Pilot project funding

Pilot project funding

This is a joint project between Doctors Nova Scotia and the Nova Scotia Department of Health and Wellness.

Physicians who participate in the blended capitation funding model pilot project will continue to receive remuneration under their existing payment model (i.e., fee for service or alternative payment plan (APP)). Physician billings and shadow billings will be used to calculate their remuneration under the blended capitation model. Physicians will receive a top-up at the end of the pilot project if their actual payments under their existing payment model were lower than what they would have been under the blended capitation funding model. 

The blended capitation payment model consists of three components: a capitated payment, a fee-for-service component for services provided to patients (consisting of in- and out-of-scope fee codes) and an access bonus. 

Physicians must bill or shadow-bill all patient services, whether they are in- or out-of-scope. This will generate the following blended capitation comparator components for rostered patients of the practice: 

Capitated payment
(Calculated based on current N.S. services and weightings based on demographics.)

  • Covers in-scope services
  • Base capitation rate ($111.57 per patient) X age/sex ratio weighting (see Chart A)
  • The total annual capitation rate per patient will appear on a blended capitation comparator statement, available on a bi-weekly basis (and will be prorated)
  • This will represent approximately 70% of the physicians’ remuneration
Fee-for-service payments 
(Based on timely and accurate billing submissions.)
  • 30% fee-for-service for in-scope services
    • All office visits (03.03 codes)
    • Psychotherapy/counselling
    • Virtual care/non-face-to-face
    • Immunization and associated tray fees
    • All minor procedures
    • IUD insertion/removal
    • General practitioner evening and weekend incentive (GPEW premium)
    • Urgent care premium visits
  • 100% fee-for-service for out-of-scope services
    • Opioid agonist treatments (OAT1 and OAT2) and methadone treatments (03.03L, K and J)
    • Medical assistance in dying (03.03 M, N and O)
    • Eye care/ophthalmology codes (09.02 and 3.12)
Access bonus 
(Bonus will decrease when patients access in-scope services outside the practice.)
  • Valued at 20% of total practice capitation payment
    • 1:1 negation for outside use (outside of clinic, i.e., walk-in clinics) for in-scope services 
  • Must be paid into a group account and distributed as determined by the physicians. 
  • All other remuneration will be calculated per individual physician (based on their roster and claims made on a biweekly basis). 

Note: Evening/weekend visits are considered in-scope for the Blended Capitation model. However, because Nova Scotia has an incentive program for these visits, claims for the GPEW/Enhanced Hours premium will be topped up to 100% to ensure physicians receive the full value of the incentive while participating in the pilot. 

Chart A:
The chart below shows the calculated Blended Capitation Patient Ratio Weightings by age and sex. These weightings were calculated based on average annual health care system cost per patient within each age/sex grouping.

Blended Capitation Patient Ratio Weightings (by Age/Sex)
Age Group Female Male
0-4 0.84 0.86
5-9 0.47 0.45
10-14 0.41 0.38
15-19 0.71 0.43
20-24 0.91 0.49
25-29 1.03 0.56
30-34 1.10 0.60
35-39 1.04 0.64
40-44 0.98 0.68
45-49 1.02 0.73
50-54 1.09 0.81
55-59 1.09 0.90
60-64 1.13 0.99
65-69 1.40 1.30
70-74 1.53 1.42
75-79 1.63 1.56
80-84 1.68 1.67
85-89 1.55 1.63
90+ 1.23 1.39

Remuneration for work done outside the pilot project funding model

The following will continue to be paid as currently arranged:

  • Primary maternity care stipends
  • Community hospital inpatient program stipends
  • Hospitalist payments
  • Emergency medicine coverage/collaborative emergency centres
  • Long-term care, nursing home visits
  • Home visits and related mileage expenses
  • One-off services provided to patients that are not part of the family practice (e.g., GP consult and follow up, services provided to tourists, etc.). Billing will be monitored and evaluated throughout the pilot project to ensure patients are rostered when appropriate. This will ensure that the data is reviewed appropriately throughout the evaluation process.  
  • WCB and other third-party payments
  • Master Agreement incentive funding (i.e., CDM, CME, EMR grants, PLP rebates, etc.)

Additional funding for participating in the pilot project

  • Rostering stipend: Rostering patients will include patient education (verbal and/or written) and updating Medavie’s rostering system to ensure accurate blended capitation funding comparator payments. This stipend will be valued at $15 per patient. Physicians/clinic staff must validate and update their patient panel using Medavie’s rostering interface.
  • Participation stipend: Each physician will receive a stipend of $1,000 per month (pro-rated and paid biweekly) for agreeing to participate in the project as outlined. 
  • Evaluation honorarium: Physicians will be required to participate in evaluation activities (e.g., surveys, consultations and/or focus groups) and will be eligible to receive an honorarium for their time using the current sessional rate ($160.80/hour). 
  • Blended capitation model payment comparator top-up: Physicians may receive a top-up payment if the Blended Capitation Funding Model funding methodology would have paid them more. There will be no funding claw-backs if the calculation shows the reverse.