Long-term Care

Updated December 16, 2024

Important update: In July 2024, in alignment with the incorporation of long-term care services in the LFP Payment Model (login required), the current LTCI (Long-Term Care Initiative) funding ($400 per year per LTCI bed) will be reallocated within the initiative to the following payments:

  • FPSC Long-term Care On-Call/Availability Funding—administered by Divisions.
  • FPSC Quality Improvement (QI)/Administration Funding for LTCI—administered by Divisions.
  • FPSC LTCI MRP Payment—direct payments to family physicians.

The final payment based on the current LTCI funding formula will be released to participating Divisions in June 2024. Application and administration information related to the new LTCI payments will be shared in the coming months.

Since 2015, the Family Practice Services Committee (FPSC) has provided approximately $12-million annually through the LTCI to support family physicians who deliver long-term care.

Divisions of family practice receive funding to organize and coordinate family physician MRP (Most Responsible Physician) services to patients in long-term care facilities through the LTCI. 

The LTCI is designed to support physicians to develop local, scalable, and sustainable solutions that target meeting the following five best practice expectations and three system-level outcomes:

Best Practice Expectations

  • 24/7 availability and on-site attendance when required
  • Proactive visits to residents
  • Meaningful medication reviews
  • Completed documentation
  • Attendance at case conferences

System-Level Outcomes

  • Reduced unnecessary or inappropriate hospital transfers
  • Improved patient/provider experience
  • Reduced cost/patient as a result of a higher quality of care

For long-term care specific billing support for fee-for-service physicians, please visit BC Family Doctors (login required) for up-to-date billing information/fee codes.

What’s new?

In July 2024, FPSC introduced the following funding programs to support family physicians long-term care.

Long-Term Care

• FPSC On-Call/Availability Funding for Long-Term Care – Each Division will receive an annual amount of $130,000 + $80 per LTCI (Long-Term Care Initiative) bed. The Divisions of family practice will administer this funding.

• FPSC LTCI Most Responsible Provider Payment – Family physicians (FPs) who provide ongoing longitudinal care to patients in long-term care facilities and are participating in the FPSC Long-Term Care Initiative (LTCI) but are not eligible for the Longitudinal Family Physician (LFP) payment model can now apply to receive a LTCI MRP (Most Responsible Provider) payment. Click here for more details.

What’s changing?

To support the new funding programs, FPSC is reallocating funding from the following FPSC programs.

Long-Term Care

• Long-Term Care Initiative (LTCI) – $400 per year per LTCI bed administered by Divisions of family practice. Divisions received the final payment in June 2024.

What remains the same?

Long-Term Care

• FPSC LTCI QI (Quality Improvement)/Administration Funding – Local long-term care QI activities currently funded by LTCI will continue to receive financial support.

Role of the Divisions of family practice

The Divisions of Family Practice have a key role in communicating local challenges and gaps in care, collaborating on solutions, supporting physician practices, amplifying physician voice, and influencing primary care delivery in their own communities. The Divisions also have an important role in supporting the changes associated with new physician payment arrangements and options. Divisions will be responsible for administering the new FPSC On-Call/Availability Payments and supporting physicians in organizing call groups. FPSC will continue to fund the Divisions of Family Practice to support their activities in recruitment and retention, supporting physician practices and physician networks, and system and quality improvement work.

 

FPSC funding supports for Long-Term Care

What are the important dates to know for FPSC funding changes for long-term care?

The table below outlines the important dates for current and future FPSC funding supports for long-term care.

When can family physicians start billing the LFP Payment Model time codes and interaction codes for long-term care services?

New LFP Payment Model time codes and interaction codes for long-term care services were made available to eligible family physicians in June 2024. 

What will happen to the FPSC Long-term Care Initiative (LTCI)?

In July 2024, the current LTCI funding ($400 per bed) was reallocated to fund the following :

  • FPSC On-Call/Availability Funding for LTC – administered by the Divisions of Family Practice
  • FPSC On-Call/Availability Administration Funding for LTC – administered by the Divisions of Family Practice
  • FPSC LTCI QI/Admin Funding for LTCI – administered by the Fivisions of Family Practice
  • FPSC LTCI Payment for FPs not eligible for LFP Payment Model – direct payments to family physicians

The final payment based on current LTCI funding formula was released to participating Divisions of Family Practice in June 2024.

FPSC On-Call/Availability Funding for Long-term Care 

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

In July 2024, a new FPSC On-Call/Availability Funding for Long-term Care program was made available to support family physicians to work together to provide after hours on-call availability to LTC patients. This funding program will provide an amount of $130,000 per Division + $80 per LTCI bed. Divisions can apply for additional funding to support the administration cost of operating call groups.

The funding is administered by the Division of Family Practice, and the maximum payable per participating physician is $21 per on-call hour. Additionally, while a physician is on-call, all patient services they provide will be compensated by the LFP Payment Model or any other payment model (e.g. fee-for-service or AP contract) by which the physician is compensated. 

Based on your feedback, we are modifying the Family Practice Services Committee (FPSC) On-Call/Availability Funding to enable more local flexibility, especially in smaller communities where one physician is simultaneously on-call for LTC and inpatient care. 

Effective April 1, 2025, when the FPSC On-Call/Availability Funding for inpatient care is introduced, the maximum weekly cap for FPSC On-Call/Availability Funding for physicians covering both inpatient care and LTC at the same time will be increased to 1.5 times the maximum amount for an individual service (based on current parameters).   
 
