How does compensation work?
Our goal is to provide a superior clinic and physician working environment, at competitive rates. As our market research indicates that a 70/30 split for most billings is standard, our fee structure is structured to achieve this result.
We do, however, plan to make an exception for new grads who are joining us via the three-year NGEP program. In particular, we are willing to adjust our fee structure for the first few years in order to share in the financial impact of this program.
Notably, this fee structure is inclusive of the HST that must be charged on our management fees.
Is Magenta Health a FHO?
Yes - we're a FHO and originally the intent was that all physicians who work with us would be expected to join our FHO as well. This would have meant a bit of after-hours coverage as required by the Ministry of Health, but on the whole, we like this model of health care delivery and enjoy the ability to roster patients.
Unfortunately, due to the unilateral action imposed by the MoH, entry into FHOs in Toronto is restricted and only new grads are able to join the Magenta Health FHO via the NGEP program. The arbitration decision between the MoH and the OMA has not changed this situation. The entry restrictions remain and the situation is unlikley to change before the next set of OMA - MoH contract negotations (scheduled for 2021/2022).
Is Magenta Health a FHG?
Yes - we're also a FHG. We started the FHG to accomodate additional family physicians who are not able to join the Magenta Health FHO, or do not wish to participate in the NGEP program. We have also worked out how FHG and FHO physicians can work together in a single clinic.
I'm a new grad: NGEP vs. FHG?
For new grads, we see there being three key drawbacks to the NGEP program:
- There is a negative financial impact if compared to working in a rural high needs area
- There are unclear metrics for graduating from the program
- Participating physicians have a restricted ability to provide care outside the FHO
As discussed in more detail below, our take on these drawbacks is that 1) and 2) can be readily overcome, but that 3) is a potentially insurmontable problem for a minority of new graduates.
Thus, for the majority of physicians for whom 3) is not relevant and for new graduates who qualify, our recommendation is to join the Magenta Health FHO via the NGEP program for the immediate benefit of participating in a rostering model and the long-term benefit of being a regular signatory FHO physician.
The NGEP program currently offers annual gross income of $162K, $178K, and $207K to participating physicians. Our calculations, as shown below, suggest that the standard NGEP program is a 10.0% reduction in base payments, over five years, as compared to the income stabilization program offerred in a rural high needs area.
In order to offset this financial impact, Magenta Health is able to adjust our fee structure, up to as follows, to reduce the impact from 10.0% to 5.0%. Put another way, over 5 years, the impact of the NGEP program could be reduced to less than $9,000 annually over 5 years.
According to the Ministry of Health documentation, participating physicians must meet or exceed performance improvement targets in order to graduate from the NGEP program. While this is a new requirement for most community physicians, our understanding is that these sort of tracking metrics are familiar to other models (e.g. FHTs).
These metrics have been recently clarified to be focused on two questions, although one point of frustration remains that specific targets have not been published or provided:
- % of patients provided with same day, next day appointments (access)
- % of target patient populations compliant with preventive care requirements (preventive care)
Our assessment of the overall primary care industry is that our technology and administrative processes are sufficiently advanced that the odds are slim that Magenta Health physicians will have problems meeting these targets in order to graduate from the NGEP program, assuming reasonable targets are issued. For example, we're one of very few primary care clinics in Canada that truly offers patients the option of online scheduling and, by default, 100% of patients have access to same day / next day appointments.
Put another way, our belief is Magenta Health physicians will be, comparitively speaking, well-placed to meet the performance targets, even though, in the absence of more information, we're unable to make specific promises or guarantees.
Providing care outside the FHO
Recent changes to the program have delivered improved flexibility for physicians to simultaneously provide care within and outside the FHO. In particular, full-time physicians (i.e. 1.0 FTE) can provide up to $35,000 in outside services annually for the first three years (albeit with some caveats).
What is more helpful is that this amount is pro-rated upwards if a physician is not part of the program full-time, meaning, for example, a 0.7 FTE NGEP physician has a cap of $83,600 annually instead of $35,000.
Is there a walk-in component?
No, we do not anticipate operating any walk-ins. Instead, Magenta Health is currently designed to operate by appointment only, including urgent and last-minute appointments.
We invest in online, print, and direct advertising to ensure physicians are appropriately busy, in lieu of operating a walk-in.
Questions or Interested in Visiting?
Contact Dr. Marco Lo with any questions or if you'd like to schedule a visit.