FHO+ Is Here: What Ontario Physicians Need to Know Starting April 1, 2026

The new FHO+ agreement has been ratified and comes into effect April 1, 2026. This marks one of the most significant updates to the FHO model in years, with direct implications for physician income, workflow, and accountability.

This is not just a policy update. It is a structural shift in how family physicians are paid and evaluated.

Below are the key changes that matter most in practice.

1. Payment changes: higher earning potential with targeted incentives

After-hours premiums increase from 30 percent to 50 percent for eligible services provided to enrolled patients. Shadow billing also increases, with in-basket services rising to approximately 30 percent and many procedures reaching up to 50 percent.

In addition, hospital care for rostered patients is now paid at full fee-for-service rates rather than shadow billing.

These changes significantly increase earning potential for physicians who provide after-hours care, procedural work, or inpatient care, without requiring increased patient volume.

2. Continuity of Care (COC): now directly tied to income

A minimum continuity threshold of 75 percent is now required. Falling below this threshold may result in up to a 15 percent reduction in capitation payments for affected patients.

The definition of continuity has been expanded. Visits provided by group members, locums, emergency departments, and hospital-based care now count toward continuity.

This makes continuity easier to maintain, but also makes it a direct financial driver rather than a performance metric.

3. Time-based billing framework introduced

A formal time-based structure is now in place. Physicians are limited to a maximum of 14 billable hours per day and approximately 240 hours per month. Indirect care is capped at 25 percent of total time, with clinical administrative work forming a small portion within that limit.

This introduces an effective ceiling on billable activity and requires physicians to actively track and manage both direct and indirect care time.

4. Fee-for-service (FFS) cap remains at the group level

The fee-for-service cap continues under FHO+, and it applies at the group level rather than the individual level.

This means total FFS billing across the group is collectively limited. Individual physician billing patterns, particularly high procedural or hospital-based billing, may impact the group’s overall capacity.

This introduces a need for greater internal visibility and alignment within groups.

5. Patient enrolment: timing now affects compensation

Patient attachment incentives have been reinstated, retroactive to July 2025. However, patients must be enrolled at or before the first billable service to qualify.

Seeing a patient prior to enrolment may result in lost eligibility for these incentives.

This makes enrolment a critical front-end workflow issue, not just a documentation step.

6. Locum model changes

Locums are now eligible for hourly billing, shadow billing, and after-hours premiums. They do not receive capitation.

This increases flexibility in coverage but may change how groups structure locum compensation and contracts.

7. After-hours care becomes a strategic revenue lever

With the increase to a 50 percent premium, after-hours care shifts from a requirement to a meaningful source of revenue.

Groups may need to rethink scheduling, coverage models, and internal compensation to reflect this change.

8. Access and group responsibility expectations

The agreement reinforces expectations for timely access to care, including same-day or next-day availability. Group-based coverage models are emphasized, with shared responsibility for patient access.

This aligns closely with continuity metrics and overall group performance.

What this means in practice

FHO+ introduces higher earning potential, but also greater structure and accountability.

Physicians who will benefit most are those who:

• Maintain continuity above 75 percent

• Optimize after-hours and procedural billing

• Track time accurately within the new limits

• Enroll patients at the first point of care

• Align with their group on FFS utilization and coverage

Those who do not adapt may see reduced income despite higher available rates.

FHO+ is not simply an update to payment levels. It changes how time, access, and continuity translate into revenue. Physicians and groups that adjust early will be best positioned to benefit.