Physician Payment Committee

Please see the Negotiations and agreements page for detailed information and the latest updates.

The 2021-24 PSA Year 3 implementation and 2024-28 Procedural Agreement articulates that 70 per cent of the increases will be allocated as an across-the-board increase including, relativity considerations. The remaining 30 per cent of the Year 1 increase will go toward targeted investments that would be determined through bilateral agreement. Once the arbitration award has been announced, the two sides will work together, through mediation and arbitration if necessary, to determine the exact allocation of targeted funding. They will also decide how to address both across-the-board increases and relativity for any general increases.

The PSA tasked the PPC with bringing forward recommendations on how to modernize the Schedule of Benefits. The goal is to have a modern schedule that better reflects current medical practice and is more fair and more equitable. This includes: 

• Fee changes to address intrasectional fee relativity
• Revision of fee code descriptors 
• Introduction of new fee codes 
• Deletion of existing fee codes 
• Changes to address gender pay equity 
• Changes to reflect innovation in medical technology 

The NTF is a board task force that works bilaterally to negotiate the Physician Services Agreement with the Ministry of Health’s negotiating team. Terms of service on the NTF are mandate driven.  The current NTF was appointed in February 2023 and is comprised of five members, with a minimum of two specialists and two general/family practitioners. The physician members of the NTF are supported by two external negotiations advisers.

Under the 2021 Physician Services Agreement, the PPC was struck to replace the Medical Services Payment Committee (MSPC). Its mandate is to make recommendations on how to implement each constituency’s compensation increases to the Schedule of Benefits, as outlined in the 2021 PSA and Arbitration Award.

The PPC operates as a standing committee reporting to the Physician Services Committee and OMA board.  The PPC is a bilateral committee comprised of eight members, with equal representation from the OMA and the Ministry of Health (four members each).  The PPC has established a process for the introduction of new fee codes or the revision of existing fee codes, including fee value changes, into the Schedule.  The fee proposals are made by OMA Constituency Executives (e.g., Section or MIG) as part of the fee allocation process.

For additional negotiations and PPC resources, please see:

• Negotiations resource page
• PPC resource page

The 2021 Physician Services Agreement included a provision that directed the Physician Payment Committee to recommend how to implement each section’s or physician grouping’s compensation increases to the Schedule of Benefits, as well as changes that are revenue-neutral. This includes introducing new fee codes, the revision of existing codes, and fee value changes. The PPC makes recommendations that are then approved by PSC and OMA’s board.

The PPC completed this process for Year 1 and 2 increases under the 2021-2023 PSA, with permanent changes implemented on April 1, 2023.

The process for Year 3 of the 2021-2023 PSA and Year 1 of the 2024-2028 PSA is ongoing, with permanent changes set to be implemented in tandem on April 1, 2026.

The PPC is a bilateral committee with equal representation from the OMA and the Ministry of Health. Its structure allows OMA constituencies (sections, MIGs and fora) to be directly involved in the process of determining which of their fees should be increased or decreased and what new codes should be created.

The historic award amount for Year 1 of the 2024-2028 PSA provides a unique opportunity for constituencies to make truly transformative changes in modernizing the schedule to reflect current practice, address intra-sectional relativity, gender pay equity, as well as changes in technology/innovation.

The size of the award could not have been anticipated when constituencies submitted their proposals in late 2024, and many constituency leaders have asked for an opportunity to submit additional proposals. To re-open the submissions process, the PPC had to reschedule the permanent changes to the schedule.

Having a clear and concise OHIP Schedule of Benefits allows all physicians to have a clear understanding of how to bill OHIP appropriately for the insured services they provide. Keeping antiquated fee codes in the schedule causes confusion and potentially incorrect OHIP claim submissions.

The PPC recognizes many other tables are considering gender pay equity and that there is no single solution; addressing it will likely require multiple strategies.

For its part, the PPC has invited OMA constituencies to bring forward proposals that contribute to addressing gender pay equity. The PPC may also pose questions to constituencies on the impact of their proposals on gender pay equity.

