FHO+ changed what a missed appointment costs you.
On April 1, 2026 the access bonus ended, the blended fee-for-service premium rose from 19.41% to 30%, and physician time became billable by the hour. Every one of those changes moves in the same direction: an empty slot in your day is now worth roughly four times what it used to be.
Four changes, one direction.
These are the changes that touch scheduling and access. All took effect April 1, 2026.
Access bonus & outside use
Outside use and access bonus payments have ended for FHO physicians. You still receive the outside use report for reference, but deductions are no longer generated.
Comprehensive care capitation
CC cap payments have ended, with reconciliation processing remaining available until March 31, 2027 for enrolment adjustments in that window.
Blended FFS premium: 19.41% → 30%
Applied to all in-basket services for enrolled patients. A further increase to 50% for specific in-basket services has been signalled, retroactive to April 1, 2026.
Hourly rate payments
Direct care, telephone care, indirect care and clinical administration are now claimable hourly in 15-minute units — $80/hour for most codes.
We had that argument in our own model until we checked the bulletins. We removed it. What replaced it is a stronger case, not a weaker one — because the changes that ended the access bonus also made your time directly billable, and made every empty slot visibly expensive.
What one recovered 15-minute slot is worth.
Under the old FHO terms, capitation was paid whether or not the patient showed, and shadow billing was 19.41% — so a no-show barely registered financially. Under FHO+, that slot is unbillable time and a forgone premium at the higher rate.
Based on an intermediate assessment at 2024 base value carried forward at the published 2026–27 relativity adjustments (4.8506% for FHO/FHN/GHC; 6.2901% for FFS/FHG/CCM), plus the $20.00 fifteen-minute Q310A unit. Your actual mix of codes will differ. This is a planning estimate, not billing advice — confirm with your billing advisor.
Rolling out online booking is itself billable time.
The Ministry's definition of Clinical Administration Time — Q313A, payable at $80/hour in fifteen-minute units — explicitly includes quality improvement planning and clinic-based implementation work. The bulletin names two things in that list that describe an online booking rollout almost word for word: planning and implementing patient access and equity initiatives, and training and change management associated with the adoption of digital health-driven solutions and initiatives. EMR updating and management requiring physician expertise is named as well.
| Code | What it covers | Rate |
|---|---|---|
| Q310A | Direct patient care — in person, in-office video, and telephone care provided in office | $80/hr |
| Q311A | Direct telephone-based care when you are not in the usual practice setting | $68/hr |
| Q312A | Indirect patient care — charting, results review, referrals, care coordination | $80/hr |
| Q313A | Clinical administration — proactive roster management, EMR management, quality improvement and digital health adoption | $80/hr |
The limits matter. Hourly billings are capped at 14 hours per day and 240 hours per 28-day cycle. Indirect care and clinical administration together cannot exceed 25% of your total monthly hours, and Q313A alone cannot exceed 5% of your total monthly hours billed for direct and indirect care. Income stabilization physicians are not eligible to bill hourly codes.
Practically: a physician billing 120 clinical hours in a month has roughly six hours of Q313A headroom — about $480 — and implementing better patient access is squarely within what that code is for. We are not telling you how to bill; we are telling you that the implementation work you were treating as unpaid overhead may not be. Ask your billing advisor.
Three consequences, in order of size.
1. No-shows got expensive
Reminders and easy self-rescheduling used to be a convenience argument for FHO physicians. At roughly four times the previous slot value, they are now a revenue argument. This is the single largest change.
2. Filling the slot matters again
Under pure capitation there was little direct reward for filling a gap. With time billable hourly and the premium at 30%, a slot that gets rebooked instead of sitting empty pays twice — the time unit and the premium.
3. Access is no longer enforced by clawback
The access bonus used to penalise you when patients went elsewhere. That enforcement is gone — so the reason to be reachable is now retention and roster stability, not avoiding a deduction.
There is a caution in here too, and we would rather say it than have you discover it. Because outside-use deductions have ended, a patient who books at a walk-in instead of with you no longer costs you a capitation deduction. If your case for online booking rested entirely on that, the case genuinely got weaker. What it did not do is get weaker overall — the no-show and hourly-billing changes are considerably larger than the access bonus ever was for most rosters. Our calculator reflects both directions.
What FHO+ changed for your clinic.
This compares the value of recovered appointment slots under the old FHO terms against FHO+, at your volume. Every assumption is documented on our evidence page.
Planning estimate only, not billing or financial advice. Slot values are built from an intermediate assessment at 2024 base value carried forward at published 2026–27 relativity adjustments, plus the $20.00 Q310A fifteen-minute unit. Your code mix, roster and hours will differ. Confirm all billing with your billing advisor. Q313A headroom shown is the 5% ceiling, not a recommendation of hours to claim.
Want this modelled against your actual roster?
Bring last month's appointment volume, your no-show count, and your current online-booking share. We'll work through what FHO+ changed for your group — and what it would take to close the gap.
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