FPRP is continually adding to these questions. If you have a question not included below, you can email it to msullivan@nlma.nl.ca
Enrollment in the Blended Capitation payment model is completely voluntary. Physicians enrolled in the model may voluntarily choose to go back to fee-for-service.
Yes, the NLMA launched an advisory service to support physicians who wish to explore what moving to the Blended Capitation Model means for their individual practices.
Services consist of a consultant (Barbara Molgaard Blake) with whom you can book a meeting to explore how you can use your EMR data to define your panel of patients, predict your future income and answer any questions you may have on the Model.
This information can help inform your decision on whether to move to Blended Capitation.
Effective June 26, 2023, appointment availability will generally be available on Tuesday evenings from 7:00 p.m. – 9:00 p.m. NT.
Please visit the booking website to look at available appointment times and make a booking.
A Group must consist of at least 3 physicians. Consistent with Schedule R, when a Group falls below 3 Physicians, the goal of the Group and the FPRC is to re-establish the minimum number of Physicians in a reasonable period. It is expected that the Group will make diligent efforts to recruit a new physician(s) to the Group as quickly as possible. The FPRC will review the Group’s efforts every 12 months to determine if a reasonable effort has been made. The FPRC’s determination will take into account the general conditions for recruitment of Physicians within the region and the province as a whole.
The FPRC will not terminate a Group if the Group is making reasonable efforts to recruit the minimum number of Physicians. The FPRC will support the process by promoting the opportunities of the Blended Capitation Model to other physicians and identifying opportunities for Group mergers. The final decision on the physicians who will be part of a Blended Capitation Group – whether through recruitment or a merger with another Group – will be that of the Group Physicians.
During the period of time in which the Group continues to practice with fewer than 3 Physicians, the Group, in consultation with the FPRC, is to continue to provide services to all attached patients of the remaining Physicians as per Schedule R of the MOA; consistent with the foregoing, the FPRC will consider, at the request of the Group, a proportionate reduction in the after-hours service of the Group for this time and any extension of time as approved by the FPRC, but in any event, the remaining Physicians are to provide a minimum of 3 hours of after-hours clinics per week.
In the event a termination of a Group occurs, the Physicians will transition back to Fee for Service (FFS) in accordance with Schedule R.
The FPRC may update its rules and processes regarding transitions in Group composition from time to time.
Physicians who have already completed an expression of interest and subsequently submitted their practice profile to the FPRP will receive an update on their eligibility status from FPRP. Once eligibility is confirmed, the NLMA will send out an email on behalf of the FPRP to each eligible physician to confirm the income floor.
Your agreement to the income floor calculation will be required prior to issuance of an agreement for enrollment in the new payment model. Physicians who have met the eligibility requirements and have confirmed their income floor calculation will receive a letter of agreement from FPRP for enrollment in the Blended Capitation Program.
To ensure full program readiness, the parties to the new Blended Capitation Model (BCM) have agreed to move the start date for accepting family physicians into the model from September 1, 2023 to October 30, 2023.
Please see the Path to Acceptance for further information.
Starting October 30, 2023, doctors will be accepted into the program, which means they will have access to the one-time bonuses and the income guarantee. The billing system for capitation claims and partial fee-for-service claims will be ready for a test group of physicians no later than April 1, 2024. Once the reliability and accuracy of the billing system are confirmed, on or before July 1, 2024, the billing system will be open to all other applicants who have been accepted into the program. In the coming months and years, the NLMA will monitor the program to determine if changes need to be negotiated in the MOA.
No. Members can apply to enroll in the Blended Capitation Program prior to making arrangements with a group.
Family physicians, who are interested in participating in the Blended Capitation program, must submit an expression of interest. To submit your expression of interest, please click here.
There will NOT be a limit of 75 on the number of physicians accepted into the program. If there are more than 75 accepted prior to the billing test phase, the first 75 accepted will move into the test
A summary of each step in the Path to Acceptance can be found here. It is important that all physicians interested in the Blended Capitation Program familiarize themselves with the Path to Acceptance.
The objective of the performance indicators process is to encourage continuous improvement and/or maintenance of accessibility and high-quality care. Therefore, there are no specific targets or goals attached to these, with the exception of after-hours access.
