CONFIDENTIAL
2012 Physician Services Agreement: Member Feedback
Instructions
Please review the OHA’s preliminary overview of the 2012 Physician Services Agreement (PSA) and provide any comments to the following sections:
1. Comments on potential impact to your hospital
2. Priority issues (p.18)
3. General comments (p.19)
Please refer to the 2012 PSA, the PSA Appendices and the Memorandum of Agreement when commenting on the document below.
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CONFIDENTIAL
2012 Physician Services Agreement: Overview
Key Issues Impacting Hospitals
Reference format in ‘Agreement
Initiatives/ Strategies’ column:
Section
Payments
Section 1
Appendix A
Review of Changes to
Schedule of Benefits
(April 2012)
Section 2
Appendix B
Agreement Initiatives/ Strategies
Payment Discount (1.1)

0.5% ‘across the board discount’ applied to all physician payments
Application of Payment Discount (1.2)

0.5% discount applied to all fee-for-service payments, primary care models, Alternate
Funding Plans/ Alternate Payment Plans, physician programs (i.e. Hospital On-Call
Coverage Program)

OMA/MOHLTC will continue to work on evidence-based initiatives
Phase ll Review (1.3; Section A, Appendix A)

Physician Services Committee (PSC) to establish a working group to conduct a Phase ll
Review that promotes the use of evidence and best practices for the appropriate provision
of health care resources

Review will investigate the overuse, misuse, underuse of resources

Recommendations from the Review will focus on 15 tests, treatments and services 1 that
are currently underused
Appropriate Prescribing (1.3; Section B, Appendix A)

PSC to develop a program that reviews prescribing practices among physicians

Targeted education strategies and mechanisms for improving the tracking of prescriptions
will be recommended

Narcotics and controlled substances will be initial focus of the program

Program will be voluntary and data used to identify physicians will be kept confidential to
the physician and the PSC
Review of Payment Discount (1.4)

PSC to conduct a review of the savings associated with the Phase ll and Appropriate
Prescribing Reviews

100% of any savings realized will be applied to the 0.5% payment discount
Amendments to Schedule of Benefits (2.1; Appendix B - #1-9)

The following changes made to the Ontario Health Insurance Plan (OHIP) Schedule of
Benefits in April 2012 will be amended:
o Optical Coherence Tomography (OCT): codes for unilateral/ bilateral retinal disease
and glaucoma to be increased from $25 to $35.
o After-hours procedure premiums: restored from 40% to 50% (evenings), 65% to 75%
(midnight)
Effective Date
(1.3; Section A, Appendix A)
Physician Services Appendix to Physician
Agreement
Services Agreement
(1) Comments on Potential Impact
April 1, 2013
April 1, 2013
October 1,
2012
April 1, 2013
October 1,
2013
April 1, 2013
1
Phase II recommendations include: Limitation of self-monitoring and blood glucose tests, Investigations in the work-up of dementia, Appropriate sleep lab testing, Anesthesia requirements for vasectomies, cataracts and
endoscopy, Lipid testing, Serum protein electrophoresis, Appropriate ultrasound imaging, Vitamin B12, Funding for pre-operative cardiac testing for asymptomatic patients, Genetics strategy, Companion diagnostics,
Schedule of Benefits for Bond Mineral Testing by DXA, Relevancy of pre-dental/ pre-operative assessments with the services provided by hospital-based pre-operative assessment clinics, Utilization and relevancy of preoperative consultations, Changes in practice patterns for the provision of cardiac services and impact on utilization arising from changes in PSA (Physician Services Agreement, 2012, S. 1.3 Appendix A)
2
Last Revised: 2/9/2016
CONFIDENTIAL
2012 Physician Services Agreement: Overview
Key Issues Impacting Hospitals
Reference format in ‘Agreement
Initiatives/ Strategies’ column:
Section
Agreement Initiatives/ Strategies
Effective Date
(1.3; Section A, Appendix A)
Physician Services Appendix to Physician
Agreement
Services Agreement
(1) Comments on Potential Impact
o
Anesthesia flat fee for procedural sedation: increased from $60 to $75 when
anesthesiologist providing one-on-one care
o Laparoscopic surgical fee premiums: restored from 10% to 25%
o Intensive and coronary care premium: complete restoration of premium applied for
each patient seen on visit to ICU or CCU claimed by a physician who was not the Most
Responsible Physician (MRP)
o Lumbar spine: removal of requirement for physicians to repay X-ray or CT studies of
the lumbar spine if found not to be medically necessary
Development of New Billing Codes and Payment Rules (2.1, Appendix B - #1-9)

