FHO+ Time-Based Billing: What It Means for Your Clinic

How many hours did you spend last month chasing down whether a patient accessed outside care, so your billing didn’t get clawed back? If your answer involves any amount of frustration, FHO+ has some news you’ll want to hear.

Starting April 2026, Ontario’s new FHO+ compensation model eliminates the access bonus and the negation system entirely. That means no more tracking outside-care penalties, no more clawbacks eating into your monthly payments. In their place: a flat $80 per hour rate for eligible time-based activities, alongside separate premium structures for after-hours and shadow billing work.

That sounds like a win. For most physicians, it probably is. But the shift from outcome-based bonuses to time-based payments doesn’t simplify things as much as it moves where the complexity lives.

What’s Actually Changing Under FHO+

The access bonus has been one of the more contested parts of Ontario’s family medicine compensation model. Physicians in Family Health Organizations were penalized financially when their rostered patients sought care outside the practice, even when that access gap wasn’t the physician’s fault. Eliminating it removes a real administrative and financial headache.

The $80/hour rate applies to eligible time-based activities including direct care and indirect care tasks like results review and referral follow-up. After-hours work sees a meaningful improvement over the previous model, with shadow-billed after-hours services now compensated at 50% of FFS, up from the previous 30%. Shadow billing has its own rate structure as well: the Q053 code has increased from $350 to $500, and a mother/newborn enrollment bonus of $350 has also been introduced—both flat fees rather than hourly rates. The minimum physician requirement to form an FHO also drops from three to two, which opens the door for smaller practices to organize.

Patient attachment bonuses are also part of the picture. For established physicians, these range from $100 to $180 per rostered patient, while new graduates may see bonuses ranging from $150 to $270, with amounts varying based on patient age and location. For practices serving patients in high-need areas or at the extremes of the age spectrum, this adds up quickly.

The big structural shift, though, is this: your revenue now depends on documenting time, not just outcomes. That changes daily operations more than most practice managers have had time to think through.

The Part Nobody’s Talking About Enough

Here’s what I keep thinking about when I look at these changes. Under the old model, physicians were rewarded or penalized based on what happened, whether a patient showed up, whether they went elsewhere, whether the chart was closed. Under FHO+, compensation is increasingly tied to what you did and how long it took.

That is a documentation problem. A big one.

Right now, most Ontario family practices have no reliable way to log indirect care time. Results management, prescription renewals, reading specialist letters, chasing referrals that have gone quiet, none of that gets tracked in a format that connects to billing. Physicians do it anyway, because patients need it, but it happens invisibly. No vendor has shipped a dedicated FHO+ time-tracking tool yet — see our FHO+ Time-Tracking Landscape for what is available.

Under FHO+, that invisible work becomes billable. But only if it’s captured. And capturing it consistently, across every physician and every MOA in the practice, is harder than it sounds without a system built to do exactly that.

My brother Jason spent 18 years as an Advanced Care Paramedic before co-founding OpsMed with me. He’s told me more than once that the documentation burden in family medicine is one of the most underestimated parts of the job. When he started talking to physicians about what FHO+ would actually require operationally, the reaction was mostly: “That’s great, but how are we supposed to track all of that?”

What Your Revenue Cycle Looks Like After April 2026

Let’s make this concrete. A busy family physician with a roster of 1,200 patients might spend, conservatively, two to three hours a day on indirect care tasks. Results review, inbox management, reviewing specialist notes, writing referral letters. Under the old model, that time generated zero additional compensation. Under FHO+, at $80/hour for eligible time-based activities, that same time block represents $160 to $240 per day in billable activity, if it’s logged.

Over a year, the difference between a practice that captures that time and one that doesn’t could be significant. We’re not talking about gaming the system; we’re talking about getting paid for work that was always happening and never being compensated.

The catch is that logging needs to be accurate, timestamped, and audit-ready. Ontario’s IPC and the CPSO both take documentation seriously, and billing practices that can’t be substantiated create compliance risk. This isn’t a situation where rough estimates or end-of-day summaries will hold up under scrutiny. For the complete documentation and compliance guide including ratio caps and audit preparation, see our FHO+ Billing Guide.

Accurate time capture means the logging has to happen as the work happens, or as close to it as possible. That’s where automation matters, not as a luxury, but as a practical requirement for making FHO+ work the way it’s intended.

What OpsMed Is Building for This

We designed OpsMed’s FHO+ time-logging module specifically for this problem. When a physician reviews a lab result in the workflow, that action is timestamped automatically. When a referral letter gets triaged and routed, that’s logged. When a patient message is reviewed and a draft response is prepared for physician approval, that time is captured.

Nothing gets billed or filed automatically. Every item with clinical implications sits in the physician’s review queue before anything moves. That’s not a feature we added; it’s how the system was built from the beginning, because review-first is the only model that makes sense in a clinical environment.

All of this runs on Azure Canada Central in Toronto. Patient data doesn’t leave Canada, PHIPA agent agreements are in place, and the security layer is backed by my brother Steven’s team at CyberLeda. Compliance isn’t something we bolt on at the end; it’s structural.

No other vendor in the Ontario market is offering automated time tracking designed explicitly for FHO+ indirect care billing. That’s not a boast, it’s just where things stand right now, and it won’t stay that way forever.

Getting Ready Before April 2026

April 2026 is approaching quickly. That is not a lot of runway, especially if you factor in the time it takes to evaluate a new system, run a pilot, train your MOA team, and integrate with your EMR. Practices that started thinking about this in late 2025 had options. Practices starting now need to move quickly.

The good news is that most of what FHO+ requires operationally, better inbox triage, reliable results routing, accurate time capture, these are things that make daily clinic life easier regardless of what the compensation model does. The billing upside is real, but the workflow improvements are worth it on their own. For a practical step-by-step approach to capturing FHO+ time, see our time-tracking capture guide.

If you want to understand what your current admin setup would look like under FHO+, and where the gaps are, we offer a free Clinic Efficiency Check-Up. It’s a 20-minute call, and you walk away with a one-page report showing exactly where time is being lost and what it would take to capture it. No obligation, no pitch deck.

And if your practice qualifies, we also offer a free 30-day pilot so you can see the workflow in action before you commit to anything.

The transition is coming fast. Worth at least knowing where you stand before it does, right?

Stay safe, Marc