Physician Services Agreement (PSA) updates to Complexity Based Capitation, Fee-For-Service (FFS) billing limit, and Preventive Care Bonuses extended to April 1, 2024

To: Family Health Network (FHN), Family Health Organization (FHO) Physicians
Category: Primary Health Care Services
Written by: Primary Health Care Branch, Physician and Provider Services Division
Date issued: January 9, 2023

Adjusted capitation system extended

The implementation of an adjusted capitation system has been extended to April 1, 2024. Because this new implementation date impacts planned changes to Preventive Care Bonuses and Fee-For-Service billing limits, these updates have also been extended to April 1, 2024.

Complexity based capitation, preventive care bonuses, and maximum FFS limit move from group pooling to the individual physician

The 2021 Physician Services Agreement (PSA) established a Ministry and OMA Diagnostic Risk-Adjusted Acuity Modifier advisory group to implement an adjustment to the current age-sex based capitation rates to include a new risk-adjustment model based on the Canadian Institute for Health Information’s (CIHI) Population Grouping Methodology by April 1, 2023.

The bilateral working group has recently agreed to an extension on the implementation of the adjusted capitation methodology to April 1, 2024. As this work also impacts PSA changes including repurposing of the Preventive Care Bonus for Colorectal Cancer, Mammography, and Pap Smear for FHN and FHO (with proration of Influenza and Childhood Immunizations Preventive Care bonuses for FHN and FHO physicians with rosters less than 1,000 patients), there will be no changes to preventive bonuses and Fee-For-Service billing limits until April 1, 2024.

For more information on these changes, please see INFOBulletin #220502


Physician Services Agreement; PSA; Complexity Modifier; Acuity Modifier; FHN; FHO

Contact information

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