The following fee codes and/ or payment rules will be developed:
o Optical Coherence Tomography (OCT)
1. Code for patients receiving active treatment for unilateral/ bilateral retinal
disease/ glaucoma ($35)
2. Code for active management of retinal disease ($25)
3. Code for OCT related to treatment of children ($35)
o Fees for anesthesia
1. Consider the development of supervisory code for anesthesiology
2. Develop code to provide anesthesia for cataracts, colonoscopy, cytoscopy,
sigmoidoscopy in low volume/ rural settings
3. Recommendation of a solution to move procedures out of hospitals and into out
of hospital facilities that have access to care provided by Anesthetic Care Teams
o Cataracts: Ontario Health Technology Advisory Council (OHTAC) to review objective
criteria for cataract extractions.
o Assessment with surgical procedures: restriction imposed on physicians from billing a
higher paying assessment/ consultation on the day of a surgical procedure when a
previous assessment/ consultation had already been billed will be reviewed.
Physicians will be permitted to submit rejected codes for manual review.
o Pediatric consults:

April 1, 2012 changes clarified that pediatricians should not be paid as specialists
when providing care to adult patients aged 18+

Pediatricians may be exempted to charge specialist fees to adult patients (a)
when such patients are developmentally delayed and (b) when pediatrician has
specialty training (i.e. allergist) and treats an adult patient requiring this care

OMA Section on Pediatrics will be solicited to determine whether exemption
process is creating problems in providing pediatric-specific services to adult
patients
April 1, 2013
3
Last Revised: 2/9/2016
CONFIDENTIAL
2012 Physician Services Agreement: Overview
Key Issues Impacting Hospitals
Reference format in ‘Agreement
Initiatives/ Strategies’ column:
Section
Agreement Initiatives/ Strategies
Self Referral Regulation (2.1, Appendix B - #10)

Removal of regulation reducing self-referrals and referrals within physician/ hospital
groups for diagnostic services by 50%2

The Expert Panel on Appropriate Utilization of Diagnostic and Imaging Studies will
continue to make recommendations to the PSC
April 1, 2012 Flow Though (3.1)

April 1, 2012 decreased to the Schedule of Benefits will be flowed through to the
payments as outlined in this section.
April 1, 2012 Flow
Through
Section 3
Appendix C
Reverse Flow Through (3.1, Appendix C)
1. Specialist Alternative Payment Plans (APPs) and Physician Programs

Changes to specialist payments in April 2012 (i.e. reduction of fees for electrocardiograms
by 50%) will be applied to specialist AFP/APP agreements and Academic APPs
o Changes (increase or decrease) will be applied to the clinical contract value of each
plan (excluding administrative and non-clinical payments)
o Where possible, flow through will be implemented as an adjustment to the Service
Encounter Premium3
o Clinical physician payments that received positive flow through4 (i.e. fee increase)
from the 2008 PSA will be subject to a reverse flow through
Primary Care Specialty Models
Reverse flow through arising from the April 2012 changes to family physicians (i.e. fee
reduction for intermediate assessments) will be applied to the clinical base of 16 primary
care specialized models (e.g. Aboriginal Health Access Centres, Rural-Northern Physician
Group Agreements 1 and 2, Community Health Centres)
Equivalent Flow Through (3.1, Appendix C)

The fee code for an Intermediate Assessment was reduced by $1.00 (fee-for-service) and
by $0.15 (primary care models) in April 2012
o The GP Psychotherapy premium will be reduced from 15% to 12% in alignment with
this decrease

Professional fees5 for diagnostic radiology, MRI and diagnostic ultrasound were reduced
by 5% in April 2012. The following professional fees will be reduced by 5% in alignment
with this decrease:
Effective Date
(1.3; Section A, Appendix A)
Physician Services Appendix to Physician
Agreement
Services Agreement
(1) Comments on Potential Impact
April 1, 2012
January 1,
2013
2.

January 1,
2013
January 1,
2013
January 1,
2013
2
Nuclear Medicine, Diagnostic Radiology, MRI, Diagnostic Ultrasound, Pulmonary Function Studies, Diagnostic and Therapeutic Procedures (MOHLTC, 2012)
Non-fee-for-service physicians practising under alternative payment plans or primary care arrangements in Ontario are required to submit Service Encounter Reporting (shadow-billing) in accordance with the Schedule of
Benefits. Under some arrangements (i.e. AFPs), shadow-billed claims generate a Service Encounter Premium that represents a percentage of the full value of the claim. (Health Force Ontario, 2010)
4 Mental Health Sessionals, Sessional Fee Supplement, Psychiatric Stipend, Physicians compensation in Divested Provincial Psychiatric Hospitals, Physicians compensation in Assertive Community Treatment Teams, OPOP
sessionals, Visiting Specialist Program and Urgent Locum Tenens Program for Specialists sessionals, and the Hospital Pediatric Stabilization Program (Physician Services Agreement, 2008, S. 3.3)
3
4
Last Revised: 2/9/2016
CONFIDENTIAL
2012 Physician Services Agreement: Overview
Key Issues Impacting Hospitals
Reference format in ‘Agreement
Initiatives/ Strategies’ column:
Section
Primary Care
Section 4
Appendix D
Agreement Initiatives/ Strategies
o Nuclear medicine
o Sleep studies
o Radiation oncology treatment planning codes
Primary Care (4.1)

All primary health care initiatives are continued and amended as outlined in this section
Primary Health Care Committee (PHCC) (4.1, Appendix D, #1)