The current allocation process is dictated by the Physician Service Agreement and based on the hybrid CANDI-RAANI score. In the 2021 PSA, there are no special funds for such a project.

If a code generates savings across different specialties, those savings are distributed to the specialties billing the code. If you are aware that what you are proposing affects multiple constituencies, it is best practice to meet with the affected constituency leaders in advance to get agreement on your proposal or create a joint proposal.

The PPC fee-setting process is limited to the funds that each section or physician grouping is currently receiving, plus the increases prescribed in the PSA. If you are looking to receive funding that goes beyond those limitations, you would need to bring this to the Negotiations Task Force (negotiations@oma.org). Additional information on the negotiations process can be found on OMA’s website.

Working on something that is overarching is complex and generally affects multiple constituencies, making it difficult to cost. Although it would be a significant challenge, that type of change is still within the PPC’s purview, and the committee would be willing to engage in that type of revision. 

The PPC is also responsible for bringing forward recommendations to the Physician Services Committee on how to manage flow through to non-fee for service payments and other programs, such as Alternate Funding Plans, as specified in the 2021-2014 PSA the 2024-2028 PSA and the Supplementary Year 3 and Year 1 Implementation agreement.. Please note that if you are on salary from a hospital, then that is not in the committee’s purview.

If there are issues with payment rejection or other technical questions about billing rules, please direct them to the OMA by contacting info@oma.org.

New and emerging technologies and/or treatment services that are generally accepted within Ontario as experimental should not yet be brought forward to the PPC. Consideration for new codes is limited to services that are now considered standard of practice within Ontario.

This is a rule change that falls into the mandate of PPC. However, the challenge is that it can be exceedingly difficult to cost and would represent a significant philosophical change that would affect multiple constituencies. In previous years, these types of changes have been made through the negotiations process.

The PPC fee allocation process allows for OMA sections, MIGs and fora to be directly involved in developing fee proposal(s) to modernize the OHIP Schedule and to address issues related to fee relativity, gender pay equity in medicine and changes related to medical innovation and technological advancements. OMA staff works closely with sections, MIGs and fora to assist them in this task. 

The process to develop recommendations is:

• Sections, MIGs and fora:
• Consult with their membership (for example, through surveys) and prepare proposals
• Submit proposals in advance of deadline
• Attend virtual consultation sessions hosted by PPC* 
• PPC 
• Share draft recommendations with sections, MIGs and fora for comment
• Consider those comments and updates the recommendations as needed
• Submit final recommendations

* The PPC will consider a proposal and, if required, the committee will request a meeting with a Section/MIG/Forum to discuss it in greater detail.

The PPC has developed guidelines and principles that will be employed when engaging OMA sections, MIGs and fora, and interpreting proposals that come forward. The orientation manual includes:

• Guiding principles to the PPC fee allocation process
• Guidelines for submitting a proposal
• Presentation guidelines

Intersectional relativity is determined by the 2021-2024 PSA and the the Supplementary Year 3 and Year 1 Implementation agreement. This matter is dealt with each time the PSA is negotiated and is not within the PPC’s scope.

More information can be found on the Negotiations webpage. 

There are several other reasons that the PPC and a constituency may meet:

• So that the PPC can obtain clarification on a submission
• To provide the constituency with more details following the release of a report with draft recommendations
• At the request of a constituency for other reasons

Constituency leaders can request a meeting with OMA’s PPC team at any time by emailing PPC@oma.org.

This process is for Year 3 of the 2021-2024 PSA and Year 1 of the 2024-2028 PSA. 

Under the terms of the 2021-2024 and 2024-2028 PSAs, a quarter of the increases will be permanently paid across the board to all physician sections and groupings, and three quarters will be allocated based on relativity. Increases will roll out in phases until permanent changes to the Schedule of Benefits are in place on April 1, 2026. 

OMA has posted a fee table with details on each constituency’s allocations.

Intersectional relativity is determined by the 2021 & 2024 PSAs. For Year 3 of the 2021-2024 PSA and Year 1 of the 2024-2028 PSA, relativity is 75 per cent of the increase, and the other 25 per cent will be permanently paid across the board to all physician sections and groupings.

