Physician Payment Committee

We anticipate the Board of Arbitration will finalize the award sometime early this fall. We will update you on this timing when we know more.

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.

Read our full arbitration submission and a summary of our proposal on our web page. The major compensation takeaways are: 

• 10.2 per cent for catch-up/inflationary repair: To repair the damage done to physicians from rising inflation, increased overhead costs and the impact Bill 124 had on the previous PSA
• Five per cent general price increase: To help preserve our health-care system and support the physicians at its core
• 7.7 per cent in targeted funding: To address a variety of critical areas identified during our comprehensive consultation and engagement process and ongoing dialogue with physician leaders

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 MOH (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.

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, 2025.

The PPC is a bilateral committee with equal representation from the OMA and the MOH. 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.

Having a clear and concise OHIP Schedule of Benefits allows all to have a clear understanding of how to appropriately bill OHIP for an insured service rendered. Having antiquated fee codes listed 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 driven 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 2024 negotiations process can be found on the 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, as specified in the 2021 PSA, such as Alternate Funding Plans. Please note that if you are on salary from a hospital it 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 is a significant philosophical change affecting 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 consultation sessions hosted by PPC*
• PPC 
• Shares draft recommendations with sections, MIGs and fora for comment
• Considers those comments and updates the recommendations as needed
• Submits 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. These include:

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

Starting before allocations were known has allowed extra time for iteration, and discussion with constituencies.

Even though constituencies did not know their allocation, they had access to an interactive table that provided useful information. It let them see current payment for various codes and in some cases helped them make some preliminary costing assumptions. Additionally, they could see what impacts their fee codes would have on other specialties and/or if any of them are out of relativity. Furthermore, access to the interactive table is an opportunity for new tariff chairs and executives to familiarize themselves with the table.

Implementation dates are prescribed in the PSA. As with Years 1 and 2, starting the process early provides constituencies with more time to consider and draft their proposals. Once Year 3 (2021-2024) and Year 1 (2024-2028) allocations are known, it may be easier for you to take another look and reprioritize your proposals.

Intersectional relativity is determined by the 2021 PSA which stipulates that 25 per cent of the global increase will be allocated to each section or physician grouping on an equal percentage amount and 75 per cent of the global increase will be allocated to each section or physician grouping based on the hybrid CANDI-RAANI score.

This matter is dealt with each time the PSA is negotiated and is not within the PPC’s scope.

A need might arise where the PPC invites a section/MIG/fora to meet and discuss a portion of their submission. For example, this may occur when a section/MIG/fora has submitted additional information (at the PPC’s request) when the committee has found it necessary to seek additional clarification, or to provide more details to the section/MIG/for following the release of draft recommendations.

This process is for Year 3. The current contract is a three-year agreement from April 1, 2021, to April 1, 2024, and thus there is no Year 4 for this contract.

This process also includes Year 1 of the next contract (2024-2028).

Please note that although the contract is for April 1, 2024, the changes to the schedule would occur on April 1, 2025. The hope is that in December 2024, PPC does not have any cost-neutral items that it needs to defer.

Our intention, starting in September this year, is to deal with the cost-neutral deferred items. As soon as an item is resolved, it can go into the queue for the next scheduled update to the Schedule, which happens every three to six months. If our deliberations on those items are completed before November 2024, then they could potentially be implemented into an earlier version of the schedule.

Cost-neutral changes can be reviewed at any time and are part of an ongoing process. Typically, the schedule is updated every three to six months, however, it takes time to incorporate new cost-neutral changes.

Under the terms of the 2021-2024 PSA, a quarter of the 2023-24 increase will be permanently paid across the board to all physician sections and groupings, and three quarters will be allocated based on relativity. The permanent allocation is scheduled to take place, at the earliest, on April 1, 2025. Until then, payments will be made on an across-the-board increase with flow through to non-fee-for-service payments as soon as possible.

Allocation details pertaining to the Year 1 of 2024-2028 award are not yet known.

As per the March 2024 implementation and procedural agreement, the Ministry of Health agreed to target the same date (April 1, 2025) for permanent implementation of both the 2021 PSA Year 3 (2023-2024) and 2024 PSA Year 1 (2024-25) increase through the Physician Payment Committee (PPC) fee setting/allocation process.

