Inpatient Care

Updated October 10, 2024

FPSC has provided significant support with individual incentives as well as inpatient care network and bridge funding through the divisions to support the care of both assigned and unassigned patients in hospital. 

Through the LFP Payment Model, a significant investment has been made in primary care to help address historic compensation gaps and offer a streamlined payment structure for this care. The transition to a new payment model, along with changes in FPSC funding supports for this work, represents a momentous change, and support is needed to ensure ongoing service provision during this transitional time.  
 
FPSC supports are designed to give more time for: 

  • Physicians to better understand LFP Payment Model compensation for inpatient care, the ways in which it differs from fee-for-service, as well as potential opportunities and impacts related to service delivery.   
  • Communities to undertake local planning in partnership with their health authority to evolve existing delivery models or develop new models as needed in response to LFP-facility billing and FPSC supports.  
  • Doctors of BC, BC Family Doctors and the Ministry of Health to discuss and address longer-term solutions to concerns raised by physicians providing inpatient care.

More information:

For more information about FPSC supports, please email fp.billing@doctorsofbc.ca.

FPSC funding administered by divisions of family practice

FPSC Transition Funding for Inpatient Care—Application deadline: August 29, 2024.

This time-limited funding consolidates and replaces bridge and stabilization funding and the additional transition funding supports previously announced for October to December. The maximum transition funding amount per hospital location is equivalent to current FPSC inpatient care funding (bridge + stabilization + unassigned inpatient care network) and is intended to be applied if needed to help maintain current inpatient care service levels, including to unassigned patients. The funding has been extended to March 31, 2025.

For the Divisions of family practice who have already applied and received transition funding up until December 2024, the FPSC finance team will provide a Funds Transfer Agreement addendum in December to reflect the extension of the funding.

Divisions must adhere to all the following requirements when administering the FPSC Transition Funding for Inpatient Care: 

Every effort must be taken to maintain current inpatient service levels, including for unassigned patients. If there are concerns about the ability to maintain services, please contact FPSC at fp.billing@doctorsofbc.ca as soon as possible.  Funding is payable to family physicians providing inpatient care services under the LFP Payment Model, fee-for-service, or blended capitation. Funding is not payable to family physicians providing inpatient care services under an AP (alternative payment) contract (e.g. hospitalist contract).   Payments paid to individual family physicians by the division from transition funding must not exceed current payments being paid by the division to physicians for inpatient care.   Payments to family physicians providing inpatient care services under the LFP Payment Model are subject to additional parameters below.  

If you have questions, please contact FP.billing@doctorsofbc.ca.

Reporting requirements 
With the introduction of LFP-facility billing and changes to FPSC inpatient care supports, this transition period provides a valuable opportunity to learn about the impacts of these changes, assess ways to improve the payment model, and inform FPSC how we can continue to support family doctors to work together to provide inpatient care in their communities.  

By August 29, 2024: Divisions submit application form describing how their services are organized and how they intend to allocate FPSC transition funding to maintain current service and payment levels.

By January 31, 2025: Divisions will submit a plan that describes the service delivery model for assigned and unassigned patients that will be implemented at each hospital site in 2025. FPSC will provide a template in early 2025 along with clarification of any additional ongoing funding or support and assist communities with this planning as needed.

By April 30, 2025: Divisions submit the completed FY2024/25 Year-End Report. A template will be provided in January 2025.

Ongoing: Divisions will continue to engage with FPSC leadership, including sharing service modeling and representative physician compensation information, to help both the division and the provincial team to better understand the impacts of the LFP Payment Model and inform longer term approaches. 

  • We anticipate that LFP facility-based billing will represent a significant increase over fee-for-service compensation for many if not most family physicians, providing this care. As the transition funding is a short-term source of funding, we want to avoid setting unrealistic compensation expectations for physicians. 
    • Payments should be used to support on-call availability, unassigned inpatient care networking, physician recruitment, or other activities not currently covered by the LFP Payment Model. 
    • Payments may not be used to pay for services already paid for by the LFP Payment Model. This includes direct/indirect patient care time, patient visits, assessments, admissions, discharges, or procedures. 
    • In practice settings where LFP payments for inpatient care services are expected to exceed current compensation (e.g. fee-for-service + FPSC inpatient care funding), no additional payments should be provided from transition funding. 
    • In practice settings where LFP payments for inpatient care services are expected to be below current compensation (e.g. fee-for-service + FPSC inpatient care funding), additional payments may be paid from transition funding to maintain, not increase, current compensation level. As needed, divisions are expected to adjust/decrease current payments to meet this parameter. 
  • Funding may be used to support physician engagement activities (e.g. sessional payments) as part of local planning of inpatient care programs. 
  • Divisions may allocate up to 10% of funding to administration expenses. At least 90% of utilized funding must be paid to FPs. 
  • Funding must not be used to cover medical services provided by specialists or other health care providers. 
  • Funding must not be used to fund equipment purchases or infrastructure upgrades. 

