Table 1 Key features of compensation models for primary care in Ontario
Overview | Examples of specific bonuses (not exhaustive) | % office visits PHV (2014) | |
|---|---|---|---|
Family Health Team | • Inter-professional team model • Regular and extended hours • Blended capitation model with complement-based remuneration and bonuses/incentives, or blended salary model • Ministry of health funded inter-professional teams providing primary health care (e.g. nurse practitioners, dieticians, pharmacists, social workers, psychologist, and occupational therapists). | • Similar to capitation models but the size of the capitated basket is smaller. | 5.3% |
Enhanced Fee-for-Service | • Comprehensive Care Management (solo practitioners) and Family Health Group Models (3+ physicians) • Primarily through fee-for-service but also eligible for specific bonuses and premiums based on patient enrolment. • Provide care to rostered patients with some after-hours care. • Limited to no professional team. | 1. Patient Registration Incentive 2. Comprehensive Care Management Fee 3. After Hours Care 4. Diabetes and Heart Failure Management Incentives 5. Cumulative Preventative Care Management Payment (Bonus): Pap smears, mammograms, childhood immunizations, flu shots, colorectal screening. 6. Smoking Cessation Counselling Fee 7. Unattached Patient Fee 8. Primary Health Care of Patients with Serious Mental Illness. | 6.7% |
Primarily Capitation | • Family health networks and Family Health Organizations • 3+ physicians compensated mostly through capitation payments + some fee-for-service payments. • Specific bonuses & premiums based on patient enrolment, after hours premiums. | 1. Patient Registration Incentive. 2. Comprehensive Care Management Fee. 3. Diabetes and Heart Failure Management Incentives. 4. Cumulative Preventative Care Management Payment (Bonus): for Pap smears, mammograms, immunizations, flu shots, colorectal screening. 5. Preventative Care Management Service Enhancement Fee (Reminder Fee): to contact patient to obtain preventative services 6. Special Payments (Premiums): eligible for all premiums in any fiscal year for: Obstetrical Deliveries, Hospital Services, Palliative Care, Office Procedures, Prenatal Care, Home Visits 7. Newborn Care Episodic Fee. 8. Smoking Cessation Counselling Fee 9. Primary Health Care of Patients with Serious Mental Illness Unattached Patient Fee | 6.0% |
Other (Salaried) | • Community health centres, salaried physicians, rural-northern physician group agreement, Group health Centre, Community Sponsored Agreements. • Primary care services alongside health promotion and community development programs for communities and individuals with complex needs. | 4.3% | |
Fee-for-Service | • Traditional model. Solo. “Full-service” primary care billing. • Episodic care for patients. Some walk-in-clinics. • No professional team. | 7.9% |