FHO+: Continuity of care measure explained
Understand how continuity of care is measured and learn about the value, timing and real-life scenarios behind capitation adjustments in this new video series.
This video explains how the Continuity of Care is measured and evaluated. It reviews:
- What the measure counts: Visits for in-basket services made by your rostered patients to family physicians (OHIP specialty ‘00’)
- The list of acceptable physicians that count towards your measure
- The threshold is 75 per cent for each quarter
Within a quarter, 75 per cent or more of visits for in-basket services should be to you, another physician in your FHO group, or to an acceptable physician.
This video explains when and how you will be notified by the ministry regarding your Continuity of Care measure.
You will:
- Receive a monthly report of your roster’s continuity of care measure, based on the available claims data for the previous month
- Continue to receive your Outside Use reports
The notification provides you with an opportunity to course correct, similarly to how you would with Negation.
This video explains what triggers a capitation payment adjustment. It illustrates the following concepts:
- Related measurement quarters are three quarters apart
- Both related measurement quarters must be below the 75 per cent threshold for a capitation payment adjustment to apply
This process resets every quarter and continues on a rolling basis.
A single quarter below the 75 per cent threshold is not a reason to worry. It’s a nudge for you to review your roster’s activities and look for ways to improve.
This video shows how a capitation payment adjustment is calculated and when it is applied. It illustrates the following concepts:
- Both related measurement quarters must be below the 75 pre cent threshold for a capitation payment adjustment to apply
- If these conditions are met, a capitation payment adjustment will be made two quarters after the second related measurement quarter
- The value of the adjustment is 15 per cent of the value of the base capitation payments made to you in the first of the two related measurement quarters
Facing a capitation payment adjustment in one particular quarter doesn’t mean that you’ll continue to face a penalty every quarter after that.
The process starts again every quarter, looking only at the two related measurement quarters.
Scenarios
This video is a case example of a physician who has a single quarter where their Continuity of Care measure is below the 75 per cent threshold. They do not face a capitation payment adjustment.
It illustrates the concept that an adjustment only applies if both related measurement quarters are under 75 per cent.
This video is a case example of a physician whose Continuity of Care measure is below 75 per cent for two related measurement quarters. She is subject to a capitation payment adjustment as a result.
She uses the information available to make adjustments to her practice and return to full capitation payments.
It illustrates the concept that financial consequences are temporary if the physician’s Continuity of Care measure improves.
Step by step: understanding the potential financial consequences
The continuity of care measure for each FHO physician is calculated quarterly and evaluated on a rolling basis. If your roster’s continuity of care is below the 75 per cent threshold for both related measurement quarters, an adjustment will be applied to a future quarter. The adjustment is calculated on the value of base capitation payments, excluding acuity payments.
Related measurement quarters are three quarters apart. For example, Q1 measurements are related to Q4 measurements. Q2 is related to Q5, and so on.
For any quarter that your roster is below the 75 per cent continuity threshold, you will be notified by the ministry via email two quarters afterward. For example, if your roster is under 75 per cent in Q1, you will be notified in Q3. For Q2, you will be notified in Q5, and so on. This is because physicians have three months to submit billings to OHIP, so the earliest the Ministry can evaluate your roster for Q1 is at the start of Q3.
The amount of the adjustment is 15 per cent of the value of the base capitation payments made to you in the first of the two related measurement quarters. So if both Q1 and Q4 are below the 75 per cent continuity threshold, the adjustment would be 15 per cent of value of the base capitation payments made to you in Q1. The adjustment is calculated on the value of base capitation payments only, not acuity payments.
The adjustment is applied once the ministry can confirm the second instance of being under the 75 per cent threshold. This is two quarters after the fact. This is because physicians have three months to submit billings, so the earliest the ministry can measure a given quarter’s continuity of care is three months + one day after the quarter in question.
For example, if Q1 and Q4 are both below the 75 per cent continuity threshold, the resulting adjustment is applied in Q6.
The value of the adjustment will be split into two equal amounts that will be subtracted from your base capitation payments in the second and third month of the adjustment quarter.
Interactive calculator
To experiment with how this will work in practice, access the OMA’s Continuity of care calculator/worksheet