PHCC to be reconstituted; mandate/ terms of reference to be developed by PSC:
1. Oversee implementation of initiatives outlined in this section of the PSA
2. Responsible for review/ evaluation prior to end of PSA
Personalized Health Visit (4.1, Appendix D, #2)

Annual health exam to be replaced by a personalized bi-annual health visit for adult
patients aged 18-64
o New fee code will be established ($50)
o Patients in other age groups will be unaffected
o Capitation rates will not be adjusted (fee-for-service only)
Alignment with Excellent Care for All Act (ECFAA) (4.1, Appendix D, #3)

Expansion of primary health care quality agenda to Family Health Teams, Aboriginal
Health Access Centres, Community Health Centres

PHCC to coordinate rollout and implementation of:
o Annual Quality Improvement Plans (QIPs)
o Development of indicators
o Development of patient experience surveys
o Public reporting
Daytime Access (4.1, Appendix D, #4.1)

PHCC to investigate daytime access to primary care physicians participating in patient
enrolment models (PEMs)6

PHCC to make recommendations on guidelines to inform PEM physicians on operating
during daytime hours (i.e. standards for group size, strategies and support for advanced
access)
Effective Date
(1.3; Section A, Appendix A)
Physician Services Appendix to Physician
Agreement
Services Agreement
(1) Comments on Potential Impact
October 1,
2012
January 1,
2013
April 1, 2013
By April 1,
2013
5
Diagnostic tests and other procedures often have two fees. Professional fees are paid to the physician who performs and interprets the test, and technical fees are paid to the facility (e.g., the hospital) to offset the costs
associated with providing the services (e.g., technicians’ salaries, overhead expenditures, capital outlays and amortization). (ICES, 2012)
6 PEMs are of two main types: (1) Harmonized models, such as the Family Health Network (FHN) and the Family Health Organization (FHO), are blended capitation models and (2) Non-harmonized models, such as the
Family Health Group (FHG) and the Comprehensive Care Model (CCM), are enhanced fee-for-service (FFS) models (OMA, 2012)
5
Last Revised: 2/9/2016
CONFIDENTIAL
2012 Physician Services Agreement: Overview
Key Issues Impacting Hospitals
Reference format in ‘Agreement
Initiatives/ Strategies’ column:
Section
Agreement Initiatives/ Strategies
Effective Date
(1.3; Section A, Appendix A)
Physician Services Appendix to Physician
Agreement
Services Agreement
(1) Comments on Potential Impact
Enhanced After-hours Access (4.1, Appendix D, #4.2)

Family Health Networks (FHNs), Family Health Organizations (FHOs), Family Health Groups
(FHGs)will be required to provide the following after-hours service blocks7 based on size of
the group:
Number of physicians
in group
10-19
20-29
30-74
75-100
100-199
200 +


Total number of after-hours
service blocks (per week)
7
8
10
15
20
25
Northern FHO and FHG groups who require 50% of its physicians to maintain active inpatient hospital privileges are exempt from after-hours coverage requirements above
FHO and FHN agreements will be amended to ensure the staffing of additional physicians
after-hours may be necessary if the group determines that the volume and needs of their
patients require additional staff
House Calls (4.1, Appendix D, #4.3)

Primary care physicians will be incented to provide more house calls with a focus on
homebound, frail/ elderly patients:
o New fee code for housecalls to homebound, frail/elderly patients to be developed by
the PHCC
o A 20% premium will be applied to Comprehensive Care Model (CCM), FHG, FHN
physicians who provide 68+ house calls per year to more than 17+ patients, if 75% of
these calls were to homebound, frail and elderly patients
o Additional bonus to all family physicians and PEM physicians will be applied on an
increasing scale for up to 32 patients served with more than 128 encounters
Termination of THAS Obligation (4.1, Appendix D, #5)

All PEM agreements will be amended to delete service requirements and payment terms
for the Telephone Health Advisory Service (THAS)

PEM groups will be permitted to provide THAS on a voluntary basis
Termination of Access Bonus Rebate (4.1, Appendix D, #6.1)

Access bonus rebate ($237.91 per eligible physician) established in 2008 PSA that
compensated capitated PEM physicians (FHO, FHN) for enrolled patient use of focused
practice GPs will be cancelled
7
April 1, 2013
April 1, 2013
January 1,
2013
October 1,
2012
A service block refers to a 3-hour period in which one physician within the group is available. Blocks are after 5pm on weekdays or anytime on weekends (MOHLTC, 2010)
6
Last Revised: 2/9/2016
CONFIDENTIAL
2012 Physician Services Agreement: Overview
Key Issues Impacting Hospitals
Reference format in ‘Agreement
Initiatives/ Strategies’ column:
Section
Agreement Initiatives/ Strategies
Review of Access Bonus (4.1, Appendix D, #6.2)

PHCC to conduct a policy review of the access bonus payment in FHO/FHN arrangements
to review intent and current application of outside use. The review will consider:
o Value of negative access bonuses
o Impact on emergency departments
o Exemptions for Urgent Care Centres and GP focused practices
o Impact from walk-in clinics
Premium and Payment Changes (4.1, Appendix D, #7)

