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Structure

Family Medicine Models

You can practise family medicine in Ontario in a number of models. Figure 1 illustrates the types of practices and, with the following descriptions, can help guide your decision on what model best suits you.

  

Figure 1. Various practice and payment models for family physicians.

Payment Models

Fee-for-Service (FFS)

  • Description: The simplest and most common form of payment. Used by all practice models, but the percentage of the fee paid to the physician may differ across models. FFS physicians receive 100% of the Schedule of Benefits fee value.
  • Details: The physician or billing agent bills OHIP according to the Schedule of Benefits (updated April 1, 2020).

Enhanced Fee-for-Service

  • Description: Payment model for Comprehensive Care Model and Family Health Group practices – see below.
  • Details: Physicians are paid primarily through FFS, with additional payment through bonuses and premiums.

Blended Capitation

  • Description: Payment model for Family Health Network and Family Health Organization practices – see below.
  • Details: Physicians are paid a base rate for each patient on their roster (adjusted for age and sex), a percentage of FFS billings, and bonuses and premiums.

Other

  • Complement-based base remuneration + bonuses and incentives. Applies to Rural and Northern Physician Group Agreements (RNPGA).
  • Blended salary model (BSM). Applies to Community-Sponsored Family Health Teams.
  • Salaried model. Applies to Community Health Centres.
  • Alternate funding plan. Applies to GP Focused Practices such as HIV, palliative care and care of the elderly.

Practice Models

Walk-in Clinic

  • Description: Episodic care of patients in a community.
  • Details: Patients are enrolled under another family physician or do not have a family physician. These clinics are usually attended for convenience or after-hours care.
  • Compensation: 100% FFS.

Solo Practice

  • Description: Independent physician practice.
  • Details: Physician provides continuity of care for their patients. Physician is not tied to any physician group and there are no financial incentives to provide comprehensive or after-hours care.
  • Compensation: 100% FFS (few additional fees are available).

Comprehensive Care Model (CCM)

  • Description: An enhanced model of care for solo physician practices.
  • Details: Designed to incentivize independent physicians to provide comprehensive healthcare (such as preventive screening) to their patients. Must provide at least three hours of after-hours care once a week.
  • Compensation: 85% FFS + 15% incentives and enhanced fees.

Family Health Group (FHG)

  • Description: A FHG (pronounced “fig”) is a collaborative model that requires a minimum of three physicians (not necessarily in the same location).
  • Details: Designed to incentivize groups of physicians to practise comprehensive healthcare. Must provide after-hours coverage.
  • Compensation: 85% FFS + 15% incentives and enhanced fees.

Family Health Network (FHN)

  • Description: A FHN (pronounced “fin”) is a collaborative model that requires a minimum of three physicians.
  • Details: Comprehensive primary care is provided in an “area of high physician need” (as determined by MOHLTC). Must provide after-hours
  • Compensation: 75% through capitation (guaranteed income) and 25% other (including 15% of FFS billings + bonuses and premiums).

Family Health Organization (FHO)

  • Description: A FHO (pronounced “foe”) is a collaborative model that requires a minimum of three physicians.
  • Details: Comprehensive primary care is provided in an “area of high physician need,” similar to a FHN. Must provide after-hours coverage.
  • Compensation: 75% through capitation (guaranteed income) and 25% other (including 15% of FFS billings + bonuses and premiums). Differs from a FHN in base rate, basket of core services and bonus amounts.

Family Health Team (FHT)

  • Description: These community-centred comprehensive primary care organizations aim to provide services and programs to specific communities.
  • Details: Interprofessional health teams comprise family physicians, registered nurses, nurse practitioners, social workers, pharmacists and dieticians.
  • Models: FHOs, FHNs and RNPGAs may be organized as FHTs.

 Sources: Ontario Ministry of Health and Long-Term CareOMA Primary Care Model OverviewOMA Primary Care Comparison ChartHealth Force Ontario Chart