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Since June 15, the Ontario Association of Optometrists has been encouraging its members to refer patients to hospitals and emergency rooms as part of a job action.

Kevin Van Paassen/The Globe and Mail

The Ontario Association of Optometrists is encouraging its 1,800 members to refer patients to hospitals and emergency rooms as part of a job action meant to address its claims of decades of underfunding.

Since June 15, the OAO has been encouraging its members to turn away patients coming for appointments outside of a regular checkup, including those with emerging eye problems such as infections and seeing spots. The association recommends sending them to the emergency room instead. According to a third-party study commissioned by the OAO, these referrals could be costing the public-health system an estimated $250,000 a day.

OAO president Sheldon Salaba said the association had no choice but to begin this job action, claiming decades of underfunding from the province have resulted in optometrists covering services “out of pocket” and putting some practices at risk of closing.

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“Our operating costs have skyrocketed, but our reimbursements to see patients has not, so we’re in a scenario where optometrists are paying more than half of the cost to deliver services to patients,” he said. “It’s just not sustainable, and what we’re really concerned about is our practices not being viable in the longer term.”

The Ontario Ministry of Health did not confirm the claims of underfunding by the OAO. It said in a statement that payments for Ontario Health Insurance Plan-insured services “have risen because of an increase in utilization,” and that the government expected optometrists “to continue to deliver the quality care that patients expect and deserve, as they always have.”

Dr. Salaba said the province has now taken a “positive step” and begun a dialogue with the OAO. But the job action will not cease until the Ontario government agrees to negotiate new fees.

“We want public commitments that they’re going to enter a negotiation process with us and figure out a way to sustainably deliver the cost of providing the service,” he said. “We’re willing to work with them to figure out what is the best solution for the government and our patients.”

According to Dr. Salaba, the fees OAO members receive from the province to pay for services covered by OHIP cover about 50 per cent of the real cost of those services. Under OHIP, patients under 20 and above 65 are covered for eye care services, as are patients with medically necessary appointments for certain types of conditions. These types of appointments make up roughly 70 per cent of an optometrist’s patients.

Dr. Salaba said the third-party study commissioned to estimate the total costs of services delivered by optometrists – including overhead costs and materials – found that services cost between $80 to $90 a patient, only $30 to 40 of which is reimbursed to doctors by the government.

While medical doctors on Ontario negotiate their fees with the government on a regular basis, fees for optometrists are not negotiated, and have not been fully updated since the late 1980s. Dr. Salaba said the fees have also not kept up with inflation.

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John Mastronardi, an optometrist based in Windsor, Ont., said the decision to turn away his patients was not an easy one, but he felt that participating in the job action was necessary in order to raise awareness of the funding issue.

He said he sends away an average of two or three patients a day, referring some to the emergency room and others to their family doctors, based on the urgency of the condition.

Dr. Mastronardi also said the COVID-19 pandemic has made it much more difficult to book enough appointments per day for non-OHIP services to cover the total costs of running his practice.

“We just can’t see the same volume so now the pain is being felt by these outdated fees,” he said.

Dr. Salaba said that before the pandemic, doctors would manage the losses created by outdated fees by seeing non-OHIP patients faster.

“But in a post-COVID environment, every appointment that occurs in the office takes us about half an hour, and it has to in order to maintain social distancing. And we have to clean behind everybody, so we can’t see patients, so the cost would be higher, and the added cost of cleaning disinfection and PPE [personal protective equipment] would also increase that cost,” he said.

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