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4. Increase to Threshold Reduction Levels and Services Exempted from Threshold

Calculations Effective April 1, 2000

Effective April 1, 2000, for fiscal year 2000/2001, the threshold levels at which reductions are calculated will increase by $10,000. For General/Family Practitioners, the starting level will increase from $320,000 to $330,000 and for specialists from $400,000 to $410,000. The threshold reductions only take effect as these higher OHIP earnings amounts are reached.

The threshold reductions are calculated at the following percentages after a physician reaches the revised payment amounts shown below.

Reduction Rate

33.3%

66.7%

75%

Old Payment Amounts Prior to April 1, 2000
GPs

$320,000

$345,000

$370,000

Specialists

$400,000

$425,000

$450,000

Revised Payment Amounts Effective April 1, 2000
GPs

$330,000

$355,000

$380,000

Specialists

$410,000

$435,000

$460,000

Calculation of Threshold Reduction

The method of calculation is unaffected, except that each threshold level has increased by $10,000. The reductions are calculated at the percentages above as physicians reach the level of payments noted. However, to reach those payment amounts, the actual billings are higher, since payments are reduced once the threshold is reached. The calculations take these reduction amounts into account prior to determining the level and percentage deduction to apply. The new total billing amounts that correspond to each revised payment level above are shown below.

Reduction Rate

33.3%

66.7%

75%

Billed Amounts Effective April 1, 2000
GPs

$330,000

$367,500

$442,500

Specialists

$410,000

$447,500

$522,500

After-Hours Non-Elective Hospital Services Exempted from Threshold Calculations

As per the April 2000 Agreement, after-hours non-elective hospital services are excluded from a physician’s income used to calculate their threshold billing amount. Once a physician’s income has reached his/her threshold, subsequent services will be reduced at the applicable rate, including those for after-hours hospital services. After-hours services include all hospital based services provided evening, nights, weekends and holidays, such as:

  • Special Visit to Hospital In-Patient: C994, C995, C996, C997 and associated services
  • Special Visit to Emergency Department or Out-Patient Department: K994, K995, K996, K997 and associated services
  • C998B and C999B: Surgical assistant special visit premiums and associated services
  • E400B and E401B: Surgical assistant after-hour premiums and associated services
  • C998C and C999C: Anesthesia special visit premiums and associated services
  • E400C and E401C: Anesthesia after-hour premiums and associated services

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Ontario Ministry of Health and Long-Term Care
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