New FPSC On-Call/Availability Funding for Inpatient Care—paused and expected to start in April 2025.

Divisions and physicians now have more time to consider to organize and optimize their call services to better support physicians in response to the change in funding. By early fall, FPSC will clarify the parameters for on-call availability payments and any additional supports.  

Note: FPSC On-Call/Availability Funding for Long-Term Care remains available from July 1, 2024. Physicians providing on-call availability for long-term care and inpatient care at the same time may receive the long-term care on-call payment and inpatient care transition funding until December 31, 2024. There is no change to the MOCAP maternity availability payments. 

What is the FPSC On-Call/Availability Funding for Inpatient Care and when will it be available?

Starting in July 2024, the new FPSC On-Call/Availability Funding for Inpatient Care will be available to support family physicians to work together to provide on-call availability to hospital inpatients. This funding will provide an amount of $182,000 (aligned with MOCAP level 2) per hospital for 24 hours/7 days per week/365 days per year. The funding will be administered by local divisions of family practices. Divisions can apply for additional funding to support the administration cost of operating call groups. 

Divisions may pay a daily rate of $150 to $750, up to a maximum of $3,500 plus $210/statutory holiday/week. While a physician is on-call, all patient services they provide will be compensated by the LFP Payment Model (login required) or any other payment model (e.g. Fee-for-Service or Alternative Payments) that the physician is compensated by. 

More details about the funding, including division application process and additional payment parameters, will be communicated to divisions in the coming months.

Will family physicians be paid less for on-call availability with the new FPSC On-Call/Availability Funding for Inpatient Care?

Currently, payment rates for on-call availability vary significantly across the province. The new FPSC On-Call/Availability Funding for Inpatient Care is designed to provide equitable compensation for on-call availability across the province – aligned with MOCAP Level 2. Family physicians providing on-call availability will be compensated by the new FPSC On-Call/Availability Funding for Inpatient Care and by their applicable payment model for patient services provided while they are on-call. The LFP Payment Model (login required) for inpatient care provides significant payment premiums for direct patient care services provided after hours.

Can family physicians receive more than one on-call/availability payment if they are providing on-call coverage for inpatient and long-term care at the same time?

No. If a family physician is providing on-call coverage for inpatient and long-term care at the same time, they can only receive one on-call/availability payment for this time. While the family physician is on-call, patient services provided in hospital or long-term care are compensated by their applicable payment models.

Can family physicians receive more than one on-call/availability payment if they are providing on-call coverage for multiple communities at the same time?

No. If a family physician is providing on-call coverage for more than one community at the same time, they can only receive one on-call/availability payment for this time. While the family physician is on-call, patient services provided are compensated by their applicable payment models.

Can family physicians receive on-call/availability payments from more than one division?

If a family physician is providing on-call coverage for more than one community at the same time, they can only receive one on-call/availability payment for this time. If a family physician provides on-call coverage for one community at one time and for another community at a different time, they may receive on-call/availability payments from different divisions.

FPSC Inpatient Care Bridge/Stabilization Funding—replaced by the FPSC Transition Funding for Inpatient Care.

The FPSC Transition Funding for Inpatient Care replaces current bridge/stabilization funding. For divisions that have already received the bridge/stabilization funding for April 1–September 30, 2024, additional transition funding will be provided for October 1 to March 31, 2025.

Unassigned Inpatient Care (“GU”) Funding—FPSC paid the final GU funding installment to the divisions of family practice in May 2024.

This was a quarterly lump sum incentive based on the annual volume of unassigned inpatients that was available for each hospital with a community family-physician-run unassigned inpatient care model. FPSC paid the final GU funding installment to the divisions of family practice in May 2024 to support inpatient care services from July to September 2024. The divisions or self-organizing groups administered the funding. This funding will be replaced by the FPSC Transition Funding for Inpatient Care from October 1 to December 31, 2024.

 

Payments directly to family physicians

Assigned Inpatient Care Network Payment (14086)—extended to March 31, 2025

This fee pays $2100 per quarter directly to individual physicians who enroll in the LFP Payment Model for inpatient care as well as those physicians compensated by fee-for-service/AP (Alternate Payment) models. The payment has been extended to March 31, 2025. The last quarterly date of billing is January 1, 2025. The payment extension covers networking activities from January 1 to March 31, 2025.

Unassigned Inpatient Care Fee 14088—remains payable for FPs on fee-for-service

This fee pays $150 per hospital admission to the physician who accepts MRP status for the unassigned inpatient’s hospital stay. 14088 remains payable to family physicians who do not opt into the LFP Payment Model for inpatient care and remain on fee-for-service. 14088 is not payable to physicians remunerated by the LFP Payment Model for inpatient care.