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Compensation,Incentives, andBenefitsTransition into Practice Ser vices (TiPS)HealthForceOntario Marketing and Recruitment AgencySeptember 2015
Compensation, Incentives, and BenefitsTable of ContentsIntroduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Compensation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Primary Care Funding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Alternative Payment Arrangements (APAs)/Alternative Funding Arrangements (AFAs). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Shadow Billing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Hospital On-Call Coverage (HOCC) Funding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Uninsured Services Billing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Third-Party Billing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Billing Guides. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Additional Compensation Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Incentives and Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Provincially Funded Incentives and Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Community Funded Incentives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10This information is accurate at the time of printing. Changes may come into play at anytime from the MOH.w w w. H e a l t h F o r c e O n t a r i o . c a / t i p s
1Compensation, Incentives, and BenefitsIntroductionAs you near the completion of your residency training and start to consider your career choices, physiciancompensation and income can be a key concern. Whether you are providing primary care or specialist services,there are a number of compensation models and incentives available to physicians practising in Ontario.TiPS Compensation, Incentives and Benefits module offers new graduates and established physicians an overviewof the types of compensation and incentives available to Ontario physicians, along with links to additionalresources to assist with your billing and remuneration.Finding Your Ideal PracticeTeaching as Part of Your PracticeOffers medical residents, relocating physicians,and practising physicians information andresources to assist with the job search andemployment process.Providing Locum Coveragein OntarioOffers information on how to integrateteaching and mentorship into your generalor specialty practice in Ontario.Physician Well-BeingOffers physicians best practice tips and resourcesfor providing locum coverage in Ontario.Offers medical residents, graduates, andpractising physicians information on resourcesand strategies for maintaining work-life balance.Physician ResourcesCountdown to PracticeOffers medical residents a step-by-step guidefor transition into practice.This module is a compilation of physicianresources from a wide variety of topics thatare relevant to practising medicine in Ontario.The Business Side of MedicineOffers medical residents and new graduates informationon professional, practical, and personal considerationswhen setting up a practice in Ontario.w w w. H e a l t h F o r c e O n t a r i o . c a / t i p s
2Compensation, Incentives, and BenefitsCompensationThe Ministry of Health and Long-Term Care (MOHLTC) is responsible for most physician payments in Ontario andemphasizes comprehensive care that encompasses health promotion and disease prevention as well as treatmentand disease management. Ontario’s health system accommodates a wide range of practice models and encouragesgroup-based practice and interdisciplinary teams. Depending on whether you are a family physician or specialist,there are a number of different sources of income for physicians.Primary CareFunding: CHC,RNPGA, FFS, CCM,FHG, r-Service(FFS)Examples s (APAs)/Alternative FundingArrangements(AFAs)HospitalOn-Call Coverage(HOCC) fundingShadow billingw w w. H e a l t h F o r c e O n t a r i o . c a / t i p s
3Compensation, Incentives, and BenefitsPrimary Care FundingIn Ontario, multiple funding models are available to familyphysicians. The MOHLTC and the Ontario Medical Association(OMA) have developed innovative and attractive compensationmodels that support family physicians in providingcomprehensive care to their patients. These types ofcompensation models are based on blended type payments,meaning that while a model may be predominantly oneform of payment (e.g. capitation, which provides a basepayment per enrolled patient), it can include a blendof financial incentives, premiums and other types ofservice-related payments for family physicians to access(e.g. Family Health Organization).Alternative Payment Agreements (APAs)/Alternative Funding Arrangements (AFPs)Specialists in Ontario may be compensated through FFSpayments or through an Alternative Funding Plan (AFP)or Alternative Payment Plan (APP). AFPs/APPs are contractualarrangements between the MOHLTC, and a group ofphysicians, and may involve other organizations such ashospitals and universities where funding is provided tothe physician group for teaching and research as part ofthe group’s responsibilities.Most funding agreements are blended models that combinea base rate and fee-for-service or shadow billings,with possible additional incentive/premium payments.Fee-for-ServiceOther family physicians are compensated througha fee-for-service (FFS) based funding model. This meansthe family physician bills for each individual serviceprovided during a patient visit – although some FFSmodels may include additional bonuses and incentives(e.g. Family Health Group).Learn more about family practice compensation modelsin Ontario.w w w. H e a l t h F o r c e O n t a r i o . c a / t i p s