To learn more about OMA’s work on relativity, please see the OMA Relativity Advisory Committee Resource page.

The PPC process now has a higher degree of transparency and includes several opportunities for physician leaders to provide feedback and engage directly with the PPC. Draft reports include the submissions of all other sections and groups, so you can identify any crossover issues that might impact your section. This increased transparency and consultation will help identify these issues and allow for mutually agreeable resolutions between sections.

OMA’s Stop the Crisis campaign advocates for policy changes that the Ontario government should implement to address the crisis in the province’s healthcare system, and is separate from the PPC process.

The current allocation process is prescribed by the 2021 & 2024 PSAs. As such, the PPC is limited to the funds which each section or physician grouping is set to receive, plus what might be negotiated in the future. If you are looking to work beyond those limitations, bring your concerns to the Negotiations Task Force in advance of the next round of negotiations.

Additional information on the negotiations process can be found on OMA’s website.

Both parties agreed to adjust the PPC’s timelines to better accommodate the inclusion of both the 2021 PSA Year 3 (2023-2024), and 2024 PSA Year 1 (2024-25) permanent increases into the current ongoing process. The committee is obligated to make recommendations regarding the April 1, 2026 permanent fee adjustments to the PSC in October 2025.

For additional information, please see Year 1 Arbitration resource web page including frequently asked questions.

These are separate increases that are scheduled to come into effect on the same date, with permanent implementation in place on April 1, 2026.

There are many reasons for the deferral of items, including:

• The OMA constituencies’ prioritization of fee proposals and decisions on how to stage their implementation
• The potential cost implications exceeded available funding
• There were wide-ranging implications on fee relativity both in terms of intrasectional and intersectional relativity
• Additional information and study were required to determine appropriate cost implications, due to the complexity of the proposal
• Cost implications would significantly impact other section or physician grouping allocations, in some cases exceeding their available funding
• Alternative solutions were raised during bilateral committee deliberations, potentially resulting in a better approach, requiring further study with the OMA constituencies (for example, revision of existing codes rather than creation of new codes)
• Lack of consensus between PPC members as to whether a proposal should be supported.  

The PPC recognizes the significant time and effort OMA constituencies put into canvassing constituency groups, developing and refining proposals and answering queries from the PPC. In fall 2023, OMA constituencies were given an opportunity to reconsider and resubmit any proposals that were not implemented in the previous round and that the OMA constituencies continue to support.

No, but the PPC provides updates on the PPC’s work, including decisions and their associated rationale.

Those codes are currently at the Appropriateness Working Group table and PPC is unable to review the item until AWG produces their recommendations. Once AWG has completed its work PPC can go back to the affected constituencies to discuss how to proceed from there.

The scope of the AWG was set by the terms of 2021 Physician Services Agreement to satisfy outstanding requirements of the 2019 Kaplan Arbitration Award in which the Ministry of Health and OMA agreed to a continuation of the working group.

Phase I of the work of the AWG was completed in October 2019. Phase II began shortly thereafter, however, it was paused due to COVID. Work has since continued on the 11 previously tabled proposals and 10 proposals have been bilaterally agreed to. Currently, only the proposal on chronic pain is outstanding.

Any PPC items deferred due to AWG work   remain out of scope for PPC consideration until they are resolved.

Additional information on the work of the AWG can be found on the OMA website.

Even though OMA-MSPC had some lead time to work with constituencies before the 2021 PSA was ratified, the bilateral PPC didn’t begin its work until after the PSA was ratified starting with the OMA-MSPC’s July 2022 report. As a result, the PPC did not have enough opportunity to provide all the feedback that it was hoping to provide. We continue to work on improving our processes, and we are doing a better job explaining the committee’s decisions in greater detail in the current round.

As per the 2021 PSA, the PPC replaced the Medical Services Payment Committee and was given the mandate to bring forward recommendations for the Year 1 and 2 fee increases by October 2022. The bilateral PPC began in July 2022, and as a starting point, considered the OMA-MSPC’s July 2022 Report.

