The Preventive Care Bonus is being repurposed and eligible categories are changing from five to two.

To: Family Health Network (FHN) and Family Health Organization (FHO) Physicians
Category: Primary Health Care Services
Written by: Physician Relations and Contract Oversight Branch, Physician and Provider Services Division
Date issued: May 6, 2024
Bulletin Number: 240503

Background

The Ministry of Health (ministry) and the Ontario Medical Association (OMA) continue to work together to implement the 2021 Physician Services Agreement.

The ministry and the OMA agreed that a portion of the Preventive Care Bonus for FHN and FHO physicians will be repurposed. The financial results achieved will be repurposed to create an Acuity Modified based capitation payment to physicians based on enrolled patient complexity.

For further information on the Acuity Modifier please see INFOBulletin 240502 – “Acuity Modifier Payment for the 2024-2025 Fiscal Year”. As a reminder, no action is required on the part of the physician or physician groups for acuity modified based capitation payments to take effect.

2024/2025 Preventive Care Bonus for FHN and FHO physicians

For fiscal year 2024 (April 1, 2024 to March 31, 2025) and billable April 1, 2025 onwards, FHN and FHO physicians will no longer be eligible to receive the Colorectal Cancer, Mammography, and Pap Smear Preventive Care bonuses, as agreed upon between the ministry and the OMA. They will continue to be eligible to receive the Influenza and Childhood Immunization bonuses with these adjustments:

  • Physicians with less than 1000 enrolled patients will have the remaining bonuses prorated.
  • Physicians with 1000 enrolled patients or more, will not have the remaining two bonuses prorated, and will bill per status quo.

Proration

Starting with the 2024/2025 fiscal year preventive care bonuses, FHN and FHO physicians with less than 1000 enrolled patients on March 31st of the fiscal year will have the Childhood Immunizations and Influenza bonuses prorated based on the following formula:

(Number of patients / 1000) X amount of bonus = prorated bonus amount

For example, a FHO physician with a roster size of 575 patients and a 75% compliance rate for the Influenza vaccine is eligible for a $633 bonus:

(575/1000) X $1100 = $633.00

Error messages

For the 2024/2025 fiscal year and beyond, physicians who bill fee schedule codes for bonus categories they are no longer eligible for will have the claims reject to their Error Report with the following message: ‘EPA – Network Billing Not Approved’. See list below for Preventive Care bonus fee schedule codes.

Reporting

FHN and FHO physicians will continue to receive the Previous and Projected Preventive Care Target Population/Service Reports.

All five preventive care categories will continue to report. The following message will be added: “The services reported for Pap Smear, Mammography, and Colorectal Cancer Screening are provided for reporting purposes only and are not eligible for the Preventive Care bonus.”

Physicians will also continue to receive the Preventive Care bonus report on their monthly Remittance Advice (RA). This report will now include an enrolled patient roster count as well as a prorated amount if applicable.

Preventive Care bonus fee schedule codes for the 2024/2025 fiscal year

Eligible fee schedule codes

Influenza:

  • Q100A – 60% compliance rate - $220
  • Q101A – 65% compliance rate - $440
  • Q102A – 70% compliance rate - $770
  • Q103A – 75% compliance rate - $1100
  • Q104A – 80% compliance rate - $2200

Childhood Immunizations:

  • Q115A – 85% compliance rate - $440
  • Q116A – 90% compliance rate - $1100
  • Q117A – 95% compliance rate - $2200

Ineligible fee schedule codes

Pap Smear:

  • Q105A – 60% compliance rate - $220
  • Q106A – 65% compliance rate - $440
  • Q107A – 70% compliance rate - $660
  • Q108A – 75% compliance rate - $1320
  • Q109A – 80% compliance rate - $2200

Mammography:

  • Q110A – 55% compliance rate - $220
  • Q111A – 60% compliance rate - $440
  • Q112A – 65% compliance rate - $770
  • Q113A – 70% compliance rate - $1320
  • Q114A – 75% compliance rate - $2200

Colorectal Cancer Screening:

  • Q118A – 15% compliance rate - $220
  • Q119A – 20% compliance rate - $440
  • Q120A – 40% compliance rate - $1100
  • Q121A – 50% compliance rate - $2200
  • Q122A – 60% compliance rate - $3300
  • Q123A – 70% compliance rate - $4000

Keywords/Tags

Preventive Care Bonus; PSA; FHO; FHO; Acuity

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.