With the Ontario Physician Services Agreement (PSA) having expired in 2024, we have been closely watching ongoing negotiations between the Ontario Medical Association (OMA) and the Ministry of Health (MOH). The latest proposal introduces an exciting new concept: the FHO+ model. The proposed agreement was sent to arbitration on June 30, 2025, and a ruling is expected this fall. Whether you are currently practicing in a FHO or are considering joining or transitioning to FHO, you need to understand how these proposed changes could impact your practice operations and compensation.
The FHO+ model represents a significant shift in how family physicians are compensated, moving toward a more comprehensive approach that recognizes the full scope of work physicians perform on a daily basis. From direct patient care to administrative tasks, this new model aims to ensure physicians are fairly compensated for all aspects of their practice.
In this blog, we’ll break down everything you need to know about the proposed FHO+ model, including what’s changing, what’s being removed, and most importantly, what these changes mean for your practice and income potential.
What is the FHO+ Model?
The FHO+ model is a proposed enhancement to the existing Family Health Organization payment structure. Rather than a complete overhaul, it’s designed to address key gaps in physician compensation while simplifying certain administrative burdens that have historically complicated practice management.
The core philosophy behind FHO+ is recognition that family physicians provide value beyond just face-to-face patient encounters. The model acknowledges the time physicians spend on indirect services, such as charting, reviewing labs and other administrative tasks, which are essential to quality patient care but often go uncompensated.
Key Changes in the FHO+ Model
What’s Being Removed in the FHO+ Model
Access Bonus Elimination: One of the most significant changes is the removal of the access bonus system. This bonus will be reallocated through hourly time-based payments as well as the across-the-board increase in shadow billing.
What’s Being Increased in the FHO+ Model
Enhanced In-Basket Payments
- Most in-basket codes will see increases to 30% of the full Fee-for-Service (FFS) rate
- Select procedure codes will receive even higher increases to 50% of FFS rates
This represents a significant jump in revenue for routine services provided within the FHO setting.
Improved After-Hours Compensation: The after-hours premium will increase from 30% to 50%, providing better compensation for physicians who provide extended care to their patients outside regular business hours.
Enhanced Group Management Leadership Program (GMLP): The GMLP will be increased up to 4 times the current rate, providing better compensation for physicians who take on leadership roles within their FHO groups.
Hospital-Based Services: In-basket services performed in a hospital setting will be considered out-of-basket and paid at full FFS rates, ensuring physicians receive appropriate compensation for hospital-based care.
New FHO+ Model Payment Structure
Hourly Time-Based Payments: Perhaps the most groundbreaking change is the introduction of hourly payments at $80 per hour, billed in 15-minute increments with a maximum of 14 hours per day. This covers four distinct categories of work:
- Direct Services – Time spent directly with patients
- Direct Telephone – Phone consultations are paid at 100% of the hourly rate if the physician is present in their clinic, and at 85% if the physician is not in their clinic.
- Indirect Services – Charting, reviewing lab results, billing, and other administrative tasks
- Clinical Administration – Roster management, chronic disease patient management, and other clinical oversight activities
This time-based payment system represents a fundamental shift in how physician work is valued, recognizing that quality patient care extends far beyond the examination room.
Enhanced Patient Attachment Incentives: The proposed FHO+ model includes substantial increases in patient attachment bonuses:
- Established physicians: $100-$180 increase per rostered patient (depending on Rural Index for Ontario (RIO) score¹ and patient age)
- New graduates: $150-$270 per rostered patient
- Increase of Q053 from $350 to $500
- New Q054 Mother & Newborn Patient fee ($350)
- Additional codes for multiple births (Q055) and Health Care Connect upgrades (Q056)
Improved Co-location Flexibility: The FHO+ model makes it easier to establish and maintain FHO groups, including:
- Minimum physician requirement reduced from 3 to 2 doctors per location
- Co-location distances adjusted based on RIO scores (5km to 30km range)
- 240 additional FHO spots will be available annually
- Updated FHO agreements will need to be signed²
What the FHO+ Model Means for Your Practice
Getting Paid for Your Time: The most transformative aspect of the FHO+ model is the recognition that physician work deserves compensation regardless of whether it involves direct patient contact. Under this system, you’ll be paid for:
- Patient Care Time: Direct consultation and examination time
- Administrative Work: Chart reviews, lab result analysis, billing tasks
- Clinical Oversight: Managing your patient roster, chronic disease management, care coordination
This means activities like reviewing your Practice Care reports with your DoctorCare team would qualify as compensable administrative work under the new model.