4Compensation, Incentives, and BenefitsIn Ontario there are currently several main agreement types available to physicians. They include:Agreement TypeDescriptionAcademic AgreementsTypically these AFP agreements are for Academic Health Sciences Centres andprovide payment to recognize the teaching, research, and administrativeresponsibilities of physicians in addition to their regular clinical work. Physiciansare still required to bill FFS or shadow bill as per the terms of their agreement.ED AFAs were established to ensure 24/7 emergency department coverage.Payments primarily consist of base funding, shadow billing and additionaladministrative funding.Emergency Department AlternativeFunding Arrangements (ED AFAs)There are two types of models: the workload model for larger hospitals,where base funding is determined by annual patient volume and acuity;and the 24-hour model for smaller hospitals, which provides tiered basefunding determined by annual patient volume.Emergency departments without an ED AFA bill FFS.Northern Specialist PhysiciansThe Northern Specialist APP is a blended FFS model designed to promotethe recruitment and retention of specialists in Northern Ontario. Physicianspractising in more remote areas may be eligible for additional incentives.OtherOther specialist APPs exist depending on specialty and community.Every APP has a physician group lead who you can speak to for details.Learn more about specialist compensation options in Ontario.Shadow BillingHospital On-Call Coverage (HOCC) FundingIn Ontario many non-FFS physicians practising underAlternative Payment Plans (APPs) or some types of primarycare funding models are required to “shadow bill” as perthe terms of their APP and in accordance with the Scheduleof Benefits. Under most arrangements, shadow billinggenerates a premium that represents a percentage of thefull value of a FFS claim. Speak with your physician grouplead regarding your APP requirements.The HOCC Program is administered by the MOHLTC andprovides hospital on-call funding to eligible physiciansto recognize their on-call responsibilities. Informationon HOCC eligibility, guidelines and funding levels canbe found on the HOCC Program website.w w w. H e a l t h F o r c e O n t a r i o . c a / t i p s
5Compensation, Incentives, and BenefitsUninsured Services BillingUninsured services are those services provided by a physicianto a patient that are not covered under OHIP. This includesservices provided to uninsured an’s Guide toUninsured ServicesA guide for Ontario physicians billing for uninsured services.It offers: guidance on uninsured and third-party requestedservices, suggested fees, relevant policies, and interpretationof relevant regulations applying to such services. Visit themembers only OMA web site for further details or send yourinquiry to info@oma.org.PoliciesThe CPSO has developed policies regarding charging foruninsured services and/or offering a block fee, includingethical guidelines regarding issues such as fee amount.OrganizationResourceDescriptionWorkplace Safety andInsurance Board (WSIB)WSIB ClaimsThe WSIB provides specific resources to physicians whotreat injured and ill workers.OMAThe College ofPhysicians andSurgeons of Ontario(CPSO)Third-Party Billingw w w. H e a l t h F o r c e O n t a r i o . c a / t i p s
6Compensation, Incentives, and BenefitsBilling GuidesThe MOHLTC and various professional medical associations offer medical trainees and practising physiciansa billing guide to help them navigate the physician billing landscape. Below is a list of some of the key billingresources available to physicians practising in Ontario:OrganizationResourceDescriptionResource Manualfor PhysiciansDesigned to provide information on various ministry-insuredservices. The manual is comprised of the following information: How to register for an OHIP billing number An overview of the Schedule of Benefits An overview of the claims submission process An overview of the monitoring of physician claims Lists of applicable acts and regulations Description of various inter-related programs.MOHLTCOntario Health InsuranceProgram (OHIP) Scheduleof Benefits and FeesOMA’s Section onGeneral and FamilyPractice (SGFP)The Canadian MedicalAssociation (CMA)The Schedule of Benefits lists all services insured by OHIP andincludes: the General Preamble (which affects all physicians),Consultations and Visits section (which applies to all specialties),and specific system and/or specialty sections (includingspecialty preambles).The Schedule of Benefits and Fees requires knowledgeableinterpretation and is intended primarily for members of theprofessional health-care community.Billing and Practice Guide*Members-only website.A resource guide for general and family doctors. The resourcehelps primary-care physicians identify the right codes andoffers information on how to bill within the various paymentmodels in Ontario.Common FamilyPractice Codes List*Members-only website.The Billing Guide and Codes List work well together: the BillingGuide tells you how to bill and the Codes List tells you what tobill. SGFP members receive hard copies of both guides, whichare updated periodically.Physician RemunerationOptionsThe Canadian Medical Association’s (CMA) module explains thevarious forms of physician payments across Canada by provinceand territory.w w w. H e a l t h F o r c e O n t a r i o . c a / t i p s
7Compensation, Incentives, and BenefitsAdditional CompensationResourcesTiPSIf you have any questions or need help withjoining the OMA and SGFP, contact OMA memberservices. Please contact the SGFP (sgfp@oma.org)for clarification or guidance in getting startedin your practice with the SGFP practice supportguides and lists.Note: Newly graduated physicians who are OMAmembers are offered a resident membershiprate, which includes the SGFP membership atno additional charge. Physicians practisingoutside of the province and considering a moveto Ontario, should contact OMA membership(membership@oma.org) to help reviewtheir options.Ministry Programs and ServicesThe MOHLTC also provides additional informationon funding, such as: OHIP Bulletins– updates from MOHLTC on billing information OHIP Forms and Applications OHIP Out-of-Country Services OHIP Payment Correction Listw w w. H e a l t h F o r c e O n t a r i o . c a / t i p s
