Nurse practitioners in Ontario warn of ‘unintended consequences’ with FHO+ funding model

Nurse practitioners have put out a position statement on Ontario’s new compensation model for primary care physicians, warning of “unintended consequences.”The new model introduces an hourly rate for direct and indirect patient care, among other changes. However, the Nurse Practitioners’ Association of Ontario (NPAO) says the new time-based funding for physician-specific work may financially discourage physicians from sharing the clinical load with NPs in a team-based setting.“[W]here practice revenue becomes increasingly linked to services or activities personally performed by physicians, there is a potential unintended consequence: physician practices may have less financial incentive or capacity to redistribute appropriate clinical work across the interdisciplinary team, including to NPs,” NPAO said in a statement released on Monday. In addition, FHO+ replaces negation (the dollar-for-dollar clawback that occurs whenever a rostered patient seeks care outside of the FHO, such as a walk-in clinic) with a new system known as the “continuity of care index.” The continuity of care index has a threshold target of 75%, calculated by setting the number of in-basket primary care visits provided to rostered patients by the physicians, another physician in the FHO or another “acceptable provider” and dividing this by the number of in-basket primary care visits provided to rostered patients by all family physicians. However, NPs are not considered “acceptable providers” under this index, although NP-provided services are also excluded from the denominator of this continuity calculation. NPAO has taken issue with this exclusion and says continuity measures “must appropriate recognize care delivered by NPs.”“Measures that primarily attribute continuity to the same physician risk underrepresenting the longitudinal care provided by NPs and the contribution NPs make to maintaining patients within their primary care team,” the statement said.In the position statement, NPAO is calling on the province to protect existing NP positions and create NP funding models that are “not dependent on physician remuneration.”Meanwhile, NPAO is also currently in talks with the Ontario government to develop a compensation model for NP-provided primary-care services, which currently doesn't exist. Because of a “loophole” within the Canada Health Act, NPs have been able to privately charge patients for primary care services. However, the federal government issued an interpretation letter of the act in January 2025, ordering provinces to ban out-of-pocket patient charges for medically necessary services provided by NPs and have a policy in place to fund NP services by April 1, 2026. That deadline has come and gone without an NP funding model in Ontario, but penalties for non-compliance don’t kick in until April 2027. NPAO says it wants to see a model that allows NPs to practice as “employees, independent providers, or within other publicly funded team-based models” and not simply as an “extension of physician-funded care.”“FHO+ should strengthen interdisciplinary primary care, not create financial structures that inadvertently make the sustainability of NP roles dependent on physician remuneration,” said NPAO.

Nurse practitioners in Ontario warn of ‘unintended consequences’ with FHO+ funding model

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