Natural Revenue Increases: The increase in shadow billing from 19.4% to 30% (and 50% for select procedures) represents a natural jump in revenue for services you’re already providing. This, combined with the new time-based payments, can significantly improve practice income without requiring changes to your current patient care approach.
Enhanced Patient Rostering Incentives: The substantial increases in patient attachment bonuses provide strong incentives for maintaining and growing your patient roster. These increases are particularly beneficial for:
- New graduates establishing their practices
- Physicians practicing in rural or underserved areas
- Practices focused on comprehensive family care
How DoctorCare Can Help You Navigate and Prepare for the FHO+ Model
While we await the final arbitration ruling, the DoctorCare team is here to support you in preparing for the implementation of the FHO+ model:
Roster Management and Optimization: Ensuring your patient roster is accurate and up-to-date becomes even more critical under the FHO+ model. DoctorCare can help you:
- Verify all eligible patients are properly attached to your practice
- Identify and resolve roster discrepancies
- Maximize patient attachment bonuses
- Streamline the rostering process for new patients
Time-Based Billing Tracking: The new hourly payment structure requires careful documentation and tracking. Our team can help you:
- Implement systems to track compensable time accurately
- Ensure you’re capturing all eligible administrative and indirect service time
- Optimize your billing to maximize the 14-hour daily limit
- Provide clear documentation for audit purposes
FHO Formation and Governance Support: Whether you’re forming a new FHO or adding physicians to an existing group, DoctorCare can assist with:
- Navigating the updated FHO agreement requirements
- Understanding co-location rules and RIO score implications
- Managing the governance aspects of multi-physician groups
- Ensuring compliance with new FHO+ requirements
DoctorCare has deep expertise in FHO creation and management. We have formed 58 FHOs, added over 200 doctors to these FHOs, and currently manage over 100 FHOs.
Revenue Optimization: Our billing experts can help ensure you’re maximizing all available revenue streams under the FHO+ model:
- Ensuring capture of billings at higher in-basket rates
- Optimizing after-hours premium billing
- Ensuring proper utilization of enhanced patient attachment bonuses
- Tracking and billing for time-based services
Looking Ahead: The FHO+ Model and a More Sustainable Future for Family Medicine
The FHO+ model represents more than just changes to physician compensation—it’s a step toward recognizing and valuing the full scope of family medicine practice. By compensating physicians for the time they spend on indirect services and administrative tasks, the model acknowledges that quality patient care extends far beyond the examination room.
This comprehensive approach has the potential to:
- Reduce physician burnout by providing fair compensation for all work performed
- Improve patient care quality by supporting proper time allocation for comprehensive care
- Stabilize family medicine practices by ensuring sustainable revenue streams
- Attract new physicians to family medicine with improved compensation models
- Support the goals of Ontario’s Primary Care Action Plan³
Conclusion
The proposed FHO+ model represents a significant evolution in how Ontario values and compensates family physicians. By eliminating administrative burdens, such as the access bonus, increasing in-basket payments, and introducing time-based compensation, the model addresses many of the challenges that have historically impacted the sustainability of family medicine practices.
At DoctorCare, we’re committed to helping physicians navigate these changes successfully. Our team of experts understands the complexities of physician billing and practice management, and we’re prepared to support you through the transition to FHO+ when it becomes available, ensuring you’re positioned to take full advantage of these positive changes. As we continue to receive updates on the arbitration ruling and implementation timeline, we’ll keep you informed and ready to optimize your practice under the new system.
Ready to learn more about how to prepare for the FHO+ model or interested in transitioning to a FHO? Contact DoctorCare below to discuss how we can help you prepare for these exciting changes and maximize your practice’s potential under the new compensation structure.
References and Additional Resources
¹ Rural Index for Ontario (RIO) Calculator: The RIO score determines rural classification and affects various compensation rates. Physicians can calculate their RIO score using the OMA’s online calculator.
² Current FHO Information: For physicians interested in learning more about existing FHO structures and requirements, the Ministry of Health provides detailed information about Family Health Organizations and primary care models on their website.
³ Ontario’s Primary Care Action Plan: The government’s strategic framework for strengthening primary care in Ontario, which includes initiatives to improve access, enhance team-based care, and support physician recruitment and retention.
Additional Resources:
- Income Stabilization Program Guide – For new FHO physicians
- Commonly Missed OHIP Q-Codes – Maximize your current billing
- Starting Your Practice in Ontario: A FHO Primer – DoctorCare webinar series
Disclaimer: This blog post is based on the proposed FHO+ model as presented during PSA negotiations. All details are subject to change pending the final arbitration ruling expected fall 2025. Physicians should consult with their professional associations and billing experts for the most current information and personalized advice.
