Bulletin 250406 — Relativity-adjusted physician payment increases

The ministry will apply relativity-adjusted increases to physician payments effective April 1, 2025.

To: All Physicians
Category: Physician Services, Community surgical and diagnostic centres
Written by: Provider Services Branch, Physician and Provider Services Division
Date issued: April 23, 2025
Bulletin Number: 250406

Overview

The Ministry of Health (ministry) and the Ontario Medical Association (OMA) have been working together to implement physician compensation increases in accordance with the Arbitration Award for year 1 of the 2024-2028 Physician Services Agreement (PSA).

Effective April 1, 2025, physician fee-for-service payments and automated payments in the Medical Claims Payment System (e.g. capitation, premiums, and salaries) will receive a relativity-adjusted increase for services provided between April 1, 2025 to March 31, 2026. Please note, the relativity-adjusted increases replace the PSA Year 1 and Year 3 compounded (13.0286%) temporary payment increase that ended on March 31, 2025. The value of Fee Schedule Codes (FSCs) reverted to the rates listed in the Schedule of Benefits (Schedule) for claims with service dates on or after April 1, 2025. Please refer to the Schedule available on the Ministry of Health's website at OHIP Schedule of Benefits and fees under Schedule of Benefits for Physician Services for current FSC values. Please see Bulletin 250401 for more information.

Relativity-adjusted payments will be made on the monthly Remittance Advice (RA), beginning on the June RA. Please note, the relativity-adjusted payments on the June RA will include payments for eligible services claimed in April and May 2025.

Effective April 1, 2025, the base funding for Specialist Physician Alternative Payment Plan payments will be increased by a relativity-adjusted percent or other percent agreed to by the parties. The outstanding 9.95% related to 2024/25 will be issued in two sums – one for base funding and one for shadow billing. Further details will be provided in a future INFOBulletin.

Relativity-adjusted Increases

The total compensation increase is 9.96%, which represents the cumulative increase from Year 3 of the 2021 PSA and Year 1 of the 2024 PSA (the compounded value of 2.8% and 6.965% (Year 1 minus targeted)). The distribution of the total compensation increase across physician specialties is subject to the relativity adjustments agreed to between the ministry and the OMA.

Relativity-adjusted physician payment increases will be applied to all physician payments set out in Table 2.

Fee-For-Service (FFS) payments (paid and shadow billed) will receive relativity-adjusted increases based on the individual physician’s derived specialty. There are some exceptions:

• Hospital-based technical fees
• Community Palliative On-call Coverage (CPOC) fees
• Ministry of Children, Community and Social Services (MCCSS) fees
• Ministry of the Attorney General (MAG) fees
• Office-based technical fees
• Facility Costs for Integrated Community Health Services Centres (ICHSC)
• Ontario Fertility Program fees

Each of the exceptions listed above will have a specific increase rate applied, regardless of the individual physician’s derived specialty. See Table 2 for additional information.

Contracts that are specialty specific (single specialty contracts) will receive increases per their identified specialty as set out in Table 1. See Table 2 for additional details for single specialty contract payment increases.

Multispecialty Alternative Payment Programs/Alternative Funding Programs (APPs/AFPs), where one specific specialty cannot be applied, have a weighted relativity adjustment calculated based on the distribution of the billings (paid and shadow billed) across physician specialties within the applicable contract. See Table 2 for the calculated relativity increase rate. The fee for service billings (paid and shadow billed) of APP/AFP physicians will receive the relativity-adjusted increase based on the individual physician’s derived specialty as set out in Table 1. The fee for service billings (paid and shadow billed) of APP/AFP ‘00’ physicians will receive the 00_2 relativity increase (see Table 3 for additional details).

Categories receiving the global increase rate (9.96%) include (see Table 2 for additional details):

• Office-based technical fees and Facility Costs for Integrated Community Health Services Centres (ICHSCs)
• Academic Health Sciences Centres (AHSC) and Northern Ontario School of Medicine (NOSM) base payments.
  • The fee for service billings (paid and shadow billed) of AHSC and NOSM physicians will receive the relativity increase based on the individual physician’s derived specialty as set out in Table 1, ‘00’ physicians will receive the 00_2 relativity increase (see Table 3 for additional details).
• Children’s Hospital Academic Medical Organization (CHAMO), Southeastern Ontario Academic Medical Organization (SEAMO), Bruyere, Bloorview, and GynOncology academic component payments will receive the global increase and other component payments have a weighted relativity adjustment calculated based on the distribution of the billings (paid and shadow billed) across physician specialty within the applicable contract. See Table 2 for additional details.
  • The fee for service billings (paid and shadow billed) of CHAMO, SEAMO, Bruyere, Bloorview, and GynOncology physicians will receive the relativity increase based on the individual physician’s derived specialty as set out in Table 1.
• On-call Programs – Complex Continuing Care On-Call (CCC), Hospital On-Call Coverage (HOCC), Community Palliative Care On-Call (CPOC), Physician On-Call (POC), Telestroke
• Other Ministry and Board payments – MCCSS, MAG, Consent and Capacity Board and Ontario Review Board
• Physicians with new Palliative Medicine derived specialty

Derived Specialty

A derived specialty is assigned based on physician billings for FY 2024/25. Derived specialty is the billing specialty associated with the claims for insured services submitted by the physician that had the highest total billings (paid and shadow billed) unless the exception listed below applies.

Note: Physicians who did not have claims in FY 2024/25 will initially be assigned the 9.96% global rate until a derived specialty can be determined based on their 2025/26 claims.

A physician may only be assigned one derived specialty.

