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Virtual care expansion moving too slow, says Ontario auditor general

By Shawn Jeffords and Paola Loriggio

TORONTO — Ontario’s expansion of virtual health-care services was too slow leading up to the COVID-19 pandemic, and will need more work to continue in an effective and sustainable manner after the global crisis ends, the province’s auditor general said in a new report.

Bonnie Lysyk examined the province’s progress in implementing remote patient care in one of 13 value-for-money audits included in her annual report released Monday. The report also includes analysis of retirement home oversight, consumer protection in the bereavement sector, the review and implementation of school curricula, and other issues.

Lysyk found the province has been slow to integrate virtual care services with its health-care system, and while the government relaxed its rules around billing for remote care earlier this year to accommodate the surge in demand, that work will need to accelerate after the pandemic.

The auditor found the Ontario Telemedicine Network, which offers remote care, and the Ministry of Health “do not have effective systems and procedures in place to offer virtual care services more long term in a cost-efficient manner to meet Ontarians’ needs,” Lysyk said in a statement.

What’s more, she said, the audit found “numerous cases” where physicians had “significantly high” billings for virtual care, including one case where a doctor billed $1.7 million for remote services in 2019-2020 and another $1.9 million for in-person services. That same doctor reported seeing as many as 321 patients virtually in one day, the report said.

Lysyk also raised concerns about the proliferation of private, for-pay virtual care services, saying they have “created risk of unequal access to health care, as well as oversight risk” since they are not under provincial purview.

Retirement homes in spotlight

The report also delves into the management and operation of Ontario’s 770 retirement homes, and found an increasing number of people living in those facilities require a higher level of care that could more suitably be provided in a long-term care facility.

More than 4,000 patients who no longer needed acute care in hospitals were discharged to retirement homes in 2019-2020, the auditor found. “Many of those people had health profiles similar to residents in long-term-care homes,” Lysyk said.

In another audit, her office found that consumers are not adequately protected from high pressure sales tactics when purchasing funeral services in Ontario and are often not provided with key pricing information.

An audit of the Bereavement Authority of Ontario found the agency must do a better job requiring the industry to provide pricing transparency to the public.

Key information such as price lists for funeral services and products are not easily accessible to the public, making it difficult for people to comparison shop at a time when they must make decisions quickly and under emotional duress, Lysyk said.

The audit sampled 100 licensed funeral homes, transfer services, cemeteries and crematoriums, and found only 26 per cent listed prices on their website, she said.

In examining the province’s education sector, the auditor found school curricula in Ontario are aging, with many not being revised in a decade or more. Many corresponding textbooks are just as old and “not relevant,” she said.

Lysyk said the Ministry of Education does not have a formal process to determine what should be updated and when to ensure that Ontario students are learning what’s most current and relevant.

While in most cases, the ministry followed the appropriate steps in reviewing, revising and developing curricula, “recent curricula were released without sufficient time for school boards and schools to review them and for teachers to prepare instructional materials and resources to properly implement them,” the report said.

The auditor also flagged a lack of transparency in the province’s gaming, alcohol and cannabis regulator.

Lysyk conducted her first ever audit of the Alcohol and Gaming Commission of Ontario this year and was critical of how it oversees its approximate 78,500 licensees across the four sectors it regulates.

She noted that compliance officials have “significant autonomy” when it comes to selecting establishments to inspect, but do not document the rationale used to make the selection.

Lysyk also noted that most recreational cannabis sold in the province continues to be sold illegally — accounting for almost 80 per cent of sales in 2019-2020.

Meanwhile, the agency is not monitoring the movement of recreational cannabis in retail stores, she said. The report found cannabis stores reported destroying nearly 5,500 units of product from September 2019 to July 2020. But the AGCO had no assurance that these units were “not lost, stolen, or diverted.”

The agency itself also does not produce or publish audited financial statements, the report said.

“We were surprised to learn it is the only regulatory government agency in Ontario to not publish such and important accountability document,” she said.

In another audit, Lysyk said the province knew as early as 2016 that a light-rail transit line planned for Hamilton would cost more than the promised $1 billion to build it. The cancellation of the project in December 2019 by the Progressive Conservative government sparked outrage in the community.

At that time, the government said the real cost to build the line would be $5.5 billion.

Lysyk said Monday that the latest government estimates are reasonable, but said that both the previous Liberal government and the Tories knew about the escalating price tag but did not tell the City of Hamilton.

The annual update comes less than two weeks after Lysyk released a special report into the province’s pandemic response, which found that it was slower and more reactive than that of other provinces.

The government took issue with many parts of that report, with Premier Doug Ford dismissing it as “21 pages of inaccuracies.”