Blended Capitation

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.

More information can be found in the Frequently Asked Questions (FAQs) section and the NLMA/CFPC info document below.

Apply

The Family Practice Renewal Program (FPRP) began accepting applications/expressions of interest from physicians interested in enrolling in the blended capitation payment model on April 3, 2023. The FPRP is inviting family physicians, who are interested in participating in the BCM program, to submit an expression of interest. At this point, the intent is to capture interested physician names and contact information, to facilitate follow-up at a later date. Please note this form is an expression of interest only and represents an ongoing process—there is no deadline for submission. 

To submit your expression of interest, please click here.

Please note that detailed program requirements are in development. The FPRP is working on formal policies and processes to guide program implementation and recruiting staff to facilitate a smooth transition to the new model.

Advisory Service

The NLMA has launched an advisory service to support physicians who wish to explore what moving to the Blended Capitation Model means for their individual practices. We have contracted a consultant with whom you can book a meeting to explore how you can use your EMR data to define your panel of patients, and to predict your future income. This information can help inform your decision on whether to move to Blended Capitation. The advisory service will also bring in support from a peer group of physicians who have been involved in the project over the past year, and who can share their perspectives on the benefits and realities of blended capitation.

The first block of appointments is available now, please visit our booking webpage for meeting times.

More appointment availability will be added in the coming weeks as we gauge demand. If there is no current availability for an appointment, we invite you to express your interest by emailing [email protected].

Timeline (UPDATED)

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.

Exemption from After-Hours Expectations During Transition Period

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.

Member Consultations Presentation

Member Consultations Video

FAQs

NLMA is continually adding to these questions. If you have a question not included below, you can email it to [email protected].

General Questions

Rostering

Compensation

Group Practice

Access Indicators

Locums

EMR

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