Should I transition to the FHO?
Should I transition my practice to the FHO?
If you are a family physician who provides comprehensive primary care to your patients, with a focus on preventive care, then your practice will make a positive transition to the FHO payment model.
Who can form or join a FHO?
The minimum requirement to become a FHO is a group of three or more family physicians who may work under the same roof or may be geographically separated. The individual FHO physicians work together as a group to provide comprehensive primary care, extended office hours, and on-call coverage to the group’s enrolled patients.
What are the benefits?
What will my revenue look like in the FHO?
After transitioning to a FHO, your revenue will consist of the following:
- Base Rate Capitation Payment (BRP) for each enrolled patient, adjusted for age and sex
- Comprehensive Care Management Payment (CCM) for each enrolled patient adjusted for age and sex (FHG physicians currently receive the CCM payment)
Together, the Base Rate Payment and Comprehensive Care Management fee provide you with a predictable and steady income regardless of the number of patient encounters.
In addition to the BRP and CCM, the following income streams will contribute to your total revenue:
- Fee for service payments for services outside of the FHO basket of codes
- Fee for service payments for all services provided to non-enrolled patients
- Shadow billing on the 119 Fee for Service codes paid at 10% for enrolled patients
- Primary care premiums/bonuses and FHO special payments
- Management payments
- Potential Access Bonus where applicable
What is a “Capitation Payment”?
A capitation payment is a regular monthly payment that flows to the physician based on their commitment to provide comprehensive primary care to their enrolled patients. It is paid to the physician regardless of the number of patient encounters.
In the FHO, the capitation payment is the Base Rate Payment (BRP). It is adjusted for the age and sex of each enrolled patient and ranges from $55.17 to $491.02 per patient per year. The BRP is paid monthly to each individual physician in the group and makes up approximately 75% of a physician’s income.
The BRP remunerates the FHO physician for the majority of comprehensive care services provided to their enrolled patients. The services covered by the BRP are referred to as the FHO Basket of Services and is defined by 119 fee codes and referred to as “included” or “in basket” codes.