The approach for defining and measuring access relies on three performance indicators, listed below:
The data to monitor access indicators exists and is easily accessible. The data will flow to and be monitored by the Family Practice Renewal Program. If patient access is reduced significantly, this may trigger communications between the FPRP and the practice group about ways to maintain and improve access.
Physicians who work part-time (e.g. two days a week with a roster size of 400 patients) may still enroll in the Blended Capitation Model as long as they provide comprehensive longitudinal services to their roster and meet access indicators. Physicians within the group may be part time as long as there is “reasonable, regular hours each week of the year”, including the required after-hours access, which can be shared among the overall group.
The after-hours requirement does not require more hours of work per week. It only requires the group to schedule a portion of its work outside the 9-5, Monday-Friday window.
There is a formula for the number of hours per week of after-hours care linked to the total number of rostered patients. For example, a group with 3,600 patients must provide a minimum of 6 hours of after-hours care each week. This obligation is divided among the doctors within the group (e.g., for three doctors it could mean 2 hours each per week, or 6 hours per doctor for one week out of three). The after hours requirement increases in proportion to the number of patients attached to the group.
This is a decision of the group, and will be guided by FPRC policy. Here are some examples:
In a group of three physicians serving 3600 patients, the obligation is 6 hours per week for the whole group.
In a group of four physicians serving 4000 patients, the obligation is 6.8 hours per week for the whole group. If three physicians have panels of 1200 patients each, and the other physician has a panel of 400 patients, the physicians can choose to divide the after-hours expectation according to their patient loads. For example, once a week each of the three physicians with larger panels could stay open two extra hours, and the physician with the smaller panel could extend by one hour. To accommodate for the later hours, they could adjust the start time of their workday.
The basket of services may be provided in-person or virtually, as determined appropriate by the provider. CPSNL standards of practice apply regarding virtual care and the use of virtual care is regulated by the College. As well, there is currently a cap on the number of virtual visits per day.
The expectation is that doctors in a group will make their after-hours care available to all the patients attached to physicians within the group.
The provincial government has agreed to the NLMA’s request to amend Schedule “R” of the MOA to enable certain groups to apply for an exemption from the After-Hours obligations of the Blended Capitation Model during the transition period.
For the first two years of the program, groups that already provide regular, ongoing provision of services to the NL Health Services, such as hospitalist services, primary care services for unattached patients, hospital emergency room coverage, anesthesia services, obstetric services, and long-term care services, will be permitted to redistribute their after-hours service obligations to the Group’s nurse practitioner (NP) or, if the Group has not hired an NP, to seek an exemption from the Blended Capitation after-hours requirement. Groups may apply to the FPRP to determine if members of the group qualify for exemption. For a physician to qualify, they must be providing at least two hours of the types of services described above to NLHS for every one hour of after-hours BCM service exempted or redistributed. Groups that do not provide any of the types of services outlined above do not qualify for the exemption/redistribution.
This exemption will be in effect until August 31, 2025.
An application will be developed at a later date and communicated to BCM applicants who wish to apply for this exemption.
The full amendment to Schedule R is available here.
There is no change to the MCP adjudication system as a result of Blended Capitation. The MCP portion of a physician’s income will become less financially significant as physicians will receive 25% of the value of MCP billings, which will represent about 20% of their overall income. The 80% of income that is derived from capitation will be freer from administrative burden with a more straightforward billing process.
The consultation code (101) is an “out-of-basket” service and is billed at 100% FFS for all patients. This code is only used by family physicians who have a focused/specialized practice and who have been approved by the department to bill a consultation. If the physician then needs to follow a non-rostered patient for a period of time, the rechecks/partials assessments would count toward the $56,000 FFS cap for non-rostered patients.
The Income Floor for physicians without a two-year billing history and physicians who do not have an established patient panel, will be at Step 1 from the MOA, or for a physician transitioning from a salaried position, their current Step of the Salary Scale for family physicians. The total amount will be adjusted to the proportion of FTE of comprehensive primary care the physician commits to provide in accordance with the table below. An additional 30% will be added to this amount in recognition of overhead expenses, and an additional 10.9% payable in year one of the Income Floor period.
The amount of FTE of comprehensive primary care that will be required to qualify for payment under Article 3.12(b) of Schedule R will be determined according to the number of three-hour community medicine blocks provided per four-week period.