Elimination of service premiums in PEM agreements
o In-office service bonus8 ($10 Million annually)
o Out-of-office service bonus9
o Preventative care management services enhancement fee (code - $6.86)
Effective Date
(1.3; Section A, Appendix A)
Physician Services Appendix to Physician
Agreement
Services Agreement
(1) Comments on Potential Impact
March 31,
2014
Oct 1, 2012
April 1, 2013
April 1, 2013

Capitation and Long-Term Care Patients
o Residents in LTC will be required to be rostered as an LTC patient or seen on a feefor-service basis
o LTC patients should not be rostered as non-LTC patients and billed the monthly
management fee in addition to that
o MOHLTC to revise LTC patient enrolment process to make it administratively easier
for physicians to enroll such patients.

Comprehensive Care Management Fee Reduction for Large Rosters
o PHCC to develop methodology in which CCM capitation payment will be reduced by
50% for each patient a physician enrolls above 2500
April 1, 2013

Diabetic Management Fee
o Fee code reduced from $75 to $60
April 1, 2013

Acuity Modifier
o $40 Million will be set aside to develop and implement a premium for PEM
agreements (for high acuity patients)

2013 (Year 1) will involve selecting an acuity adjustment tool, testing it against
OHIP data and designing the payment system
October 1,
2012
Interim ToolMarch 31, 2013
8
The In Office Service Bonus Payment is intended to recognize PEM physicians and PEM physician groups who provide a broad range of in-office services. These services fall under the categories of complex procedures,
mental health, minor office procedures and reproductive health. Initial payment of $5 million paid in 2010/ 11 (MOHLTC, 2010)
9 Out-of-office bonus reflects the extent to which rostered patients reflect population demographics in the physician’s community. In 2011/12, it rewarded top performing groups who provided the broad range of out of
office services which meet the needs of their rostered patients (i.e. aging at home/ end of life care, maternity/ newborn care) (Physician Services Agreement, 2008, S. 5.2)
7
Last Revised: 2/9/2016
CONFIDENTIAL
2012 Physician Services Agreement: Overview
Key Issues Impacting Hospitals
Reference format in ‘Agreement
Initiatives/ Strategies’ column:
Section
Agreement Initiatives/ Strategies
Effective Date
(1.3; Section A, Appendix A)
Physician Services Appendix to Physician
Agreement
Services Agreement
(1) Comments on Potential Impact

2014 (Year 2) will involve conducting systems testing, adjusting the tool to
MOHLTC payment systems, providing physician education and developing a
communications plan
o PHCC will report back to OMA/MOHLTC with recommendations for the tool that will
be selected as the Acuity Modifier
Managed Entry Process (4.1, Appendix D, #8)
1. Family Health Groups

No limit will be applied to physicians joining FHG groups
2.

Virtual Care
Section 5
Appendix E
Family Health Organizations/ Family Health Networks
Registration of 40 new physicians into FHN and FHO models each month in two streams:
1) 20 physicians in prioritized stream for new graduates and physicians seeking to
practice in high need areas, and
2) 20 physicians in regular stream- first come, first serve

Unused spots from one stream will shift to the other stream and/or rolled-over to
subsequent months

Replacement physicians (i.e. for deceased/ retiring physicians) will be processed outside
of managed entry process
Interprofessional Health Provider (IHP) Funding (4.1, Appendix D, #9)

Expansion of availability of IHPs for patients in community with primary care needs

Full salary funding made available to support full integration of IHPs (i.e Physician
Assistants) into non-Family Health Team affiliated PEM groups (i.e. FHNs, FHOs) of three
of more physicians (i.e. not CCMs)

PHCC will oversee implementation and establishment of criteria which will examine (a)
community need, (b) roster size, (c) involvement in quality improvement initiatives, (d)
integration with other providers in region to support population-based planning
Family Health Group Governance Agreements (4.1, Appendix D, #10)

Amendment of FHG agreement to require each group to establish and maintain a written
governance agreement between the physician members to formally set out the terms of
their relationship
Virtual Care (5.1)

OMA/MOHLTC have committed to the virtual care initiatives outlined this section.
Northern Health Travel Grant (NHTG) (5.1, Appendix E, #1)

Modification of NHTG approval process (i.e. increased difficulty)

Replacing face-to-face visits with virtual equivalents
Final Tool –
January 1, 2013
October 1,
2012
April 1, 2013
April 1, 2013
By April 1,
2013
April 1, 2013
8
Last Revised: 2/9/2016
CONFIDENTIAL
2012 Physician Services Agreement: Overview
Key Issues Impacting Hospitals
Reference format in ‘Agreement
Initiatives/ Strategies’ column:
Section
Agreement Initiatives/ Strategies
Specialist to Primary Care Virtual Follow-Up (5.1, Appendix E, #2)

Establishment of a Working Group to evaluate existing programs to recommend a
comprehensive provincial business and technology model for hospital to primary care
communications.
Patient eConsults(5.1, Appendix E, #3)

Funding for an evaluation project to enable patient-initiated patient to primary care
provider eConsultations