Divisions can also submit proposals to repurpose existing unspent on-call/availability funds for the Long-term Care Initiative (LTCI) as part of FPSC’s commitment to flexibility when meeting community service needs. This includes physician sessional payments for quality improvement (QI) and leadership, and/or physician payments for attachment stipends, first available bed, and recruitment incentives. Unspent funds must be allocated to physician payments only.  
 
Please contact FPSCLTCI@doctorsofbc.ca for details on the process for submitting these proposals.  
 
Unspent on-call/availability funds for inpatient care can be repurposed specifically to support inpatient care activities. More details about the FPSC On-Call/Availability Funding for inpatient care will be shared as soon as they become available.

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

Currently, payment rates for on-call availability vary significantly across the province. The new FPSC On-Call/Availability Funding for Long-term Care is designed to provide equitable compensation for on-call availability across the province. Family physicians providing on-call availability will be compensated by the new FPSC On-Call/Availability Funding for Long-term Care program (max $21 per hour) and by their applicable payment model for patient services provided when they are on-call. 

The LFP Payment Model for Long-term 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?

A family physician may provide coverage simultaneously for more than one approved call group but can only receive one daily on-call payment. For example, if an FP is on-call for LTC and IPC, the FP may only be compensated for being on-call for one program. If an FP is on-call for LTC and ER, they may only be compensated through the FPSC On-call/Availability funding or MOCAP.

Effective April 1, 2025, when the FPSC On-Call/Availability Funding for inpatient care is introduced, the maximum on-call payment for physicians covering both inpatient care and LTC at the same time will increase to up to 1.5 times the maximum cap for an individual service (based on current weekly/daily maximum parameters).

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?

A family physician may provide coverage simultaneously for more than one community at the same time but can only receive one daily on-call payment. For example, if an FP is on-call for LTC and IPC, the FP may only be compensated for being on-call for one program. If an FP is on-call for LTC and ER, they may only be compensated through the FPSC On-call/Availability funding or MOCAP.

Effective April 1, 2025, when the FPSC On-Call/Availability Funding for inpatient care is introduced, the maximum on-call payment for physicians covering both inpatient care and LTC at the same time will increase to up to 1.5 times the maximum cap for an individual service (based on current weekly/daily maximum parameters).

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 for one time and for another community at a different time, they may receive on-call/availability payments from different Divisions.

What is the FPSC LTCI (Long-term Care Initiative) QI (Quality Improvement)/ Administration Funding? 

The FPSC LTCI QI/Administration Funding provides continued financial support to Divisions to engage in local LTCI QI activities to support the iterative design and implementation of local solutions that deliver dedicated MRP (Most Responsible Physician) services for patients in long-term care facilities. Funds are based on the QI and administration budget outlined in each Division's fiscal year 2023/24 MOU (memorandum of understanding). 

Funds may be used to support quality improvement and educational activities such as projects (e.g., streamlining admissions or SBAR usage), developing educational materials, mentoring, CME (continuing medical education) and LTCI Steering Committee; physician sessional time for non-clinical LTCI leadership or quality improvement activities; Division administrative or LTCI project management staff support and costs supporting QI activities such as facility rental and catering costs.

More details will be communicated to Divisions in the coming months.

FPSC Long-Term Care Initiative Most Responsible Provider Payment

 What is the FPSC Long-Term Care Initiative Most Responsible Provider (MRP) Payment?

The Long-Term Care Initiative (LTCI) Most Responsible Provider (MRP) Payment is intended to support family physicians not enrolled in the Longitudinal Family Physician (LFP) Payment Model to continue providing care to long-term care (LTC) patients according to the 5 Best Practice Expectations, providing they meet all the other requirements of the payment outlined below. FPs are required to participate in their local LTCI to be eligible for the payment.

To be eligible to receive the FPSC LTCI MRP payment, family physicians must meet the following requirements:

  • Not be enrolled in the LFP Payment Model.
  • Be MRP for a minimum of 5 Long-Term Care Initiative (LTCI) facility-based beds.
  • Not be on a service contract, salary agreement, or sessional arrangement that includes payment for facility-based LTC services.
  • Actively participate in the FPSC Long-Term Care Initiative (LTCI) with their local Division including the community solution for 24/7 availability and approach to MRP coverage for the beds in the community.
  • Provide LTC services according to the five Best Practice Expectations (BPEs):
    • Provide 24/7 availability and on-site attendance when required
    • Proactive visits to residents
    • Meaningful medication reviews
    • Completed documentation
    • Attendance at case conferences
  • Meet all the requirements of the payment and commit to continuing to meet all requirements for the duration of the payment period.

Providing they meet all the requirements of the payment, eligible physicians include:

  • FPs who bill under fee-for-service for their clinic-based longitudinal services and NOT enrolled in the LFP Payment Model.
  • FPs who are compensated under service contract, new-to-practice contract, salary agreement, or blended capitation for their clinic-based longitudinal services and NOT enrolled in the LFP Payment Model.
  • FPs who provide long-term care services and do not have a clinic-based longitudinal family practice.

The following FPs are NOT eligible for the payment:

  • FPs enrolled in the LFP Payment Model for clinic-based longitudinal care.
  • FPs who provide long-term care services under a service contract, salary agreement, or sessional arrangement.

Eligible physicians will receive an invitation email every payment period with details on how to claim subsequent payments. Eligible physicians must complete and submit once per payment period to verify the number of LTCI beds for which they are the MRP.

If you believe that you are eligible for this payment but have not received an invitation email, please review the FPSC LTCI MRP Payment FAQs and contact fp.billing@doctorsofbc.ca to inquire about your eligibility.

 

More information:

For questions or details on available resources, contact: fpscltci@doctorsofbc.ca.