What Ontario Family Physicians Actually Need to Know About the New Model (And What to Do First)
On April 1, 2026, every Family Health Organization in Ontario transitioned to FHO+. If you signed your updated contract by March 31, you’re in the new model. If you missed the deadline, you need to call the OMA today. Either way, your compensation structure just changed — and most FHO physicians don’t yet fully understand how. This post breaks it down in plain language, with a focus on what practice owners actually need to manage, not just the headline numbers.
Context
- FHO+ is not a new model from scratch — it’s an evolution of the existing FHO framework, negotiated as part of the 2024–28 PSA.
- The OMA has been positioning FHO as the future of family medicine in Ontario, and the April 1 launch is the fulfilment of that promise.
- In Windsor-Essex, the stakes are especially high: the region has an estimated 40,000+ patients without a family physician. FHO+ creates new incentives for physicians to roster these unattached patients.
- MedPros recently published an explainer on FHO+ focused on the headline compensation figures. MAP’s version goes further — into practice operations, billing optimization, and what groups need to do now.
What This Means for Your Practice
Time-Based Billing — The Biggest Structural Change
- FHO+ introduces an $80/hour rate for all direct AND indirect patient care, including reviewing lab results, reading specialist notes, responding to in-basket messages, and completing clinical admin.
- Telephone-based virtual care pays $68/hour when the physician is not physically in clinic — slightly lower to reflect the absence of in-person overhead.
- This is a fundamental shift: physicians can now bill for work they were already doing but not being paid for. Proper documentation of time spent is now essential.
Shadow Billing Increases
- Shadow billing rates increase to 30% for most services (up from prior rates).
- For select in-basket procedures, shadow billing rises to 50%. Identifying which procedures qualify is a key task for your billing coordinator.
- This is one of the biggest financial improvements for FHO physicians who have been under-claiming shadow billings.
Group Management Leadership Payments
- Existing Group Management Leadership Payment (GMLP): $1/patient/year, up to $25,000 per group.
- New Enhanced GMLP: $4/patient/year, up to $100,000 per group.
- Combined maximum: $125,000/year for group leads. This is designed to compensate leads for after-hours availability compliance, contract management, and group operations.
- Groups should review whether they have the documentation and infrastructure in place to qualify for the Enhanced GMLP.
Rostering Bonuses for Unattached Patients
- FHO+ introduces a bonus payment for each new unattached patient rostered.
- The bonus is higher for complex or older patients and in remote or underserved areas — making Windsor-Essex practices especially well-positioned to benefit.
- This is a direct incentive aligned with Ontario’s primary care shortage strategy. If your practice has capacity, this is a revenue opportunity worth pursuing deliberately.
What Didn’t Change
- Capitation payments remain the same under FHO+.
- After-hours premium has increased significantly — confirm your practice’s after-hours documentation is capturing this correctly.
What You Should Do
- ACTION 1: Confirm your FHO contract was signed and accepted. If not, contact the OMA immediately.
- ACTION 2: Update your billing system to reflect new shadow billing rates — especially the 50% rate for eligible in-basket procedures.
- ACTION 3: Brief your billing coordinator on the new time-based billing requirements. Documentation of indirect care time is now a revenue-critical function.
- ACTION 4: Calculate your group’s eligibility for the Enhanced GMLP. Review compliance with after-hours requirements and contract obligations.
- ACTION 5: Assess your roster for capacity. The unattached patient bonus is a real revenue opportunity — especially for Windsor-Essex practices serving an underserved population.
How MAP Can Help
MAP supports FHO practices with billing optimization, financial modelling, FHO contract compliance, and strategic growth planning. Our team helps you understand what you’re owed under FHO+ — and builds the practice workflows to capture it.