Evaluations to beginning in capitated sites (i.e. FHO, FHN) followed by fee-for-service
setting
Primary Care to Specialist eReferral (5.1, Appendix E, #4)

eReferral fee codes will be developed for ophthalmology and dermatology

Eventual expansion to other specialties
Evidence and
Appropriateness
– Phase I Review
Section 6
Appendix F
Realignment of Telemedicine Premium (5.1, Appendix E, #5)

Ontario Telemedicine Network working group will be established to evaluate personal
video conferencing (PVC) deployment, utilization, and volume and workflow trends.
Working group will ensure:
o PVC utilization targets that signal a diminishing need for full telemedicine premium
o Establishment of new premiums for northern/ non-northern telemedicine
consultations based on adoption requirements
Evidence and Appropriateness (6.1)

Use of evidence and best practice to ensure provision of healthcare is relevant to and
appropriate for the clinical needs of patients. OMA/MOHLTC has agreed to:
o Changes to Schedule of Benefits
o Inclusion of ‘comments’ on fee codes to ensure appropriate provision
o Removal of selected tests from the MOHLTC’s requisition form
o Recommendations for further analysis and/or consultations
Revised Laboratory Requisition Form (Appendix F, Section A, #1)

Due to oversuse/ misuse, the following tests are recommended to be removed from from
the Ontario laboratory requisition forms:
o Ferritin
o Thyroid stimulating hormone
o Vitamin B12
Asparate Aminotransferase (AST) (Appendix F, Section B, #1)

AST testing in community laboratories is recommended to be restricted to patients under
the care of a specialist at a hospital.
o Aligned with OHTAC recommendation
Effective Date
(1.3; Section A, Appendix A)
Physician Services Appendix to Physician
Agreement
Services Agreement
(1) Comments on Potential Impact
April 1, 2013
November 1,
2012
January 1,
2013
9
Last Revised: 2/9/2016
CONFIDENTIAL
2012 Physician Services Agreement: Overview
Key Issues Impacting Hospitals
Reference format in ‘Agreement
Initiatives/ Strategies’ column:
Section
Agreement Initiatives/ Strategies
Chloride (Appendix F, Section B, #2)

Chloride testing recommended to be removed from the Ontario laboratory requisition
form based on limited utility in community setting.
o Aligned with OHTAC recommendation
Creatine Kinase (Appendix F, Section B, #3)

Due to inappropriate ordering as a screening agent creatine kinase recommended for
removal from the laboratory requisition form.
o Aligned with OHTAC recommendation
Folate (Appendix F, Section B, #4)

Restriction of folate ordering to red blood cell folate when ordered on advice of physicians
with expertise in hematological, inflammatory, or gastrointestinal orders.
o Aligned with OHTAC recommendation
Reflexive Testing (Appendix F, Section B, #5)

Reflexive testing can be used to increase efficiency of ordering, as it allows the physician
to indicate the condition and the laboratory to run the necessary tests based on this.
Thyroid Scans (Appendix F, Section B, #6)

Language will added to the OHIP schedule of benefits under which specific circumstances
thyroid scans should be ordered (i.e. adult hypothyroidism)
Diagnostics Ordered by Other Practitioners (Appendix F, Section B, #7)

Appropriateness of diagnostic studies (i.e. x-rays) ordered by non-physicians (i.e.
chiropractors) will be reviewed; referring provider number will now have to be included.
Colon Cancer Screening Intervals (Appendix F, Section C, #1)

Colorectal cancer follow-up screening intervals will be increased.

Recommendations for colonoscopy follow-up are 1 every 5 years or 1 every 10 years
based on individual patient indications.
o Aligned with recommendation from Cancer Care Ontario (CCO)
Cervical Cancer Screening (Appendix F, Section C, #2)

Revision of the cervical cancer screening bonuses to reflect CCO’s guidelines on cervical
cancer screening
o Bonus for PEMs (i.e. FHO, FHN)
o Schedule of Benefits changes

Interval for screening recommended to increase from 2 years to 3 years, and for those
within 21-70 age group
Annual Stress Tests (Appendix F, Section C, #3)

De-listing of annual stress tests for asymptomatic patients at low risk for heart disease
o Aligned with recommendation from American College of Cardiology and the
American College of Physicians
Effective Date
(1.3; Section A, Appendix A)
Physician Services Appendix to Physician
Agreement
Services Agreement
(1) Comments on Potential Impact
January 1,
2013
January 1,
2013
10
Last Revised: 2/9/2016
CONFIDENTIAL
2012 Physician Services Agreement: Overview
Key Issues Impacting Hospitals
Reference format in ‘Agreement
Initiatives/ Strategies’ column:
Section
System Savings and
Sustainability
Section 7
Appendix G
Agreement Initiatives/ Strategies
Pre-operative Cardiac Testing (Appendix F, Section C, #4)

De-listing of pre-operative cardiac testing for patients undergoing low/moderate risk noncardiac surgery (i.e. echo, ECG, nuclear imaging, routine chest x-rays)
o Aligned with recommendation from American College of Cardiology and the
American College of Physicians
Chest X-Rays (Appendix F, Section C, #5)