Given the deadline to make recommendations by no later than October 2022, the committee found itself short for time to fully consider all fee proposals and consult the various constituencies.

In many cases, proposals were deferred due to requests exceeding the available funding in Years 1 and 2. These deferred proposals remain under consideration by the PPC as Year 3 (2021-2024 PSA) and Year 1 (2024-2028 PSA) funding becomes available.

We continue to work on improving our processes by explaining the committee’s decisions in greater detail.

Please send us an email if you wish to set up a face-to-face meeting.

No. Since there are a myriad of factors that influence the utilization of medical services, decomposing the cost implications of the fee code changes alone would be incredibly challenging, if not impracticable. For example, there could be changes in physician/patient populations or changes in physician practice that could influence a service's utilization beyond the price change. In addition, it could take a period of time for the profession to become fully aware of some schedule changes. The costing estimates provided as part of the process assume utilization to be constant to avoid these complex methodological problems.

If a member of your section executive needs to spend their own time doing work to support a PFAF, then there may be funds available. There are 24 allocation units that may be dedicated to this type of work.

The PPC is currently accepting proposals. Constituencies have until February 3, to submit them via the Professional Fee Assessment Form (PFAF).

Febuary 3, 2025, is the firm deadline and reflects the need for the PPC to prepare recommendations by October 2025. The deadline aims to allow time for multiple feedback cycles to occur directly with section, MIG and forum leadership. Although this is an iterative and ongoing process, all groups are encouraged to provide robust submissions with data, along with any relevant supporting evidence.

The Professional Fee Assessment Form (PFAF) is used to assist the committee in evaluating a fee proposal. It contains valuable information needed to determine whether the proposal has merit and, if so, determine an appropriate fee value and payment rules. Some key aspects contained in the form include:

• Description of the service
• Physician time required to perform the service
• Intensity of the service provided
• Relativity with similar services

Submissions for new services or revision of services will require the completion of a PFAF and/or the inclusion of reference materials supporting the proposal. If this information is not provided to the PPC at the outset, the PPC may need to request the missing details, which may delay the process and cause the proposal to be deferred to a future fee allocation process.

Each proposal to add, revise or delete a fee code should have an accompanying PFAF. However, where a submission involves a price change  of multiple fee codes with a common rationale, a single form may be completed.

For proposals that do not conform to the constraints of a PFAF (e.g., large scale intrasectional relativity initiatives, major schedule re-writes), you can use the Schedule Modernization Brainstorming Form (a.k.a. “big ideas” form).

Please note that all ideas must fall within the scope of the PPC (i.e., specific to revisions to the schedule of benefits). The PPC intends that this process bring forward novel ideas which assist the PPC in achieving its ongoing objective of schedule modernization.

This should not be submitted in lieu of a PFAF for fee setting proposals. 

Yes, you can attach files to the form.

Yes, you can describe this in the form. You will be able to see all the proposals from other sections/MIGs/fora following the submission window. If that proposal causes concern, you can provide that feedback to the PPC.

All PFAF submissions must be made electronically: Access the Professional Fee Assessment Form (PFAF).

You can also download a Word version of the form (to help prepare your responses or collaborate with others before filling out the fields in the  online portal above):

• Revision to an existing fee code (Word document)
• Deletion of a fee code (Word document)
• Introduction of a new fee code (Word document)
• Fee value changes only (Word document)

The goal of the process is to modernize the Schedule of Benefits to reflect how physicians currently practise medicine. Proposals should be clear, actionable and fall within the mandate of the PPC. The merits of proposals are evaluated based on the evidence and rationale provided by the section/MIG/forum. This could take a number of forms depending on the proposal. Some examples of supporting evidence include:

• Academic research on best practices or standard of care associated that would support the creation or deletion of a code
• Survey results indicating a fee is misvalued relative to the time and intensity

When considering a fee proposal, the PPC will take the following into consideration:

• Physician time taken to provide the service (pre-service, intra-service and post-service)
• Intensity of the service provided
• Knowledge and judgment
• Communications and interpersonal skills required to provide the service
• Technical skills (complexity of the service)
• Risk and stress
• Fee relativity with other comparable services
• The proposals do not exacerbate existing intrasectional relativity issues

There is no limit on the number of proposals that can be submitted and the PPC will make every effort possible to evaluate all submissions. Unfortunately, the volume of such requests may mean that the PPC does not have adequate time to give requests the proper attention they are due. As a result, the PPC requests that, in instances where your section/MIG/fora has a large volume of requests, you:

• Prioritize all requests, starting with the most critical and continuing the list in order of descending priority
• Ensure the requests you are bringing forward have the support of your full executive
• Understand there will be limited time for presentations and items that are not presented to the PPC in this time period may be deferred to another fee allocation cycle for proper consideration
• Complete a single PFAF for a submission involving a price change of five or more fee codes with a common rationale

Items that have not been submitted by the stated deadline (with the appropriate form, where applicable) will not be considered during the current cycle.

For services that are billed by multiple OMA constituencies, the PPC encourages the constituencies to work collaboratively in developing their proposals. All OMA constituencies will be consulted about services that are billed by multiple OHIP specialties. However, if there are differences in opinion, then the OMA constituencies may bring forward separate proposals.

The PPC may meet with multiple constituencies to help resolve any disputes. In situations where an agreement cannot be reached, the opinions of all OMA constituencies affected by the change will be considered, while making every effort to ensure undervalued services are addressed fairly. Cost-impact analysis of a fee proposal will be estimated proportionately among affected sections or physician groupings.

The PPC considers proposals that are revenue neutral and those that require funding. Before revisions to the Schedule of Benefits can be finalized, constituencies may need to prioritize their proposals. If you’re able to move funds from one code to another, then you may not need to rely on new funds in the allocation process. Likewise, decreasing or deleting a code could free up funding that could be redirected toward other fee proposals.

Yes, the PPC is considering proposals for a range of new fees.

Yes, the PPC considers proposals that would equate your specialty’s consultation fee with another. Note that a stronger submission would reference comparison evidence between fees within your own specialty’s menu of codes.

When considering a fee proposal, the committee takes the following into consideration:

• Physician time taken to provide the service (pre-service, intra-service and post-service)
• Intensity of the service provided
• Knowledge and judgment
• Communications and interpersonal skills required to provide the service
• Technical skills (complexity of the service)
• Risk and stress
• Fee relativity with other comparable services
• The proposals do not exacerbate existing intrasectional relativity issues

Consider the following when preparing your section’s presentation:

• The PPC has set specific deadlines for this process. Missing these deadlines means your requests will have to wait for another fee allocation cycle
• In preparing your presentation, please ensure you include the completed Professional Fee Assessment Form for each requested item. The PPC will prioritize requests that are accompanied by these forms
• Please try to be concise when making arguments in favour of your section’s position on the requested item(s). Any related documentation (scientific papers, data from other jurisdictions, expert opinions, etc.) should be included in your submission

For additional information, please refer to the presentation guidelines in the orientation manual.

Usually, sections/MIGs/fora are represented by one or two members of the executive (for example, chair and/or tariff chair). It is not unusual to have additional physician(s) to attend the discussions with expertise on a particular item or field. Please reach out to your senior lead for more information.

We ask that your section attend at the scheduled date and time, if possible. You may, for example, ask your section/tariff chair or another designate familiar with the item(s) to attend on your behalf. If this is necessary, please take the time to inform OMA staff of this change. This will ensure the PPC is aware of the change and the section designate(s) will be permitted to represent your section.

Alternatively, you may submit your pre-recorded presentation electronically in advance of the scheduled date.

The PPC makes every effort to create an informal, inviting environment that promotes the frank exchange of ideas and opinions relating to the presented issues. To create this environment, the PPC makes every effort to schedule “like” clinical sections around the same time. This facilitates a two-way flow of information and allows the PPC to ask the opinion of other OMA constituencies where there is clearly an inter-sectional crossover of medical knowledge relating to the proposal items.

