Blended Capitation

The Family Practice Renewal Program (FPRP) is responsible for administration of the Blended Capitation Program, including project management, physician engagement, enrolling physician practices, entering into agreements with physician practices, and practice improvement initiatives to support successful practices. For more information about the Blended Capitation Program, including how to submit an expression of interest, advisory services and answers to frequently asked questions, please click here.

The Memorandum of Agreement (MOA) signed on May 3, 2022, included a commitment from the NLMA and the provincial government to establish Blended Capitation as a new payment schedule of the MOA. The final agreement was arrived at with the assistance of a mediator and officially released on April 3, 2023.

Blended Capitation is a voluntary payment option for independent community-based family physicians. The payment model includes a bi-weekly capitation payment ($180.97 per rostered patient adjusted by a complexity modifier) for providing a “Basket of Services”. This is blended with a partial fee-for-service payment for direct patient encounters based on 25% of the MCP Fee Schedule rate. All codes that are “Out of Basket Services” are billed at 100% of the MCP rate. There is no negation if a rostered patent receives care elsewhere. If a physician sees a non-rostered patient, they will receive 100% for “In Basket Services” up to $56,000 per year, and 100% for all “Out of Basket Services”.

The new model represents a 21.8% increase in clinical compensation based on average family physician MCP billing rates, on top of the 13.3% increase last year. Those who choose to enroll in the new payment model will also receive income guarantees to facilitate the transition. This includes a guaranteed income floor in the first two years based on an individual’s previous two-representative years billing average, plus a 10.9% premium payment applied in the first year. In addition, physicians will receive a one-time Transition Grant of $11,250 and a one-time Start-up Grant of $10,000 in recognition of start-up costs. Physicians who choose to enroll in the Blended Capitation Model can also qualify for an annual $7,500 Quality of Care Bonus and an annual Procedures Bonus of $2,500 for physicians who bill more than $1,200 in procedures annually. The Capitation Rate has also been boosted in value to help pay for two-weeks of locum coverage. If a physician does not use locums in a year, the locum funding stays with the physician. Monthly EMR subscription costs will be paid by the provincial government. Physicians who agree to join the Blended Capitation Model will group together (minimum of three) to provide after-hours care and act as a team in the provision of care.

The agreement is appended as Schedule R of the Memorandum of Agreement (MOA) and is available in its entirety here.

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