De-listing of routine chest x-rays for screening and routine pre-admission for ambulatory
and in-patients with unremarkable history/ physician exam
Arthoscopic Lavage (Appendix F, Section D, #1)

De-listing of arthoscopic lavage for osteoarthritis of knee
o Aligned with OHTAC recommendation
Injection of Hyaluronic Acid (Appendix F, Section D, #2)

De-listing of the injection of hyaluronic acid
o Aligned with OHTAC recommendation
System Savings and Sustainability (7.1)

Measures outlined in this section ensure sustainability in health care system and promote
efficiency of resources.
Annual Consecutive Consultations (7.1, Appendix G, #1)

Fee for annual consecutive consultations by the same specialist on same patient for same
clinical diagnosis will be reduced to a limited/ repeat consult fee or a specific assessment
fee
Multiple Consultations (7.1, Appendix G, #2)

Language to be clarified in the OHIP Schedule of Benefits to limit patient to one second
opinion consultation when patient requests
Group Appointments (7.1, Appendix G, #3)

Creation of group care codes to promote shared medical appointments for diabetes,
congestive heart failure, asthma, chronic obstructive pulmonary disease.
Hospital Supplies and Equipment (7.1, Appendix G, #4)

The OMA/MOHLTC to establish a province-wide product/supplies standard for specific
procedures to reduce variation among vendors and cost.

OMA will encourage physicians to standardize use of hospital supplies and equipment (i.e.
technology, prosthetics). Areas of initial focus:
o Hip/ knee replacements
o Spine
o Cataracts/ cataract lenses
o Vascular/ cardiac stents
Effective Date
(1.3; Section A, Appendix A)
Physician Services Appendix to Physician
Agreement
Services Agreement
(1) Comments on Potential Impact
January 1,
2013
April 1, 2013
11
Last Revised: 2/9/2016
CONFIDENTIAL
2012 Physician Services Agreement: Overview
Key Issues Impacting Hospitals
Reference format in ‘Agreement
Initiatives/ Strategies’ column:
Section
Bilateral Monitoring and
Accountability Process
Section 8
CPSO Complaints
Process
Section 9
CMPA
Section 10
Appendix H
10
Agreement Initiatives/ Strategies
Medically Complex Patients (7.1, Appendix G, #5)

$10 Million will be reserved for October 1, 2013 – October 1, 2014 in order to develop
demonstration projects for medically complex patients (post-discharge, on-going) to
measure results, to be evaluated after one year.
Bilateral Process between OMA/MOHLTC

PSC to develop a bilateral monitoring and accountability process to monitor and evaluate
initiatives within this PSA. Specific components include:
o MOHLTC/OMA Responsibilities (8.1)
o Measurement and Evaluation Process (8.2)
o Workplan (8.3):
o Development of a Sub-Committee (8.4):
o Assessment of Bilateral Monitoring and Accountability Process (8.5):
o Amendments to Data-Sharing Agreement (8.6)
CPSO Complaints Process (9.1)

Request by the OMA to the MOHLTC for the amendment of the Health Professions
Procedural Code such that CPSO will not be tied to a full investigation into complaints
about matters outside their jurisdiction
Increase Contribution of CMPA Payments (10.1, Appendix H)

OMA/MOHLTC to enter into negotiations with the CMPA to replace the current
agreement (2013 expiry) with a new agreement (2022 expiry)

OMA/MOHLTC will request across-the-board increases of 2.1% between 2015-23, based
on the average of the Consumer Price Index10 between 2001-2011

In 2014, physician contribution will increase the greater of $200 or 22%
o Interns and residents, clinical fellows exempted from increase

Increases will be revised if Ontario’s CPI exceeds 4%.
Tort Reform Measures (10.2)

OMA/MOHLTC to review and update tort reform measures recommended by the
OMA/MOHLTC/CMPA Medical Malpractice Coverage Committee in 2001, including
reforms for:
o OHIP subrogation
o Prejudgment interest
o Family Law Act awards
o Limitation of general damages
Effective Date
(1.3; Section A, Appendix A)
Physician Services Appendix to Physician
Agreement
Services Agreement
(1) Comments on Potential Impact
October 1,
2013
October 1,
2012
Recommendations
for legislative
amendments
(March 2014)
October 1,
2012
June 2013
Measures changes in the price level of consumer goods and services purchased by households in a particular period
12
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CONFIDENTIAL
2012 Physician Services Agreement: Overview
Key Issues Impacting Hospitals
Reference format in ‘Agreement
Initiatives/ Strategies’ column:
Section
Physician Programs
Section 11
Appendix I
Committees
Section 12
Appendix J
11
Agreement Initiatives/ Strategies
Continuance of Physician Programs (11.1, Appendix I, Section 1)

22 total physician programs will be continued, as outlined in Appendix I. Of interest to
hospitals may include:
o Emergency department coverage demonstration project
o Hospital pediatric stabilization program
o Hospital on-call coverage program (HOCC)
o Divested psychiatric physician hospital funding
o Northern physician locum initiative
Modified Programs (11.1, Appendix I, Section 2)

