Home visits dropped nearly 30% in Ontario after COVID-19 and physician compensation changes

A recent study from McMaster University has found that home visits in Ontario dropped “sharply” after the COVID-19 pandemic. It also noted changes to physician compensation that took effect around the same time.The researchers examined patient data from all Ontario residents 65 years or older who were eligible for provincial health insurance between July 2014 and June 2024 and calculated the number of home visits per 10,000 patients, counting billing codes for palliative and non-palliative home visits by physicians. The findings, published in the Annals of Family Medicine in January, showed that the frequency of home visits largely stayed the same between July 2014 and September 2019, with a slight trend upward. However, from October 2019 to June 2020, home visits plummeted by 29.7%. In addition, there was minimum change in the frequency of home visits after June 2020.The sharp drop in home visits coincided with the start of the COVID-19 pandemic, which ushered in greater adoption of virtual care as an alternative for home visits.“In Ontario, virtual visits temporarily replaced most in-person visits and have persisted as a major mode of primary care delivery. Virtual primary care, which had been uncommon in Ontario before the pandemic, serves as an alternative way to enable continuous primary care for older adults facing challenges accessing office-based care,” the researchers wrote.Billing premiumsOn top of that, provincial policy changes took effect in October 2019 that removed billing premium for general home visits to curb the potential for overuse. However, the premiums for homebound or frail patients, as well as patients in palliative care, remained.But even for palliative patients, home visits still declined between October 2019 and June 2020, albeit not as much. During this period, palliative visits dropped by 21.3%, compared to 34.5% for nonpalliative visits. Home visits in for patients in rural communities, as well as patients with dementia, also saw a lower relative decrease.Home visits are an essential service for many older patients, with evidence showing that they lead can to lower rates of emergency visits, fewer hospitalizations and better quality of live. However, the researchers say their findings show a “structural shift in primary care delivery” and warn that a “sustained decrease in home visits . . . could negatively affect health outcomes.”“Both short-term outcomes, such as emergency department visits and hospital admissions, and long-term outcomes, such as nursing home admissions and time spent living in the community, are important to consider,” they wrote.“Health systems must ensure that an appropriate mix of primary care services is available and accessible to optimize health outcomes and health equity for older adults.

Home visits dropped nearly 30% in Ontario after COVID-19 and physician compensation changes

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