Family & General Practice

Family & General Practice has three different derived specialties:

1. The 00_1 specialty is applied to ‘00’ physicians who are affiliated to a capitated model. (see Table 3 for additional details)
2. The 00_2 specialty is applied to ‘00’ physicians who receive FFS payments including Family Health Group (FHG), Comprehensive Care Model (CCM) and other FFS payment models. Additionally, the 00_2 specialty is applied to ‘00’ physicians who receive payments from contract models (e.g. Academic Comprehensive, Academic Specialty, AHSC, Community, Northern Specialists, and Family Medicine programs such as Locum, Underserviced Area Program (UAP), and Physician Collaboration). (see Table 3 for additional details)
3. The 00_3 specialty is assigned to ‘00’ physicians who receive payments from primary care salary and contract models. (see Table 3 for additional details)

For ‘00’ physicians who receive payments through various payment models, the following is the order of assignment of derived specialty:

1. 00_1
2. 00_2 CCM/FHG
3. 00_3
4. Emergency Medicine
5. 00_2 contract models
6. Critical Care Medicine
7. 00_2 FFS

Emergency Medicine

The Emergency Medicine specialty is applied to physicians who meet one or more of the following criteria:

1. a derived specialty of ‘12’ (Emergency Medicine),
2. a derived specialty of ‘00’ (Family & General Practice), are not in a primary care model (PCM) and are affiliated with an Emergency Department Alternative Funding Agreement (EDAFA) group (excluding General Practitioner (GP) Experts and Second On-call) and received payment for at least one claim under their affiliated group,
3. a derived specialty of ‘00’ (Family & General Practice), are not in a PCM, are not affiliated with an EDAFA group (excluding GP Experts and Second On-call), and whose FFS is predominantly (>50 percent) for emergency department services (relevant H-prefix codes: 'H065', 'H100', 'H101', 'H102', 'H103', 'H104', 'H105', 'H112', 'H113', 'H121', 'H122', 'H123', 'H124', 'H131', 'H132', 'H133', 'H134', 'H151', 'H152', 'H153', 'H154', 'H960', 'H962', 'H963', 'H964', 'H980', 'H981', 'H984', 'H985', 'H986', 'H987', 'H988', 'H989').

Critical Care Medicine

The Critical Care Medicine specialty is applied to physicians who meet one or more of the following criteria:

1. a derived specialty of ‘11’ (Critical Care Medicine),
2. whose FFS is predominantly (> 50 percent) in critical care per diem fee codes (relevant G-prefix codes: 'G400', 'G401', 'G402', 'G405', 'G406', 'G407', 'G557', 'G558', 'G559').

Processing

Payments flowed through the Medical Claims Payment System which are made to a physician, group, or contract for 2025/26 will be multiplied by the appropriate relativity increase rate [as detailed in Table 1, Table 2 and Table 3] to determine their relativity-adjusted payment for 2025/26.

For FFS payments (paid and shadow billed), the amount eligible for payment, including applicable premiums, will be multiplied by the appropriate relativity increase rate for services rendered between April 1, 2025 and March 31, 2026.

Increases will be applied to all eligible payments flowed through the Medical Claims Payment System on a monthly basis and will be flowed to the recipient in the usual manner (e.g. to individual physicians, group, contract, or institution).

Compensation increases to physicians, physician groups or other facilities not flowed through the Medical Claims Payment System, such as those paid under contracts or under other programs, will be paid using the regular payment process associated with the contract or payment. It is expected that payments made to a group or facility will be distributed to the physicians who provided services for the period April 1, 2025 to March 31, 2026.

Reporting

The monthly RA will include a Relativity Summary Report. This report will list the total relativity payment for approved claims, in addition to all other relativity payments (i.e. Age and Blended FFS Premiums, Comprehensive Care Capitation, etc.) for the month and the year to date. This report will be available on both group and solo RAs and will confirm month to date and year to date information. Only the solo RA will display the MTD payment column, the derived specialty, relativity rate and rate description, this detail will not be available on the group or governance RAs.

No changes to the Schedule of Benefits

The 2025-2026 FFS compensation increases are temporary relativity-adjusted increases and do not increase fee code values in the Schedule of Benefits for Physician Services.

Appeals process

The relativity-adjusted increases have been assigned based on the methodology agreed to between the ministry and the OMA in accordance with the Physician Services Agreement.

As such, the agreed-to methodology between the ministry and the OMA does not provide for an appeal process for physicians who received a relativity-adjusted increase and are disputing the amount of the increase that they received.

Appendix

Table 1 –Relativity-adjusted Increases by Specialty

The rates in the table below will be applied to a physician’s FFS billings (paid and shadow billed).

Table 2 – Relativity-adjusted Increase by Payment Type

The rates in the table below will be applied to the applicable payment type.

* in the table below indicates the individual physician’s derived specialty rate applies.

MS in the table below indicates the payment is a multispecialty contract, a weighted relativity adjustment has been calculated.

GB in the table below indicates the payment will receive the global increase rate.

Table 3 – ‘00’ Physician Derived Specialty by Funding Model

The rates in the table below will be applied to a ‘00’ physician’s FFS billings (paid and shadow billed).

‘00’ physicians whose derived specialty is Emergency Medicine or Critical Care Medicine will have those rates applied to their FFS billings.

Keywords/Tags

PSA; payments; physicians; Physician Services Agreement; relativity

Contact information

Do you have questions about this INFOBulletin? Email the Service Support Contact Centre or call 1-800-262-6524. Hours of operation: 8:00 a.m. to 5:00 p.m. Eastern Monday to Friday, except holidays.

As such, the agreed-to methodology between the ministry and the OMA does not provide for an appeal process for physicians who received a relativity-adjusted increase and are disput