Status Update: March 2026 The primary care landscape in Ontario is entering its most significant transition phase to date. Following the conclusion of the 2024–2028 Physician Services Agreement (PSA) and the final arbitration rulings, the Family Health Organization Plus (FHO+) model is set for its official province-wide launch on April 1, 2026. This model represents a fundamental restructuring of family medicine, moving toward a hybrid system that compensates physicians for time, complexity, and clinical oversight. As of March 3, 2026, the OMA has released new resources specifically detailing patient attachment bonuses and guidelines for FHO+ locums to ensure a smooth transition.
Evolutionary Context of Ontario Primary Care Enrollment Models
Ontario utilizes several Patient Enrolment Models (PEMs) to incentivize longitudinal care and preventive health.
The Baseline: Fee-for-Service and solo Models
The Fee-for-Service (FFS) model remains volume-based, offering autonomy but low income stability. The Comprehensive Care Model (CCM) serves as a solo-practitioner alternative, providing a modest capitation payment alongside FFS billings.
Collaborative Group Models: FHG, FHN, and the Traditional FHO
The shift toward team-based care led to Family Health Groups (FHGs), Networks (FHNs), and Organizations (FHOs).
- FHG Update: Starting April 1, 2026, the FHG premium on core services for rostered patients will increase from 10% to 15%, with a further jump to 20% scheduled for 2027.
- Traditional FHO/FHN: These models utilize “blended capitation,” where income is derived from age/sex-adjusted base rates. FHO+ is the evolution of these models, designed to capture “invisible work”.
| Model Type | Primary Payment Mechanism | Key Incentives | Status (March 2026) |
| Fee-for-Service (FFS) | 100% OHIP Billing | None | Best for episodic care |
| Comprehensive Care (CCM) | FFS + Small Capitation | Preventive bonuses | Solo practitioners |
| Family Health Group (FHG) | FFS + 15% Premium | After-hours & Preventive | Premium rises to 15% on April 1 |
| Traditional FHO | Blended Capitation | Shadow billing (19.4%) | Most existing FHOs move to FHO+ |
| FHO+ (April 2026) | Capitation + Hourly | $80/hr Admin Pay + 30% Shadow | Full launch April 1, 2026 |
Technical Architecture of the FHO+ Model
FHO+ addresses deficiencies in recognition of medical labor by introducing time-based payments and higher shadow billing rates
The $80 Hourly Compensation Framework
Physicians can now bill $80 per hour, recorded in 15-minute increments, for up to 14 hours per day. This covers direct patient care, indirect care (labs/referrals), and clinical administration (EMR management). Telephone consultations are compensated at 85% of this rate ($68/hr).
Enhancements to Shadow Billing and Premiums
- In-basket Shadow Billing: Increases from 19.4% to 30% of FFS rates.
- Procedural Work: Select procedures are now incentivized at 50% of the FFS rate.
- Hospital Work: In-basket hospital work performed by FHO+ physicians is now paid at the full 100% FFS value, removing previous shadow-billing discounts.
- After-Hours: The premium for care provided during evenings/weekends increases from 30% to 50%.
Income Stabilization and Practice Sustainability
FHO+ creates a resilient financial profile through diversified revenue streams. For physicians building a roster, the Income Stabilization (IS) program provides guaranteed monthly payments for up to 12 months. As of April 1, 2025, rural physicians (RIO ) receive a 30% increase to this base salary.
Patient Attachment Bonuses
New incentives encourage the rostering of unattached patients 2:
- Q053 (Attachment Bonus): Increased from $350 to $500 per patient.
- Q054 (Mother & Newborn): A new $350 bonus for joint enrollment.
- New Graduate Bonus: Rates range from $150 to $270 per rostered individual.
The New Accountability Framework: 75% Continuity of Care
Arbitration has finalized the replacement of the “Access Bonus” and “Negation” system with a Continuity of Care (CoC) metric.
The 75% Threshold
Physicians must ensure that at least 75% of in-basket primary care visits for their rostered patients are provided by them or their FHO group.
- The Penalty: If a physician falls below 75% for two related quarters, a 15% reduction is applied to their capitation payments (regular and LTC).
- Exclusions: Out-of-basket services like prenatal care, diabetes management, and palliative care do not count toward this metric.
Strategic Benefits for Specific Practice Types
- New Graduates: Benefit from high attachment bonuses and the removal of walk-in policing burdens.
- Complex Care: The $80/hour rate finally compensates for the heavy administrative load associated with multi-morbid patients.
- Rural Practitioners: Relaxed co-location rules allow FHO groups to form with just two physicians at distances of 5km to 30km, depending on RIO score.
Managed Entry and Transitions
For those moving models, the current monthly allowance of 60 physicians to join FHOs continues. Crucially, physicians transitioning from FHG to FHO are exempt from these managed entry restrictions.
The FHO+ Countdown: Are You Ready for April 1?
The wait is almost over. On April 1, 2026, Ontario’s primary care landscape changes forever with the launch of FHO+. This isn’t just a new acronym—it’s a fundamental shift in how your expertise and time are valued.
At Bill Medics, we’ve been tracking every update of the 2024–2028 Physician Services Agreement to ensure our clients are ready for Day 1. Here is the March 2026 update on what FHO+ means for your practice.
Why FHO+ is the New Gold Standard
The traditional FHO model was revolutionary for its time, but it ignored the “invisible” hours doctors spend on administration. FHO+ fixes this by making your time a billable asset.
Key Financial Upgrades Coming April 1:
- The $80/Hour “Time-Floor”: You can now bill $80 per hour (in 15-minute increments) for the administrative work you’ve been doing for free—labs, referrals, and EMR management.
- Higher Shadow Billing: Your in-basket services now pay 30% (up from 19.4%), and key procedures pay 50%.
- Full Hospital Pay: If you see patients in the hospital, you now receive 100% of the FFS rate, with no shadow-billing deduction.
Goodbye Negation, Hello Continuity
One of the biggest wins for March 2026 is the finalized removal of the Access Bonus and “Outside Use” negation. You will no longer be financially penalized every time a patient visits a walk-in clinic.
Instead, the system moves to a 75% Continuity of Care metric. As long as 75% of your patients’ primary care happens within your group, your income is protected. Falling below this threshold for two quarters, however, triggers a 15% capitation discount, making efficient roster management and practice access essential.
What Should You Do This Month?
With only weeks left until the launch, proactive steps are critical:
- Check Your FHG Status: If you are in an FHG, your premium automatically rises to 15% on April 1.
- Roster Cleanup: Maximize the new attachment bonuses, including the $500 Q053 code and the $350 Q054 Mother & Newborn bonus.
- Locum Planning: Review the newly released OMA resources for FHO+ locums to ensure coverage doesn’t impact your continuity score.
Maximize Your Transition with Bill Medics
FHO+ is about more pay for the work you already do, but only if you track it correctly. At Bill Medics, we specialize in:
- Time-Based Billing Setup: Ensuring you capture every 15-minute unit of administrative time.
- Continuity Tracking: Monitoring your 75% threshold to avoid the 15% penalty.
- Roster Optimization: Reconciling Ministry records to capture every dollar of capitation and attachment bonuses.
Don’t leave money on the table in April. Contact Bill Medics today for a final pre-launch billing review.