FFS cap limit change deferred until April 2024  (more)

PSA update: Risk-adjusted capitation payment system deferred

Dear colleagues,

The 2021 Physician Services Agreement includes a provision for the current age-sex based capitation rates in the Family Health Organization and Family Health Network models to be adjusted to include a new risk-adjustment model based on the Canadian Institute for Health Information (CIHI) Population Grouping Methodology. This new system will improve equity in physician remuneration by rewarding physicians to care for more complex patients.

The bilateral Acuity Modifier Working Group is developing the new risk-adjustment system. This working group has held meetings to discuss the path forward and the work required to achieve the deliverable for physician members within the mandated timeline. Following a bilateral discussion, which staff subject matter experts informed, the working group recommended the implementation date be deferred to April 1, 2024. This is an extension of one year from the original target implementation date of April 1, 2023.

The rationale for the extension includes allowing the working group to:

The OMA Board of Directors and the Physician Services Committee, a bilateral committee with the Ministry of Health, concur with this decision and have approved the recommendation.

This deferral impacts the timing of changes to preventive care bonuses for colorectal cancer screening, mammography, Pap smears, influenza and childhood immunizations, and changes in the fee-for-service billing limits. Accordingly, there will be no changes to preventive care bonuses and fee-for-service billing limits until April 1, 2024.

The Ministry of Health is preparing an INFOBulletin on this initiative, which will be posted online and announced to members in OMA News. As always, if you have any questions, please don't hesitate to reach out to info@oma.org and OMA staff will be happy to support you.

Thank you,
Dr. Cathy Faulds
OMA Board Chair

Posted: December 08, 2022 by Cathy Mastrogiacomo
Regions: Ontario
Tags: FFS Fee For Service, Capitation