Please click the image below for income floor calculations.
Each physician will be entitled to receive an annual procedures bonus as follows:
The fee-for-service component will only be paid when services are being provided, but the capitation payment will continue on a 26 pay period basis. This feature assists with the cash flow for a practice
You’re correct that the long-term care codes are not in the basket of services and can therefore be billed at 100% with no cap.
Physicians who have a private primary care practice located in a health authority facility that is part of Newfoundland and Labrador Health Services (NLHS) shall, for the purpose of FFS billings, bill office codes for services provided in their private primary care practice and facility-based codes for services provided as part of their NLHS services.
As of the commencement date of the billing system and, subject to the provisions of the test group, each physician will receive from MCP:
As of April 1, 2023, the base capitation rate will be $180.97 per attached patient. The base capitation rate, and the complexity modifier, may be adjusted from time to time as mutually agreed in writing by the Government and the NLMA.
Following the end of the two-year Income Floor period, the annual FFS billings of a physician for in-basket services provided to patients are who not attached patients is capped at $56,000. For greater certainty, there is no limit to FFS billings of a physician for out-of-basket “services” to rostered and non-rostered patients.
Capitation payments do not include payments received by a physician for services to patients outside the normal in-basket private setting, including such payments as emergency department payments, the rural retention bonus, CMPA reimbursement, obstetrical bonus, on-call payments, surgical assist payments, academic payments, and other sessional payments and/or employment income from NLHS, from third parties, or such other categories of excluded payments as may be added by the FPRC.
The provincial government felt that cyber-security would be enhanced, communication within and between groups would be facilitated, and technical support to EMR users would be better scaled, with one system.
The CHR implementation has been pushed forward several times. Timelines to transition to that EMR remain unclear.
Transition grants for adoption of the eDOCSNL EMR will only be available to physicians using a separate EMR. The grant is in recognition of the previous investment they have made in their EMR system. Physicians who are adopting EMR for the first time are protected within the two-year income guarantee against any productivity losses that may occur in the adoption process. This protection was not available to EMR users in previous years. In addition, EMR users will not have to pay EMR subscription fees.
You can have success with any size group. The size of the BCG impacts many aspects of a practice: physician schedules related to regular, reasonable hours; how competing demands outside of the practice are managed; distribution of after hours responsibilities to name a few considerations. Other provinces have demonstrated success with BCGs of varying sizes.
Yes. Blended capitation requires a relationship between a patient and a most responsible provider. Under the Blended Capitation Model, two doctors can choose to share that care and see each other’s patients for both after-hours care and for routine medical appointments. However, patients would need to be rostered to one doctor for the purpose of payment.
A group of physicians in the Blended Capitation Model do not need to co-locate in the same physical space. After-hours care for patients within the group can be provided virtually and in-person.
FPRP has a Practice Facilitator who can assist you in finding other physicians who are interested in forming a Blended Capitation Group.
Co-location is not a requirement; groups do not have to be under the same roof.
The future of team-based care has two paths. Under the Blended Capitation Model, physicians can group together as a physician-only team or they can choose to add nurse practitioners and/or registered nurses to their team. All private family physicians, regardless of payment modality, will also have an opportunity to affiliate with the new provincial Family Care Teams and collaborate with providers on those teams who are employees of the provincial health authority.
The basket was reached through negotiation and it can be adjusted in the future by the parties, through negotiation. The parties have committed to continuing assessment and evaluation of the model and that would include the basket.
The basket of services is listed in Schedule R – Appendix B. The procedures that are eligible for the procedures bonus are listed under “Procedures”.
Out of basket procedures do not count toward the $1,200 FFS billing threshold for the procedures bonus. The bonus is related to in-basket procedures only. Out of basket procedures will continue to be billed at 100% FFS for all patients, including rostered patients.
Physicians who have already completed an expression of interest and subsequently submitted their practice profile to the FPRP can expect an update on their eligibility status in the next several weeks.
Once eligibility is confirmed, the NLMA will send out an email on behalf of the FPRP to each eligible physician to confirm the income floor with applicants and the Department of Health and Community Services prior to issuing letters of agreement for enrollment in the new payment model.
The email sent by the NLMA will contain a link to an Income Floor Decision Form; please use the form to indicate your response to your calculation. You may choose to accept the calculation or request a review of your Income Floor.
