Acuity modifier payments will be made for eligible FHN and FHO physicians effective April 1, 2025.

To: Family Health Network (FHN) and Family Health Organization (FHO) Physicians
Category: Primary Health Care Services
Written by: Physician Relations and Contract Oversight Branch, Physician and Provider Services Division
Date issued: September 2, 2025
Bulletin Number: 250901

Overview

The Ministry of Health (ministry) and the Ontario Medical Association (OMA) have been working together to introduce an acuity modifier into the capitation system for Family Health Network (FHN) and Family Health Organization (FHO) models as directed by the 2021 Physician Services Agreement.

The new acuity modifier being introduced to the current capitation system is based on the Canadian Institute for Health Information (CIHI) Population Grouper methodology and is intended to improve equity in FHN and FHO physician compensation for complex patient care. It came into effect on April 1, 2024.

Acuity payment for fiscal year 2025-2026 and beyond

Acuity has been implemented into the capitation system in August 2025, and Base Rate Acuity payments for eligible physicians and physician groups will begin to appear on the September 2025 Remittance Advice (RA).

Remittance advice reporting

Base Rate Acuity payments will be included as part of all FHN and FHO physician capitation payments on their monthly remittance advice (RA).

Base Rate Acuity payments will appear on the RA under accounting transaction “Network Base Rate Acuity Modifier Payment”. Adjustments to Base Rate Acuity payments will appear on the RA under accounting transaction “Network Base Rate Acuity Modifier Adjustment”.

For clarity, the “Network Base Rate Acuity Modifier Payment” accounting transaction will represent acuity payments for the period August 1, 2025 to August 31, 2025. Acuity payments for the period April 1, 2025 to July 31, 2025 will appear under the “Network Base Rate Acuity Modifier Adjustment” accounting transaction.

Base Rate Acuity payments and adjustments will be included on the monthly RA in both the Group Total Summary Report and the Payment Summary Report.

Figure A: Group Total Summary Report

Table showing Group Total Summary Report highliting base acuity payment values

Figure B: Payment Summary Report

Screenshot of a table showing Payment Summary Report highliting base acuity payment values

A new Base Rate Acuity Group Summary Report will be created, providing groups with monthly and year-to-date Base Rate Acuity payment and adjustment totals for all physicians in the group.

Figure B: Base Rate Acuity Group Summary Report

Screenshot of a table showing Base Rate Acuity Group Summary Report


Other reporting

A new Base Rate Acuity Payment Summary Report will be sent to all eligible groups and physicians to their Medical Claims Electronic Data Transfer (MCEDT) mailboxes. This comma separated values (CSV) file will include similar information to the current Base Rate Summary Report (patient count, member days, and payment amount) by age, sex, and acuity band.

The Group Payment Summary Report sent via MCEDT will be updated to include Base Rate Acuity payments and adjustments.

Figure C: Group Payment Summary Report

Screenshot showing Group Payment Summary Report

The Roster and Capitation Payment Reconciliation Report sent via MCEDT will be updated to include a new column for Base Rate Acuity payment and adjustment amounts.

Keywords/Tags

FHN; FHO; 2021 PSA; Capitation; Acuity Modifier

Contact information

Do you have questions about this INFOBulletin? Email the Service Support Contact Centre or call 1-800-262-6524. Hours of operation: 8:00 a.m. to 5:00 p.m. Eastern Monday to Friday, except holidays.