The evidence behind every number in our calculator.
Most vendor ROI calculators are a black box with a big number at the end. Ours isn't. Here is every assumption, what it's based on, and where our defaults sit relative to the published range — which is deliberately at the conservative end.
Five layers, not one big number.
Each layer is calculated separately so you can discard the ones you don't believe and still keep the rest. Layers do not overlap — recovered no-show time is counted once, in Layer B, and nowhere else.
A · Admin booking labour
Every appointment booked online is a phone call your staff didn't handle. This is the most reliable layer in the model — it depends only on volume and wage, not on clinical behaviour.
Default: 8 minutes to book by phone, under 1 minute for an online booking, at a $26/hr fully loaded wage (wage plus roughly 18% payroll burden). That works out to about $3.00 of staff time per booking diverted from the phone.
B · No-show recapture
Two distinct effects. Automated reminders reduce missed appointments across all your appointments. Online booking adds a second, larger effect on the share booked online — because a patient who can cancel at 9pm without a phone queue actually cancels, freeing the slot for someone else.
Defaults: 9% reminder effect, 35% additional online-booking effect at full uptake, 70% of freed slots actually refilled, capped at a 70% total reduction. The published ceiling is higher than our default — see the table below.
C · Billable clinical administration (FHO+ terms only)
The Ministry defines Clinical Administration Time (Q313A, $80/hour in fifteen-minute units) to include quality improvement and clinic-based implementation work — naming patient access and equity initiatives and change management for the adoption of digital health solutions. Implementing and managing online booking sits inside that definition.
This layer replaced our access-bonus layer. Access bonus and outside-use deductions ended for FHO physicians on April 1, 2026, so that argument is gone and we no longer make it. This layer is zero for fee-for-service, FHG, CHC and salaried models.
D · Scenario upside
Rostering new patients through online meet-and-greets, capturing same-day demand at a walk-in, or consolidating booking desks across sites. Chosen by scenario; zero for a fully rostered single-site clinic, where layers A and B carry the entire case.
E · Directory exposure
Empower-only. Your clinic's listing and live booking availability on findhealth.ca and iamsick.ca, valued at its advertising equivalent. Editable, and easy to zero out if you want the comparison on licence and workflow alone.
What a recovered appointment slot is actually worth depends on how you're paid.
Under fee-for-service, a recovered slot bills at full fee. Under capitation it used to bill shadow billing only — so a no-show barely registered. That changed on April 1, 2026. The FHO+ implementations ended the access bonus and outside-use deductions, raised the blended fee-for-service premium from 19.41% to 30%, and introduced hourly payments for direct care, indirect care and clinical administration. A calculator still modelling access bonus protection is modelling a payment that no longer exists.
| Payment model | Value per recovered 15-min slot | Where the real return comes from |
|---|---|---|
| Fee-for-service | Full fee | Direct billing recapture on every slot that gets filled instead of sitting empty. |
| FHG (enhanced FFS) | Full fee + top-up | Same as FFS, with the enhanced fee-for-service premium applied. |
| FHO+ (April 2026) | Q310A time unit + 30% premium | An empty slot is unbillable time. The blended FFS premium rose from 19.41% to 30% and time became hourly-claimable, so a recovered slot is worth roughly four times what it was. Full explanation → |
| FHO (now on FHO+ terms) | Q310A time unit + 30% premium | The April 2026 changes apply to FHO physicians. Access bonus and outside-use deductions ended; comprehensive care capitation ended. |
| FHT (on FHO/FHN) | Q310A time unit + 30% premium | As FHO+ for physicians — plus admin savings across the whole salaried interdisciplinary team, not just the front desk. |
| CHC / salaried | Loaded hourly value | Recovered clinician and staff time, and reaching populations that an English-first, phone-gated system structurally misses. |
Slot values are built from an intermediate assessment at 2024 base value carried forward at the published 2026–27 relativity adjustments (6.2901% for fee-for-service, FHG and CCM family practice; 4.8506% for FHO, FHN and GHC), plus the $20.00 Q310A fifteen-minute unit for FHO+ models. Sources: OHIP INFOBulletin 260307 (relativity), 260308 (FHO+ implementations), 260309 (hourly rate payments), all issued April 1, 2026. We keep these as updatable constants rather than hardcoded figures. This is a planning estimate, not billing advice — confirm against the Schedule of Benefits, the bulletins, and your own remittance advice.
Owning a booking tool and getting value from one are different things.
Industry survey data for 2024 found that while a large majority of providers offered patient self-scheduling, only about 3% of practices reported more than three-quarters of their patients actually using it. Every layer above scales with uptake — which means a tool your patients can't or won't use returns close to nothing, whatever its sticker price.
Tier 1 — Low
Typical of restriction-first tools that gate on health card and exact record match. Most patients still phone; the front desk workload is essentially unchanged.
Tier 2 — Moderate
Phone volume measurably drops. Savings become visible on the schedule but reception is still booking-led.
Tier 3 — High
The front desk shifts from booking appointments to coordinating care. No-show recapture compounds as self-rescheduling becomes the norm.
Tier 4 — Leading
Where Empower clinics operate, with some running effectively all bookings online. Only a small fraction of practices anywhere reach this band.
Most EMR-integrated booking tools tag online-booked appointments in the chart, so you can run a report of appointments booked online over the last month and divide by total appointments. That is your current tier. Bring it to a demo and we'll model the delta against what your clinic could reach — using your numbers, not ours.
An English-first booking tool cannot exceed the share of your roster that reads English.