If you indicate on the Income Decision Form that you would like a review of your Income Floor, you will be contacted by the Blended Capitation Advisor to book a session to review your request and to prepare any relevant documentation for submission for reconsideration. A session with the Blended Capitation Advisor is mandatory prior to having any review of your Income Floor completed.
Your agreement to the income floor calculation will be required prior to issuance of an agreement for enrollment in the new payment model (Step 6).
To ensure full program readiness, the parties to the new Blended Capitation Model (BCM) have agreed to move the start date for accepting family physicians into the model from September 1, 2023 to October 30, 2023. The new start date will ensure time for physician engagement in program design and policy development, and will ensure supports and processes relating to program implementation are in place.
On the acceptance date of a newly-established Group, each member of the Group will be entitled to receive:
On the acceptance date of an individual physician who is joining an established Group, the physician will be entitled to receive from the Government a transition grant of $11,250.
Each physician on their acceptance date will be entitled to receive from the FPRP an annual quality of care stipend of $7,500 in recognition of the physician’s participation in FPRP or practice-initiated quality programs, practice improvement and related professional development. Entitlement to the payment of this stipend will at all times be subject to the application of FPRP guidelines with respect to the professional development initiatives that will be considered as acceptable for purposes of the stipend.
All grants and stipends will be prorated in the event of a Physician’s departure from the Model.
The transition grant is automatically paid with no receipt requirement.
Practices will be required to commit to using the provincial EMR as a condition of acceptance into the Model. Each practice who is using a different EMR at the time of their acceptance into the Model will be entitled to receive an EMR transition grant of $30,000. Blended Capitation Model billing will commence on confirmation of successful transition to the provincial EMR. Physicians shall complete the transition to the provincial EMR within six months from the date of their acceptance into the Model. Billing under the Blended Capitation Model cannot start until the provincial EMR is in place. If the transition is not completed within six months, access to the 10.9% premium will be held in abeyance until such time as the provincial EMR transition within the practice is complete.
Yes
Yes
If a learner sees one of your rostered patients on your behalf, the service will be billed at 100% fee for service (FFS).
These billings by learners will not affect the FFS cap of $56k, which is only applicable to in-basket services provided to non-rostered patients
Locums will be paid by the blended capitation group. Capitation revenue will come to the group regularly over 26 pay periods, and this revenue is the main source of funding to pay locums when they are replacing a physician. The locum’s services will also be billed to MCP, and this serves as an additional source of funding to pay the locum. If a group chooses not to use a locum during a physician’s leave, the capitation funding will remain within the practice.
Locum arrangements may vary based on terms decided upon by the host physician and locum.
No recommendation has been developed on a locum rate.
Locum physicians will submit all billings for services rendered through the locum physician’s billing number, with the payment assigned to the blended capitation physician or blended capitation group. This will generate the FFS payment for in-basket services delivered to attached patients, as well as the FFS payment for out-of-basket services delivered to all patients and in-basket services delivered to non-attached patients.
The typical payment agreement often includes an hourly rate paid to the locum, and FFS could be kept by the host physician or paid to the locum. There are different ways those two elements can be balanced to produce a fair and appropriate arrangement. A sample contract template for locums will be developed by FPRP.
If a group chooses not to use a locum during a physician’s leave, the capitation funding will remain within the practice.
The model that was arrived at through mediation does not provide non-participating physicians with access to the benefits of the model, like the procedure bonus and the quality of care bonus. Similarly, it does not create requirements for non-participating physicians to meet service obligations.
Please see Schedule R which outlines the principles, structure, rates, rules and other related matters for a blended capitation remuneration model for primary care.
The Department of Health and Community Services may develop updated forms to document MCP details for locums under blended capitation. It is expected that such forms would be made available when the new billing system is ready in spring 2024.
Physicians who work part-time (e.g. two days a week with a roster size of 400 patients) may still enroll in the Blended Capitation Model as long as they provide comprehensive longitudinal services to their roster and meet access indicators. Physicians within the group may be part time as long as there is “reasonable, regular hours each week of the year”, including the required after-hours access, which can be shared among the overall group.