Total allocation will not be known until after the award has been announced by the Board of Arbitration. The award date is anticipated to be sometime in late summer. As soon as PPC is aware of each section’s or physician grouping’s estimated compensation increase for 2021 PSA Year 3 and 2024 PSA Year 1, PPC will inform the constituencies and incorporate it into their respective interactive fee tables.

Intersectional relativity is determined by the 2021 PSA and the March 2024 implementation and procedural agreement and is not within the PPC’s scope to change. For Year 3, relativity is 75 per cent of the increase as agreed under the 2021-2024 PSA. The other 25 per cent of the 2023-2024 increase will be permanently paid across the board to all physician sections and groupings. The ratio under the 2024-28 PSA has not yet been determined.

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

This round of the process has a higher degree of transparency and includes several opportunities for physician leaders to provide feedback and engage directly with the PPC. The draft report includes 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.

Prescription for Ontario recommends policy changes to the Ontario government that would address issues in the province’s health-care system, and is separate from the PPC process.

Each section’s or physician grouping’s fee increase is prescribed by the 2021 PSA.

The PPC will consider the following general criteria:

• Total time a typical physician takes (pre-, intra- and post-service) to provide the typical service
• Intensity of the service provided, including knowledge and judgment, communications and interpersonal skills required to provide the service, technical skills (complexity of the service), and risk and stress
• Fee relativity with comparable services

Where appropriate, the PPC may also consider the following:

• Practice expense/overhead costs, such as rent, staff compensation, medical supplies and equipment needed to perform a service
• Add-on fees and premiums commonly billed with the base service

There will be a particular focus on addressing intra-sectional fee disparities, gender pay inequities and modernization vis-à-vis medical innovation and technological advances.

The current allocation process is prescribed by the 2021 PSA. 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 2024 negotiations process can be found on the OMA’s website.

In the March 2024 implementation and procedural agreement, The Ministry of Health agreed to target the same date (April 1, 2025) for permanent implementation of both Year 3 of the 2021-2024 PSA and Year 1 of the 2024-2028. Implementation of this increase is being managed through the PPC process.

Separating out Year 1 mediation, and now arbitration, from the rest of the PSA negotiations allows you to receive your Year 1 compensation increase much sooner than would have been the case otherwise, puts the focus on catch-up for the effects of inflation, and reflects our member-driven high-priority proposals for targeting funding in areas affecting all physicians.

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

They are only connected in terms of timing. The agreement on Year 3 (2023-24) implementation and the timing of the Year 1 (2024-25) arbitration speaks to the joint commitment of the OMA and government to find solutions to issues impacting Ontario’s doctors, as soon as possible.

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 will provide 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. The hope is that over the following year, AWG will be able to complete its work and then PPC can go back to the affected constituencies to discuss how to proceed from there.

The bilateral Appropriateness Working Group (AWG) recently reached an agreement on several proposals, as announced in an OMA board chair alert shared in June 2023. Eight proposals have now been approved by the OMA Board of Directors and the Ministry of Health of the 11 topics listed in the ratified 2021 PSA (Part F) and implemented on July 1, 2023; three items remain outstanding.

PPC items deferred due to AWG work are all related to the remaining outstanding AWG items. As such, those deferred items remain out of scope for PPC consideration.

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 of 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 the consideration of the PPC as Year 3 funding becomes available.

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.

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 advocating for a multi-year iterative process; however, the decisions surrounding the timing of a future intake are at the discretion of the OMA Board and Physician Services Committee. The PPC is a bilateral committee and implementation also requires the commitment of the OMA and the Ministry of Health. 

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, additional details may be requested, which may delay the process and cause the proposal to be deferred to a future fee allocation process.

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

The PPC considers proposals that are revenue neutral and those that require funding. When the Year 3 (2021-2024 PSA) and Year 1 (2024-2028 PSA) permanent fee increases are known, 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

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

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 2024.

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, 2024, and all reimbursement requests must be submitted to the OMA by Jan. 15, 2025, 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, 2024.

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.