8Compensation, Incentives, and BenefitsIncentives and BenefitsPhysicians practicing in Ontario may be eligible for additional incentives and benefits through a number of provincialincentive programs. In addition to the provincial programs, there may be regional incentives available to physicianssetting up practice in a specific community. This section outlines the provincial incentives and programs available tophysicians setting up practice in Ontario as well as a brief discussion of community/regional incentives.PhysicianOutreach Programfor General/FamilyPractitionersNorthern and RuralRecruitment andRetention (NRRR)IncentivesNorthernPhysician RetentionInitiative (NPRI)w w w. H e a l t h F o r c e O n t a r i o . c a / t i p sPregnancy andParental LeaveBenefit Program
9Compensation, Incentives, and BenefitsProvincially Funded Incentives and BenefitsResourceDescriptionPregnancy and ParentalLeave Benefit ProgramProvides eligible physicians with a pregnancy leave benefit for nine weeks anda parental leave benefit for eight weeks, of up to a maximum of 1,000 per week.The Northern PhysicianRetention Initiative (NPRI)Enables eligible physicians in Northern Ontario who have been practising in theNorth full-time for at least four continuous years to receive the equivalent ofa 7,000 retention incentive paid at the end of each fiscal year.Northern and RuralRecruitment and Retention(NRRR) InitiativeOffers financial incentives to each eligible physician who establishes a full-timepractice in an eligible community of the province. The grants range between 80,000 and 117,600, paid over a four-year period.To apply for the grant, visit the MOHLTC website and submit the application andcorresponding documentation.As well, your local Regional Advisor is always available to answer your NRRR questions.Physician OutreachProgram for General/Family Practitioners1. Primary-Care Clinics: To provide regularly scheduled primary-care clinics to outlyingcommunities with eligible nursing stations or medical clinics. Fee-for-service plus 200 honorarium for each day of outreach service or stipend of 500 plus 200honorarium for each day of outreach service.2. Physician Telephone Back Up: To provide direct, 24-hour emergency physicianback up to the nurse/nurse practitioner working in eligible nursing stations/clinics. 300 per month per eligible nursing station/clinic covered. This amount may beshared between two or more physicians.Community Funded IncentivesSome communities/clinics/hospitals in Ontario may offerincentives for physicians to practise medicine in theirarea. These incentives are often tied to some type of“return of service” obligation. Typically, the communityor hiring organization will require a new physician to signan agreement outlining the number of years he/she is toprovide patient services in the community in order to receivethe incentive. Incentives can range from cash to goods andservices to accommodation assistance. Cash-based incentivesvary widely and you need to research what is available bycommunity. Many communities/clinics/hospitals that offeredcash incentives in the past now offer a different type ofassistance, such as office start-up costs or the purchasingof equipment.w w w. H e a l t h F o r c e O n t a r i o . c a / t i p sTiPSTreat incentives like “icing” on the cake.The “cake” needs to consist of a funding modeland practice model you want; a collegial teamwith which to work; and a community youcan see yourself living in for the long term.If all of those ingredients are included andthe community/clinic/hospital also offers“icing,” that is a “sweet deal.”
10Compensation, Incentives, and BenefitsConclusionNow that you have an understanding of physician compensation and incentives inOntario, be sure to review our additional TiPS resources to assist you in your transitionto practice: Countdown to Practice: Offers medical residents a step-by-step guide for transitioninto practice. Finding Your Ideal Practice: Offers medical residents, relocating physicians, andpractising physicians information and resources to assist with the job search andemployment process. Providing Locum Coverage in Ontario: Offers physicians best practice tips and resourcesfor providing locum coverage in Ontario. Teaching as Part of Your Practice: Offers information on how to integrate teaching andmentorship into your general or specialty practice in Ontario. The Business Side of Medicine: Offers medical residents and new graduates informationon professional and personal considerations when setting up a practice in Ontario. Physician Well-Being: Offers medical residents, graduates, and practising physiciansinformation on resources and strategies for maintaining work-life balance. Physician Resources: A compilation of important resources and links related to practisingmedicine in Ontario.For more information, contact your Regional Advisoror email practiceontario@healthforceontario.ca.Ava ila ble in a cce s s ible format upon request: w w w. heal thforceontario. c a/acsw w w. H e a l t h F o r c e O n t a r i o . c a / t i p s
Uninsured Services A guide for Ontario physicians billing for uninsured services. It offers: guidance on uninsured and third-party requested services, suggested fees, relevant policies, and interpretation of relevant regulations applying to such services. Visit the members only OMA web site for further details or send your inquiry to info@oma .