Physicians will coordinate with other members of their group to provide primary care during “reasonable, regular hours each week of the year”. This obligation means that every doctor must make themselves available for reasonable and regular hours each week to schedule their rostered patients for routine appointments. It does not require every doctor to work Monday to Friday, 9:00am to 5:00pm. Doctors who typically take a day or a half day to do administrative work may continue to do so. Doctors who provide services to a hospital for a part of the week may continue to do so. In general, doctors will customize the “reasonable, regular hours each week” to the size of their roster and their other clinical obligations.
Physicians are also expected to use best practices in scheduling to provide timely access to appointments. This includes, where appropriate, the ability for a patient to access their physician or another physician in the group, or other team members, on the same day. If a physician spends four days a week seeing patients, they are only expected to arrange same-day or next-day urgent appointments for the days they are in the office. However, as a group, the doctors can arrange to cross-cover urgent appointments for days when a doctor is not working.
The program will monitor the percentage of same-day or next-day appointments made available to patients. The purpose of monitoring this indicator is to determine whether access is being maintained over time. If there is a decrease in access over time, groups are expected to take measures to restore this type of access to their practices.
Physicians may benefit from the assistance of a practice facilitator in their BCM journey. The practice facilitator will help practices identify essential BCM processes, optimize operations, improve quality, and ensure success. The practice facilitator can also help address any questions about the BCG process by connecting you with appropriate resources.
The Practice Facilitator (Nancy Dillon) will contact the identified BCG physician lead to coordinate a meeting.
Blended Capitation Program partners are in discussions to determine the required patient rostering processes including which EMR fields that will be used to confirm patient and provider relationships.
Additional information about the rostering process will be forthcoming and communicated.
A new billing system is being developed that will extract roster numbers from each physician’s EMR. While the details have not yet been finalized, it is expected that this data will be collected at least every two weeks for the purposes of the bi-weekly capitation payment.
Capitation revenue will still be paid to physicians for all rostered patients. The capitation rate remains the same regardless of how many appointments they have in a year.
Details will be forthcoming and communicated.
That’s right. Each physician has their own roster but the group works together to provide all of their patients access (patients are attached to the group/practice). As well, a service provided to the patient of another physician in the group will receive 25% of the MCP rate. Therefore, it will be important that physicians have a common understanding with each other about how to balance workload and collaborative activities.
MUN student health physicians could be eligible to participate in blended cap. Students/families would only be rostered for their period at MUN, but during that time they would receive comprehensive, longitudinal care from their physician and the group. As long as those patients are not rostered to another physician in their home community, this should work. There might be some unique considerations given the nature of the practice (for example, perhaps around de-rostering patients as they graduate or otherwise leave the university, but we do not think those would prevent you from participating.
Yes. Blended capitation requires a relationship between a patient and a most responsible provider. Under the Blended Capitation Model, two doctors can choose to share that care and see each other’s patients for both after-hours care and for routine medical appointments. However, patients would need to be rostered to one doctor for the purpose of payment.
Physicians who have a private primary care practice located in a health authority facility that is part of Newfoundland and Labrador Health Services (NLHS) shall, for the purpose of FFS billings, bill office codes for services provided in their private primary care practice and facility-based codes for services provided as part of their NLHS services.
As of the commencement date of the billing system and, subject to the provisions of the test group, each physician will receive from MCP:
As of April 1, 2023, the base capitation rate will be $180.97 per attached patient. The base capitation rate, and the complexity modifier, may be adjusted from time to time as mutually agreed in writing by the Government and the NLMA.
Following the end of the two-year Income Floor period, the annual FFS billings of a physician for in-basket services provided to patients are who not attached patients is capped at $56,000. For greater certainty, there is no limit to FFS billings of a physician for out-of-basket “services” to rostered and non-rostered patients.
Capitation payments do not include payments received by a physician for services to patients outside the normal in-basket private setting, including such payments as emergency department payments, the rural retention bonus, CMPA reimbursement, obstetrical bonus, on-call payments, surgical assist payments, academic payments, and other sessional payments and/or employment income from NLHS, from third parties, or such other categories of excluded payments as may be added by the FPRC.
The Basket of Services may be provided in-person or virtually, as determined appropriate by the provider. CPSNL standards of practice apply regarding virtual care and the use of virtual care is regulated by the College. As well, there is currently a cap of number of virtual visits per day.