's online roster of completed access to information requests. The five-year contract, which began March 1, is worth over $31 million and pays between $82 and $92 for virtual care appointments with nurse practitioners.
Meanwhile, the province pays family doctors about $37 for a standard in-person visit and $47 for a virtual care visit, with a cap of 40 virtual appointments per day, the medical association said in a letter to its members about the contract.
"Like Fonemed, a family doctor's clinic also operates as private businesses with their own staff, equipment and overhead," association president Dr. Kris Luscombe wrote in the letter dated Tuesday, adding: "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."
St. John's-based Fonemed runs the province's 811 HealthLine, which connects residents with nurse practitioners who provide health advice. The contract renewed the company's previous service for the HealthLine.
Though the contract does not explicitly list the company's cost per call to the 811 line, it does specify that it covers up to 72,000 calls a year.
Using the monthly payments to the company specified in the contract, the medical association calculated that the cost works out to just over $82 per call in the first year of the contract. That cost increases each year to over $92 in the final year of the contract.
If the 811 service receives more than 72,000 calls in a year, the province will pay between $58.70 and $66.10 for each additional call, the contract specifies.
In his letter, Luscombe writes that the figures are "certainly surprising," given the rates paid to family doctors.
Newfoundland and Labrador has a population of about 525,000, and nearly a quarter of residents are without a family doctor, according to polling done this year by the medical association. Doctor shortages prompted intermittent closures of rural emergency rooms through the summer and fall.
The provincial Health Department said in an email Wednesday that the fees paid to Fonemed "reflect the overall costs to provide the virtual services," including overhead, infrastructure and technology costs, staff education, a 24-hour mental health crisis line and costs related to the HealthLine app.
The money also provides for virtual appointments with registered dietitians three days a week, as well as an outbound call service for people who left emergency departments without being seen by a physician or nurse practitioner, the email said.
The medical association noted in an email Tuesday that doctors also pay for all of their practice's overhead, infrastructure and staff costs through the money they collect -- including the $37 for an in-person visit -- through the province's fee-for-service payment structure.
On average, physicians spend roughly a third of their income on overhead costs, according to a 2018 report on family medicine in the province. That works out to about $82,496 in expenses each year, though in rural areas those costs can exceed $94,500, the report says.
The medical association said it is still seeking further explanation from the provincial government about why Fonemed is paid so much more than doctors for taking calls.
This report by The Canadian Press was first published Dec. 8, 2022.
CTVNews.ca Top Stories
Beyonce becomes most decorated artist in Grammys history; Harry Styles wins album of the year
Beyonce sits alone atop the Grammy throne as the ceremony's most decorated artist in history, but at the end of Sunday's show it was Harry Styles who walked away with the album of the year honour.

First tank sent by Canada for Ukrainian forces arrives in Poland
The first of the Leopard 2 tanks Canada is donating to Ukrainian forces has arrived in Poland.
Advocates come together to help sailors stuck for months on tugboats in Quebec port
Groups that advocate for seafarers are expressing concern for 11 sailors who are spending a harsh Quebec winter aboard three tugboats that have been detained for months in the port of Trois-Rivières.
At least 200 dead as powerful 7.8 earthquake hits Turkiye, Syria
A powerful 7.8 magnitude earthquake hit southern Turkiye and northern Syria early Monday, toppling buildings and triggering a frantic search for survivors in the rubble in cities and towns across the area. At least 207 were killed and hundreds injured, and the toll was expected to rise.
Drake, Michael Buble, Tobias Jesso Jr. among Canadian Grammy winners
Canadian pop favourites Michael Bublé and Drake each have a shiny new Grammy on their shelves, while singer-songwriter Tobias Jesso Jr. has two, thanks in part to Harry Styles.
'Natural power': 17-year-old undefeated Quebec boxer gears up for Canada Games
She started throwing punches to get exercise during the COVID-19 pandemic, but now 17-year-old Talia Birch is gearing up to compete in the Canada Games as it opens up to female boxers for the first time
31,000 cards: Montreal woman passing along father's extensive collection of Expos baseball cards
A Montreal woman is passing along her father's extensive collection of over 31,000 Expos baseball cards. April Whitzman's father, Steve Whitzman, collected the cards from 1969 to 2016. A huge Expos fan, he's got every player covered.
Charles Kimbrough, best known for role in 'Murphy Brown,' dies at 86
Charles Kimbrough, a Tony- and Emmy-nominated actor who played a straight-laced news anchor opposite Candice Bergen on “Murphy Brown,” died Jan. 11 in Culver City, California. He was 86.
New study highlights increasing prevalence of muscle dysmorphia among Canadian boys, young men
Canadian researchers are drawing attention to the increasing prevalence of 'a pathological pursuit of muscularity' among Canadian boys and young men, with a new study that found one in four were at risk of developing what's known as muscle dysmorphia.