Your Guide to the New FHO+ Model, Ontario’s Next Chapter in Primary Care Starts April 2026

03 comments

July 08, 2025

A New Era in Family Medicine Compensation

In April 2026, Ontario will introduce FHO+, an upgraded compensation model for Family Health Organizations. This new framework aims to more accurately reflect the reality of modern primary care by offering physicians compensation for both direct patient care and the essential behind-the-scenes work that keeps a practice running. As the system moves away from older tracking requirements and underpayments for non-clinical services, FHO+ creates new opportunities for stability, fairness, and growth.

What Is FHO+?

FHO+ is not a complete replacement of the traditional FHO model, but rather an evolution. It was designed to fix long-standing gaps in physician compensation and streamline administrative obligations. This model recognizes the full range of services physicians deliver, not just face-to-face appointments, but also indirect efforts like patient follow-up, reviewing test results, care coordination, and maintaining records. FHO+ shifts the focus toward rewarding comprehensive care and modern practice realities.

What’s Different with FHO+

Access Bonus Removed

Say goodbye to tracking patient walk-in visits and worrying about Outside Use penalties. With FHO+, the access bonus is gone, removing a major administrative burden.

Higher Shadow Billing Rates

In-basket services: Now paid at 30% of FFS (was 19.4%)
Select procedures: Paid at 50% of FFS
In-basket hospital work: Paid at full FFS (not shadow billed)

After-Hours Premium Boosted

Physicians will now receive 50% of FFS for after-hours work, up from 30% under the current FHO model.

More Leadership Support

Group Management Leadership Program (GMLP) incentives will increase up to 4x, recognizing the value of physician leadership in practice operations.

A New Way to Bill: Time-Based Payments

FHO+ introduces a major shift in how physicians are paid by recognizing their time as a valuable asset. Rather than being tied only to patient visits, doctors can now bill for time spent on a range of eligible activities. Physicians will be able to bill $80 per hour, recorded in 15-minute increments, for up to 14 hours per day.

This covers:

Direct patient care (in person)
Telephone consultations (paid at 85% of the full rate)
Indirect care tasks such as charting, labs, patient messaging, and administrative responsibilities
Roster management, chronic disease oversight, and care planning

This new structure acknowledges that the work of a family physician extends far beyond the exam room, and ensures that work is financially recognized.

More Support for Patient Attachment

FHO+ offers more generous incentives for physicians to build and maintain their patient panels. The payment per patient will range between $100 and $180 for established physicians, depending on patient age and location, while new graduates will receive between $150 and $270 per rostered individual.

Fee code Q053 is increasing from $350 to $500, and a new code, Q054, adds a $350 bonus for mother and newborn enrollment. There are also new codes to reward practices supporting multiple births and transitions through Health Care Connect.

Forming a FHO Just Got Easier

The FHO+ model offers improved co-location flexibility, making it easier to form and maintain FHO groups. The minimum number of physicians required per location is reduced from 3 to 2, and the acceptable distance between providers now ranges from 5 to 30 kilometres based on their Rurality Index of Ontario (RIO) score. To support growth, over 240 additional FHO spots will be available each year. Clinics joining this model must sign updated agreements reflecting the new terms.

What This Means for Your Practice

The bottom line: you’ll be paid for more of the work you already do, with less administrative burden. FHO+ ensures physicians are rewarded for both clinical and non-clinical services. You’ll no longer need to police patient walk-in activity or navigate complex bonus eligibility calculations. Instead, you’ll benefit from higher revenue potential, more predictable income, and a more holistic recognition of your role in the healthcare system.

How MedPros Can Help

MedPros supports physicians through every phase of transitioning into FHO+. Our experienced team helps clinics manage everything from initial enrolment and onboarding to long-term compliance and optimization. We offer services in:

FHO application and formation
Billing strategy and implementation
Roster management and incentive tracking
Time-based billing setup and support
EMR optimization and workflow consulting

Get Ahead of the April 2026 Launch

The sooner you start planning for FHO+, the better positioned your practice will be.

3 Comments

Posted on July 10/2025 By Sanjeev K

Great read. I’m looking forward to seeing more feedback once this is implemented.

Posted on July 09/2025 By user

It’s refreshing to see a model that finally values the full scope of primary care, especially the indirect work that often goes unpaid. Removing the access bonus and improving shadow billing rates are real wins for both efficiency and fairness. The leadership and after-hours incentives are a smart recognition of the extra roles many of us take on. One thing I’m wondering: will there be support or training to help physicians transition smoothly to the time-based system? Excited to see where this goes. Thanks for such a well-written and informative summary.

Posted on July 08/2025 By user

As a family physician who’s been navigating the complexities of the current FHO model, I’m genuinely excited to see Ontario finally recognizing the true breadth of our work. The shift to time‐based billing for indirect tasks: charting, care coordination, follow-up calls feels like a long-overdue step toward fairness. Eliminating the access bonus and boosting shadow billing rates will remove so much administrative overhead, letting me focus on patient care rather than paperwork.

I’m particularly pleased by the new after-hours premium and leadership incentives. These acknowledge the extra hours we put in and the organizational roles many of us carry. And the streamlined formation requirements should make it easier for rural colleagues to band together and form FHOs.

My big question: with the $80/hour rate capped at 14 hours per day, how will “eligible activities” be audited? Will EMR logs suffice, or is there a new reporting tool in the works? Overall, though, this model feels like it finally aligns compensation with the realities of modern primary care. Well done!