Can Ontario’s FHO+ model save the comprehensive care career?

Thousands of Ontario family doctors practising in Family Health Organizations (FHOs) are celebrating the renegotiated physician services agreement that will for the first time compensate them for so-called indirect services, including time spent charting, reviewing labs, billing and other administrative tasks beginning April 1.“Family doctors have been overburdened with administrative work,” said Dr. Zainab Abdurrahman, president of the Ontario Medical Association. “We’ve seen some family doctors spending up to 19 hours per week on paperwork. That takes away from patient time and wears down on morale, so the FHO+ is better designed to reflect how family medicine is actually being practised and makes comprehensive family medicine a more viable career choice.”Family doctors in the FHO+ model will be able to bill $80 per hour for time spent with patients as well as for time spent on indirect services and clinical administration. Time-based billing will be capped at 240 hours per month, billing for indirect services and clinical administration will be capped at 25% of total hours billed and billing for clinical administration will be capped at 5% of the amount billed for direct and indirect services.Doctors will now have to develop a system for keeping track of their hours without adding to their administrative burden, but ongoing engagement with the ministry is underway to ensure implementation goes forward as seamlessly as possible, said Dr. Abdurrahman.Capitation pay, which currently consists of a base rate payment, and a comprehensive care payment, will see the latter payment accounting for 20% of capitation pay discontinued, but time-based payments and an increase in shadow billing rates will more than make up for the loss.Shadow billing rates for in-basket services–the most common services performed by family docs–will increase from 19.4% to 30% of the fee-for-service rate. Shadow billing rates for select office procedures–less commonly performed services like pap smears, for example–will increase to 50%, as will the premium billed for rostered patients seen after hours and on weekends. Also welcomed by family docs in the FHO model is the elimination of negation–the hated dollar for dollar penalties that doctors in the FHO model now face when a rostered patient seeks care outside the FHO–at a walk-in clinic, for example.The FHO+ model, based on an arbitrator’s decision, “will instead look at continuity of care over time to ensure that rostered patients are mostly seeing their family doctor or another doctor in the group,” said Dr. Abdurrahman. A doctor whose continuity of care falls below a threshold of 75% in any quarter will receive a warning and be given a chance to make improvements in the following quarter before being hit with a 15% reduction in capitation pay for any three-month period in which they fall short of the threshold.Established doctors practising in the FHO+ model will also be eligible for patient attachment bonuses ranging from $100 to $180 for new rostered patients depending on the rural index for Ontario score and the patient’s age, while new graduates will receive between $150 and $270 for each new rostered patient. There are also new patient attachment bonuses for newly rostered mothers and newborns, as well as bonuses of between $350 and $500 for rostering complex and vulnerable patients referred through the Healthcare Connect program.“The new patient attachment bonuses are helpful,” said Dr. Abdurrahman, but it’s the increased funding for team-based care to support physicians that will do more to increase the number of Ontarians with a family doctor.Additional changes included in the FHO+ model include an increase in group management leadership pay from $25,000 per annum to $100,000 and a reduction in the number of doctors practising in an office from three to two in order to qualify as a FHO. The latter change will make it easier for Northern Ontario family doctors practising in different offices and locations to organize as a family health organization.What does all of this mean in terms of total compensation for family doctors practising in the new FHO+ model? Dr. Abdurrahman is reluctant to offer an estimate, noting that it depends on roster size, the location of the practice and whether a doctor has an established practice or is just starting out. Others, however, estimate an average 18% increase in compensation–from $335,000 to just under $400,000 per annum.Asked if there were any improvements doctors would like to see that didn’t make it into the new physician services agreement, Dr. Abdurrahman pointed to the OHIP billing system which is complex and time consuming to use and desperately in need of modernization. “There are always areas for improvement that may not have come through this time but there are always opportunities for the future,” she remarked.

Can Ontario’s FHO+ model save the comprehensive care career?

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