Modification of the ED Summer Incentive to restrict access to the Summer Incentive to
highest need hospitals, including:
o Rural-Northern Physician Group Arrangement hospitals with 2 physicians and 24hour emergency coverage
o ED Coverage Demonstration Project (EDCDP) participating hospitals
o EDCDP Regional Referral Centres
o Fee For Service (FFS) physicians practicing in hospitals with total volumes of 30,000 or
less no longer eligible
Discontinued Programs (11.1, Appendix I, Section 2)
1. Service Recognition Program: funding to remain in Physician Services Budget (PSB).
2. HOCC Collaboration Fund: $22 Million fund established to recognize physicians in each
LHIN where a comprehensive regional on-call coverage program is in place and aligned to
the community needs. $22 M will be repurposed in the PSB.
3. Technical Fee Payment: $15 Million fund established for selected technical fees (t-fees) for
eligible diagnostic services11 in the 2008 PSA discontinued, as was always meant to be a
one-time payment. $15 M has been paid out.
Continued Bilateral Steering Committees (12.1)

Bilateral subcommittees in this section will continue under their respective terms of
reference, subject to revisions indicated below
Joint Forms Committee (12.1, Appendix J, Section 1)

The mandate of the Committee is expanded to include:
o Fees for Forms (including Out of Country forms)
o Review of undervalued and unremunerated government forms
o Standardize hospital forms that require physician input
o Review of document requirements for the exceptional access program process (S. 16
of Ontario Drug Benefit Act)
Effective Date
(1.3; Section A, Appendix A)
Physician Services Appendix to Physician
Agreement
Services Agreement
(1) Comments on Potential Impact
October 1,
2012
October 1,
2012
Discontinuance:
October 1,
2012
October 1,
2012
October 1,
2012
October 1,
2012
October 1,
2012
Neurology, allergy testing, gastroenterology, neurology, physical medicine, ophthalmology, pulmonary functions, nuclear medicine, mammograms (MOHLTC, 2011)
13
Last Revised: 2/9/2016
CONFIDENTIAL
2012 Physician Services Agreement: Overview
Key Issues Impacting Hospitals
Reference format in ‘Agreement
Initiatives/ Strategies’ column:
Section
Agreement Initiatives/ Strategies
Non-Fee-For Service
Agreements
Section 13
Appendix K
Primary Health Care Committee (12.1, Appendix J, Section 2)

PHCC will be tasked with developing implementation strategies for the initiatives
established in Section 4, including:
o Expansion of Excellent Care for All Act to primary care (including development of
Quality Improvement Plans)
o Daytime access
o House calls
o Review of the access bonus
o Payment change: (a) Comprehensive Care Management fee reduction for large
rosters and (b) acuity modifier
o Interprofessional health provider funding (i.e. Physician Assistants in primary care)
Non Fee-for-Service (NFSS) agreements (13.1)

Standard agreements will facilitate the negotiation of future NFFS contracts with the
MOHLTC.

Agreements require physicians to require arbitration to resolve any disputes with the
MOHLTC regarding the interpretation and application of the NFFS agreement.

Standard NFFS agreements will apply to specialist and primary care NFFS agreements.
Specialist NFFS Agreements (13.1)

Entered into or renewed after the date of this PSA (with adjustments to the template as
needed)
Primary Care NFFS Agreements (13.2)

OMA/MOHLTC to begin negotiating standard template for primary care NFFS agreements.
Terms from the specialist NFFS agreements will apply.
Review Existing Primary Care Agreements to Standardize (13.3)

OMA/ MOHLTC will review existing primary care agreements to standardize/ update
terms

Recommendation will be made to PSC
OMA request to permit non-voting shares of a Medicine Professional Corporation (MPC) to
be held by a family trust (14.1)

MOHLTC acknowledges OMA request

MOHLTC to lead consultation with CPSO, Ministry of Finance and others by and report
back to the PSC with recommendations
OMA request that corporations whose voting shares are held by physicians and partnerships
of physicians be allowed to hold voting shares of MPC (14.2)

MOHLTC consultation to begin in January 2013

MOHLTC to provide status report to PSC by June 2013

Recommendations brought forth by the PSC in 2014
Incorporation
Section 14
Effective Date
(1.3; Section A, Appendix A)
Physician Services Appendix to Physician
Agreement
Services Agreement
(1) Comments on Potential Impact
October 1,
2012
October 1,
2012
January 31,
2013
January 31,
2013
Review/
recommendations
by June 2013
January 1,
2013
14
Last Revised: 2/9/2016
CONFIDENTIAL
2012 Physician Services Agreement: Overview
Key Issues Impacting Hospitals
Reference format in ‘Agreement
Initiatives/ Strategies’ column:
Section
Statutory Amendments
Section 15
Term and Renewal
Section 16
OMA Representation
and Negotiation Rights
Agreement
(Memorandum of
Agreement)
Agreement Initiatives/ Strategies
Statutory Immunity (15.1)

