FHO+: Continuity of care measure

Continuity of care remains an important goal of the FHO model. The FHO+ model will include a new continuity of care measure and accountability process linked to capitation.  

The new continuity of care measure will calculate the proportion of in-basket visits that are provided to your rostered patients (including long-term care enrolled patients) by you, a physician in your FHO or another “Acceptable Provider” (for example, a focused practice physician) versus in-basket visits provided to your rostered patients by any family physician (OHIP specialty code ‘00’). Please note that LTC enrolled patients will be measured using the LTC basket of fee codes.

The continuity of care threshold was set at 75 per cent by the arbitrator – this means 75 per cent of in-basket primary care visits in a quarter should be provided to your rostered patients by you or other acceptable providers. Currently, the vast majority of FHO physicians (86 per cent) are meeting this threshold, and another 9 per cent of FHO physicians are within 10 per cent of doing so. 

As with the previous FHO model, physicians will be held accountable for providing continuity of care. If the minimum continuity of care threshold is met, there will be no financial consequence. However, FHO physicians whose rosters fall below the threshold in two related measurement quarters will have a 15 per cent discount applied to their capitation payment.   

The continuity of care measure will take effect on April 1, 2026, with the new FHO+ model. 

How it is calculated

The OMA and the Ministry of Health have agreed on how the continuity of care measure will be calculated. The measure will reflect in-basket visits for both regular and LTC rostered patients, using the respective baskets. Details on how visits will be defined, such as whether they can include multiple in-basket services, will be determined through implementation. 

The continuity of care measure will be calculated as a percentage for each individual FHO physician based on their rostered patients. It is calculated for the entire roster each quarter. The calculation is as follows:

The numerator

The numerator is the number of in-basket primary care visits to any of the following physicians by your rostered patients: 

• You, the family doctor they are rostered to; 
• Someone in your FHO group, including other FHO signatories, income stabilization physicians and locums registered to the group; 
• Another “Acceptable Provider,” defined as:
  • Designated GP focused practice physician (including GP psychotherapy) for in-basket visits using fee or diagnostic codes identified for their area of practice
  • HIV or Care of Elderly (COE) physicians billing in-basket fee codes
  • ED and hospital for in-basket visits identified by a master hospital number, including special visits to an ED, using codes K990-K999, H980-H981, H984-H989
  • Oculo-visual physician for in-basket services using fee codes A110A and A112A 

Primary care visits that use fee codes within the LTC basket, which are provided by the above providers to your patients rostered as Q202, will also be included in the numerator.

The denominator

The denominator is the number of in-basket primary care visits to any family physician (OHIP specialty code ‘00’) by your rostered patients (both regular and LTC enrolled patients). It includes all visits captured in the numerator as well as visits to: 

• Walk-in clinics 
• Non-designated focused practice family physicians 

If you or another physician in your FHO is practising in a walk-in clinic and seeing your rostered patients for in-basket services, this would count towards your numerator as you are still considered a FHO physician providing care to your rostered patient(s).

What is not included in the measure

All out-of-basket services (such as pre-natal care P004, diabetes management K030, sexually transmitted disease management K028, etc.) are excluded from the calculation. This is mainly because capitation payments fund in-basket services only, and the continuity of care measure is intended to provide accountability for capitation payments. 

Additional clinical tasks, such as answering patient questions by secure email, are not included in the measure.

Care provided to your patients by non-physicians in your practice, such as nurse practitioners, is also not included in the measure. However, having NPs and other professionals in your practice can provide your roster with overall better access to care, thus decreasing outside use that could otherwise impact your continuity of care measure.

Reporting

The ministry will provide a new standalone monthly report on continuity of care via the existing Medical Claims Electronic Data Transfer (MCEDT) account. More details on this report, including whether a baseline continuity of care measure will be provided, are forthcoming with implementation.

Accountability for continuity of care

The arbitrator concluded that there should be a modest financial consequence for FHO physicians who fall below the minimum continuity of care threshold of 75 per cent. Note that the vast majority of FHO physicians (86 per cent) are meeting this threshold, so will not face any financial consequences. For physician rosters not meeting the threshold, here’s how accountability will work.

For the first quarter of your roster not meeting the continuity of care threshold of 75 per cent, you will be notified by the ministry. Because you have up to three months from the date of service to submit billings, a notification for Q1 will come early in Q3. There is no financial consequence for being under the threshold for a single quarter. The notification serves as an opportunity to course correct.

If your roster does not meet the 75 per cent continuity of care threshold for the quarter following notification (Q4) – a second quarter of your roster being below 75 per cent – 15 per cent of what was paid to you in Q1 will be subtracted from your Q6 capitation payment. This discount will be applied to your total capitation payments (including both regular and LTC capitation payments).

An example of how this works

Looking at the quarters following implementation of the continuity of care measure, here is an example of what the notification and capitation discount processes will look like for a physician’s roster that does not meet the threshold in either the first or fourth quarter.

In the example, the capitation payment is discounted in Q6 by 15 per cent of the Q1 capitation payment total, which is the first instance when the physician’s roster did not meet the continuity of care threshold.   

The continuity of care measure for each FHO physician is calculated quarterly and on a rolling basis. If your roster initially falls under the threshold in Q2 instead of Q1, you will be notified by the ministry in Q4. If your roster falls below the threshold again in the next reportable period (Q5), then your capitation payment will be discounted in Q7.

How the continuity of care discount differs from negation

The continuity of care measure makes more allowances for the realities of how patients access health care and allows more outside use than negation. The vast majority of FHO physicians (86 per cent) will not face financial consequences since their roster is currently meeting the 75 per cent threshold. For physicians whose rosters are not meeting the threshold, there is still an opportunity to improve their continuity of care measure and avoid financial consequences over time if their roster previously did not meet the threshold but does in the future.

Avoid comparisons with the access bonus

Your continuity of care measure will not be the same as your access bonus capture rate. For example, if you typically receive 65 per cent of your access bonus, that does not mean that your continuity of care measure will be 65 per cent. The continuity of care measure is calculated differently. It includes your rostered patients’ visits to your group and to other acceptable providers as part of continuity of care and counts the visits towards your continuity of care percentage. Some of these, like Emergency Department or hospital visits that used in-basket fee codes, were previously considered as outside use.