This is not a soft benefit — it is a hard arithmetic ceiling, which is why the calculator treats it as one. If 25% of your roster prefers another language, an English-only booking flow tops out around 75% uptake no matter how good the rest of the product is, and those patients arrive by phone, through an interpreter, or not at all. Canadian census data puts the number of people with limited English proficiency in the millions nationally, and far higher than the national average in many urban and newcomer-dense neighbourhoods. Published research links language barriers directly to difficulty booking and attending appointments, and to delayed use of preventive and screening services.
There is a fairness argument here too, and it cuts against the industry. Research from England found online booking awareness and use clustered away from deprived populations, with a sharp decline among the oldest patients — the usual reading being that online booking widens access gaps. Our reading is narrower and more useful: online booking widens gaps when it is designed for the easiest patients to serve. Booking that works in every language, without a login, without a health card match, for unattached and new patients, closes them instead. That design choice is why the language ceiling in the calculator applies to English-first tools and not to ours.
The numbers and where they come from.
| What it drives | Our default | Published range / basis | Source type |
|---|---|---|---|
| Staff time per phone booking | 8 min | Industry analyses of practice scheduling report roughly 8 minutes per booking by phone, and a similar average for a reschedule call | INDUSTRY |
| Staff time per online booking | <1 min | Same analyses report under a minute of staff handling for a self-scheduled appointment | INDUSTRY |
| Loaded reception wage | $26/hr | Ontario MOA wages of roughly $22–26/hr plus approximately 15–20% payroll burden | INDUSTRY |
| Baseline no-show rate | 7% | Canadian primary care studies report roughly 10% at academic family practices in Quebec, about 25% at an inner-city Saskatchewan clinic, and 11–30% in older Newfoundland and Alberta reports. Our default sits below all of them. | PEER-REVIEWED |
| Reminder effect on no-shows | 9% | Systematic reviews and large pragmatic trials of text reminders find reductions in missed visits in the range of roughly 7–11% depending on specialty | PEER-REVIEWED |
| Online booking effect on no-shows | 35% at full uptake | A survey study found a 53% relative reduction for patients using an online portal with scheduling. A 2025 study in Frontiers in Digital Health found median no-show rates of 1.8% for online-booked versus 5.9% for phone-booked appointments — roughly a 70% reduction. Our default is half the lower of those figures. | PEER-REVIEWED |
| Unused and never-booked slots | Not claimed separately | The same 2025 study found online scheduling cut unused appointments from 22.7% to 10.3% and never-booked appointments from 8.6% to 1.6%. We deliberately leave this out of the model rather than risk overlapping Layer B. | PEER-REVIEWED |
| Share of freed slots refilled | 70% | Not every cancelled slot gets refilled. We assume nearly a third are lost. | ESTIMATE |
| Value per recovered slot | By payment model | OHIP Schedule of Benefits fee for an intermediate assessment; FHO shadow billing at 19% of the traditional fee; average FHO capitation per rostered patient per year, age- and sex-adjusted | GOVERNMENT |
| FHO+ blended FFS premium | 30% | Increased from 19.41% effective April 1, 2026 for all in-basket services to enrolled patients; a further increase to 50% on specific in-basket services has been signalled, retroactive to the same date | GOVERNMENT |
| FHO+ hourly rate | $80/hr | Q310A, Q312A and Q313A are payable at $20.00 per fifteen-minute unit; Q311A telephone care outside the office at $17.00 per unit. Relativity adjustments apply. | GOVERNMENT |
| Q313A ceiling | 5% | Clinical administration time cannot exceed 5% of total monthly hours billed for direct and indirect care; indirect care and clinical administration together cannot exceed 25% of total monthly hours; overall cap of 14 hours daily and 240 hours per 28-day cycle | GOVERNMENT |
| Access bonus & outside use | Removed from model | Outside use and access bonus payments ended for FHO physicians effective April 1, 2026; outside use reports continue for reference but deductions are not generated. We removed this layer rather than keep claiming it. | GOVERNMENT |
| Why patients miss appointments | Narrative basis for Layer B | In the Quebec study, more than half of no-show patients said they forgot to call and cancel, and about one in ten said it was impossible to reach anyone at the clinic | PEER-REVIEWED |
| Self-scheduling adoption gap | Basis for uptake tiers | 2024 industry survey data: a large majority of providers offer self-scheduling, but only about 3% of practices report more than 75% patient use | INDUSTRY |
| Language ceiling | Your roster's share | 2021 Census figures on limited English proficiency; peer-reviewed qualitative research linking language barriers to difficulty booking and attending appointments and to delayed preventive care | GOVERNMENT PEER-REVIEWED |
| Provincial policy alignment | Context, not dollars | Online appointment booking is one of the pillars of Ontario's Digital First for Health strategy, with a published Ontario Health OAB service standard | GOVERNMENT |
Figures are summarised in our own words from the cited literature and public documents; where a range is reported we take the conservative end. This page is for planning and comparison purposes and is not clinical, financial, or billing advice — confirm OHIP and capitation values against the Schedule of Benefits and your own remittance advice. Vendor pricing referenced in the calculator reflects public list prices as of July 2026 and may have changed; verify with the vendor. If you believe we have a number wrong, tell us and we will correct it: team@empower.ca.
Now run it against your clinic.
Pick your payment model, set your uptake, and change any assumption on this page that you disagree with.
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Bring last month's appointment volume and your current online-booking share. We'll model it live — including the subsidy and pilot programs you may qualify for.
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