MOHLTC to support legislation (upon return of Legislature) providing statutory immunity
from litigation against the OMA’s directors, officers, members, employees, agents for ‘acts
done in good faith’

Legislation to be applicable when the OMA:
1. Enters into agreements with the MOHLTC/ government (e.g. PSA)
2. Makes recommendations to the MOHLTC/ government regarding fee codes or other
matters affecting physician payments
Term and Renewal (16.1)

PSA to begin on October 1, 2012 and terminate on March 31, 2014

Negotiations to establish next PSA will begin no later than January 1, 2013

OMA/MOHLTC agreed to negotiate in accordance to process identified in the OMA
Representation and Negotiation Rights Agreement (OMA Memorandum of Agreement)
OMA Representation and Negotiation Rights Agreement (Refer to Memorandum of
Agreement)

Future negotiations to be conducted in accordance with process set out in OMA
Representation and Negotiations Rights Agreement:
o OMA recognized as exclusive representative of physicians
o Parties agree to negotiate ‘in good faith’ in accordance with Joint Process (below)
o Minister will negotiate all template agreements12 (and amendments) with the OMA
o Minister may not deal directly with a Physician Group in respect of negotiating
ancillary agreements13 if majority of Group elects to have the OMA as its
representative
o All current and future template and ancillary agreements will include OMA as
signatory

Physician Services Committee
o Will continue to provide broad process for regular liaison between MOHLTC/ OMA
o Expanded mandate

Dispute Resolution Process
o Either party may refer disagreement to PSC for consideration
o PSC may enlist support of agreed upon facilitator
o Facilitator may issue written recommendations for resolution to parties
Effective Date
(1.3; Section A, Appendix A)
Physician Services Appendix to Physician
Agreement
Services Agreement
(1) Comments on Potential Impact
October 1,
2012
October 1,
2012
October 1,
2012
12
Template agreement is a funding agreement that the Minister intends to offer to more than one group of physicians
Ancillary agreement is either (a) unique agreement that provides funding to a specific group of physicians in a NFFS basis or (b) template agreement when it is applied to and entered into with a specific group of
physicians
13
15
Last Revised: 2/9/2016
CONFIDENTIAL
2012 Physician Services Agreement: Overview
Key Issues Impacting Hospitals
Reference format in ‘Agreement
Initiatives/ Strategies’ column:
Section
Agreement Initiatives/ Strategies
o
Physician Services Appendix to Physician
Agreement
Services Agreement
(1) Comments on Potential Impact
Matters unresolved within 2 weeks from written recommendations will be made
public and affected groups may use any other available dispute resolution process

Amending Procedure
o OMA/MOHLTC may amend this agreement by providing other party with written
notice of proposed amendments
o Parties must operate in ‘good faith’ when reviewing proposed amendments
o If parties are unable to reach an agreement respecting the proposed amendment
within 60 days of the written notice then either party may refer the dispute to a
special committee of the PSC for consideration
o Special committee will make written recommendations within 30 days of referral
o Special committee may then enlist support of agreed upon facilitator to help parties
to reach a resolution

Term of Agreement
o Will come into effect when Minutes of Settlement abandoning OMA Supreme Court
Case 344/12 are executed

Joint Process
o Phase 1: Negotiation and Facilitation

Parties to commence negotiations at least 4 months before end of PSA term

Parties agree to bilaterally negotiate for no longer than 120 days

After 120 days any party may request a facilitator for remainder of negotiations

Facilitator will issue written recommendations to both parties if after 14 days of
his or her appointment a resolution cannot be reached

Parties will reconvene within 14 days of recommendations to continue
negotiations
o Phase 2: Conciliation

Conciliator will issue written recommendations to both parties if after 14 days of
his or her appointment a resolution cannot be reached

Parties will reconvene within 14 days of recommendations to continue
negotiations (negotiations no longer than 10 days)

Minister will not advise the government to unilaterally implement decisions unless Joint
Process occurs
Neither party will seek to end negotiations prior to conclusion of Joint Process

Effective Date
(1.3; Section A, Appendix A)
16
Last Revised: 2/9/2016
CONFIDENTIAL
2012 Physician Services Agreement: Overview
Key Issues Impacting Hospitals
Reference format in ‘Agreement
Initiatives/ Strategies’ column:
(1.3; Section A, Appendix A)
Physician Services Appendix to Physician
Agreement
Services Agreement
(2) If you could identify the key issues for the OHA to focus on during the implementation of the 2012 PSA, what would they be? Please list your issues in
priority order and be as specific as possible.
Priority Issue #1:
Priority Issue #2:
Priority Issue #3
17
Last Revised: 2/9/2016
CONFIDENTIAL
2012 Physician Services Agreement: Overview
Key Issues Impacting Hospitals
Reference format in ‘Agreement
Initiatives/ Strategies’ column:
(1.3; Section A, Appendix A)
Physician Services Appendix to Physician
Agreement
Services Agreement
(3) Please list any general comments, concerns, or questions you may have regarding the 2012 Physician Services Agreement:
18
Last Revised: 2/9/2016