As per Schedule B of the 2021 Physician Services Agreement (PSA), Phase Two of the Hospital On-Call Coverage working group mandate is to design for implementation of a burden based HOCC program to replace the existing program. Planning and development of the burden based HOCC program is underway. The application process for the burden based HOCC model is now closed (as of November 24, 2023). The working group will no longer be accepting applications for consideration.

Please note that for the purpose of continuing to manage the current HOCC program until the new Burden-based model replaces it, and for the information of current HOCC recipients, the information below continues to apply to the current HOCC model only.

Overview

The Hospital on-Call Coverage (HOCC) program was developed to:

  • enhance and stabilize the delivery of hospital on-call services to Ontario patients
  • provide stability and predictability in physician on-call coverage across Ontario

The program:

  • recognizes the additional burden placed on physicians for providing on-call services beyond their normal workday
  • provides funding for hospital on-call coverage to offset coverage expenditures previously borne by hospital operating budgets

Currently, there are approximately 16,000 physicians participating in the program at 170 hospitals.

HOCC background

The HOCC program was first established under the 2000 Framework Agreement between the Ministry of Health (MOH) and the Ontario Medical Association (OMA) to provide funding for direct physician payment for hospital on-call coverage or to offset existing payments for hospitals on-call coverage borne by hospital operating budgets.

Part of the agreement provided for a HOCC committee, made up of representatives from both MOH and OMA to oversee the establishment and coordination of the program. Since its inception in 2000 the HOCC program has been updated to include:

  • enhanced funding program
  • funding for additional on-call rotation scheduled (rotas)
  • intra-sectional allocations
  • regional on-call arrangements

MOH is currently responsible for policy, operations and financial components of the HOCC program. Under the 2021 Physician Services Agreement (PSA) a fundamental re-design of the HOCC program into a burden-based funding model is to be undertaken by the ministry and the OMA with an anticipated implementation date of April 1, 2024.

Funding amounts, programs and calculation guidelines

Specialty groups and funding amounts

The table below shows the distribution of specialties of practice into 4 distinct groups, for which different funding amounts are available. The total number of physicians providing on-call service in each rota determines the amount of funding.

Base HOCC program

Available funding is shown in the table below (HOCC funding stipends by General Practitioners (GP)/Specialty Group and number of participating physicians).

Interim Enhanced HOCC program

The 2004 Physician Services Agreement provided for increases to Base HOCC funding over the term of the agreement, provided eligibility criteria are met.

To be eligible for Enhanced HOCC funding amounts, physicians must sign a written declaration confirming they will accept no direct or indirect top-up payments/compensation for on-call service. Participation in this “Interim Enhanced HOCC program” is voluntary, however physicians must agree to participate as a group, not as individuals.

HOCC funding stipends by GP/Specialty Group and number of participating physicians

Funding table - Updated April 2023 - See Note

PhysiciansLevel ILevel IILevel III SpecialistsLevel IV Specialists
Eligible Physician Groups
  • General and Family Practitioners
  • Anesthesia
  • General Surgery
  • Orthopedic Surgery
  • Psychiatry
  • General Internal Medicine
  • Obstetrics & Gynecology
  • Pediatrics
  • Neurosurgery
  • Vascular Surgery
  • Urology
  • Plastic Surgery
  • Cardiac/Thoracic Surgery
  • Critical Care Medicine
  • Transplant Services
  • Cardiology
  • Emergency Medicine
  • Gastroenterology
  • Hematology/Oncology
  • Infectious Disease
  • Neurology
  • Ophthalmology
  • Otolaryngology
  • Respiratory Medicine
  • Diagnostic Radiology
  • Endocrinology
  • Nephrology
  • Geriatric Medicine
  • Hyperbaric Medicine
  • Cardiac Surgical Assistant
  • Immunology
  • Dermatology
  • Physical Medicine and Rehabilitation
  • Rheumatology
  • Nuclear Medicine
  • Interventional Radiology
  • Radiation Oncology
  • Gynaecologic Oncology

Enhanced HOCC Funding - Current annual - See Note

PhysiciansLevel ILevel IILevel III SpecialistsLevel IV Specialists
5 or more physicians$181,677 or $96,890* per year$181,677 per year$36,335 per yearGuidelines for Level IV payment
4 physicians$164,719 or $87,204* per year$164,719 per year$33,911 per year
3 physicians$145,341 or $79,938* per year$145,341 per year$32,701 per year
2 physicians$145,341 or $72,671* per year$145,341 per year$29,068 per year
1 physician$109,006 or $60,555* per year$109,006 per year$19,377 per year

* for physicians providing on-call in Level A, B, 1, 2 or 3 hospitals (as set out in the Alternative Funding Agreement for Emergency Services)

Guidelines for Level IV payment

Effective February 1, 2015, the submission of Level IV Specialist Reports (Appendix “C” form) and call-in fees was replaced with monthly payments (see PSA Increase Note below) based on call in fee utilization at eligible hospitals in FY 2014/15.

Level IV payments are eligible for the following specialties:

  • dermatology
  • immunology
  • physical medicine and rehabilitation
  • rheumatology
  • nuclear medicine
  • interventional radiology
  • radiation oncology
  • gynaecologic oncology

Note: MOH and OMA have worked together to implement physician compensation increases in accordance with the 2021 Physician Services Agreement (PSA). Accordingly, an increase of 2.0100% to the rate has been applied to HOCC payments effective April 1, 2023.

The following historical information is archived content regarding Level IV HOCC prior to February 1, 2015.

  • Level IV payments $103.54 call-in fee will be made to certified specialists practising in the specialties of:
    • dermatology
    • immunology
    • physical medicine and rehabilitation
    • rheumatology
    • nuclear medicine
    • interventional radiology
    • radiation oncology
    • gynaecologic oncology
  • staff who are available to provide on-call hospital services in those specialties, and who perform a special visit (at the hospital) in the evening, night, on weekends or on holidays [HOCC Agreement, Article 3.4.4]
  • where a special visit is defined, for HOCC purposes, as “one initiated by a patient or patient’s representative(s) where the physician is required to travel from one location to another to see the patient from a location outside any premises of, or operated by or on behalf of, the hospital special visit premiums only apply to non-elective or emergency calls” [see the Schedule of Benefits, General Preamble, 23.a-c, p. GP-53, July 1, 2003 ed.]
  • a specialist shall be limited to two call-in fees per calendar day [HOCC Agreement, Article 3.4.4]
  • for a physician to be paid two call-in fees in a calendar day each claim must arise from a distinct special visit - claims made for attending to additional patients during the same special visit as that for which the first claim was made are not eligible for payment
  • call-in fees will be paid for special visits made to OHIP-insured patients only - the patient encounter must have generated OHIP-eligible fee-for-service claims
  • no physician who receives Level II funding for his/her participation in an Obstetrics and Gynaecology on-call group may submit a Level IV claim for Gynaecologic Oncology