Submitting a pre-recorded video prior to the in-person meeting date can be beneficial to constituencies, because the session time can be used to discuss your submission in detail and to answer questions.

A link to your recording can be submitted to PPC@oma.org. Please note, we are unable to receive actual video files by email due to file size limitations. Many common software products have easy-to-use recording features, (for example, MS PowerPoint, MS Teams and Zoom). Videos can be uploaded and shared using a variety of cloud-based hosting services, such as Vimeo, YouTube, OneDrive, Google Drive and Dropbox.

The PPC considers all reasonably presented and documented requests from constituency representatives. However, certain elements can help the PPC easily understand and engage with the material during the session, such as:

• A concise, well-organized and to-the-point presentation
• Prioritizing items by starting with the most important request
• Strong supporting documentation and presenters with familiarity with the material, to permit a productive exchange with the committee members
• Consistency between the written and oral presentation
• Submitting materials in advance of the presentation date or pre-recording a presentation

OMA staff supports the committees and constituencies by:

• Working with the OMA constituencies to undertake customized intrasectional fee relativity surveys
• Hosting information/education sessions with OMA constituency executives and answering their questions. A recording of the sessions is available on the PPC web page for those who were unable to attend
• Providing an orientation manual with FAQs on the fee allocation process
• Creating an interactive costing table by fee code allowing OMA constituencies to evaluate individual fee value changes
• Analyzing customized OHIP physician billings
• Providing assistance with developing fee proposals
• Co-ordinating constituency leadership meetings
• Sharing updates on the dedicated PPC web page
• Leveraging a web-based portal for fee-setting proposals to make the process more efficient for members and staff
• Closely monitoring member reaction and sharing with the OMA constituencies to ensure appropriate follow-up where necessary

Subsequent to an anticipated release of the list of submitted proposals if members are aware of a proposal submitted to their constituency and not submitted to the PPC by their constituency, and that they believe should be considered by the PPC, then they may submit a proposal to the PPC by the deadline (tentatively Mar.7, 2025).

Member group submissions:

• Require the support of the lesser of 50 or more members or 20 per cent of members of a given constituency whose names, OMA numbers and contact information must be included in the submission
• Must identify two physicians as the leads for the proposal
• Must follow the guidelines for submitting a proposal
• Shall address why their proposal was not brought to PPC2024 PPC entitlement

The OMA has allocated an additional 24 entitlement units (1 unit = 1 hour of time x $130/hour), to every section, MIG and fora to be used to participate in the PPC fee allocation process in 2025.

All submissions for reimbursement should be sent to MemberHonoraria@oma.org. Please include the following information:

• Member name and OMA number
• Date that work was completed or meeting was held
• Start time and end time of time spent on the activity or at the meeting
• What work was accomplished or specify that a meeting was attended

Approvals for honoraria will follow the standard approval process. The chair of the section/MIG/fora will need to approve applications from other executives and an executive member will have to approve the chair’s time. Please copy the appropriate approver when sending your email for honoraria submission.

Eligible tasks include:

• Preparing fee allocation proposals
• Presenting to the PPC (up to three members can be reimbursed for attending each section presentation)
• Preparing for the PPC presentations
• Reviewing and responding to questions and recommendations from the PPC
• Attending section/MIG/fora meetings to discuss fee allocation proposals or PPC recommendations

Eligible work must be completed by Dec. 31, 2025, and all reimbursement requests must be submitted to the OMA by Jan. 15, 2026, as this coincides with the OMA’s year end. Please note that entitlements can be used retroactively for any work done back to Jan. 1, 2025.

Yes, any member that contributed to the fee allocation process will be eligible for reimbursement. The chair of the section/MIG/fora would have to approve the work. Please note, that in order for a member to receive payment from the OMA, they will need to have their social insurance number and direct deposit information associated with their OMA account. The SIN can be added to OMA’s My Account system. If a member needs help adding these details to their account, please call 416-340-2987 for assistance.

Please email the direct deposit form along with a personal void cheque to MemberHonoraria@oma.org.

Please reach out to your dedicated Sr. Lead.