Physician Comprehensive Care Model (PCCM) payments estimator

The PCCM is a new compensation option for Family Physicians who primarily practice in community clinics and deliver comprehensive, life-long patient care.

Participation in the PCCM is voluntary
The PCCM is an agreement with an individual physician (not a clinic) and applies to community-based empaneled patients
There are no limits on claims or hours spent outside the PCCM (e.g., hospital, separate walk-in clinic, etc.)

Please see the PCCM webpage for more information.

Calculate using estimates

Instructions: enter your average fee-for-service payment estimates in the form below for your community-based practice. The default values are for the average full-time community family physician.

Practice characteristics

The PCCM has a minimum service requirement of 400 hours per year spread somewhat evenly across 40 weeks.

s of work per year providing services in a community clinic

Encounter payments (visits and procedures)

In the PCCM, the majority of visits and procedures are defined as 'in basket' and a proration of 68.5% is applied to fee-for-service payments. CMGP and CMXC30 are not paid. The proration does not apply to tray fees. All out-of-basket services pay at regular fee-for-service rates/rules and are not prorated. The Business Costs Program (BCP) does not apply under the PCCM.

Average gross community fee-for-service payments
(Inclusive of visits, procedures, trays, and modifiers; excluding Business Costs Program [BCP] payments)

Average BCP payments under fee-for-service

The Business Costs Program (BCP) is paid at $3.59 on select visits/consults to a maximum of 50 payments per day per physician. As a ball-park estimate, the average full-time community-based family physician receives BCP payments of $114/day.

Current average gross fee-for-service payments including BCP

Of the above $ average gross payments, what is the dollar value of CMGP and CMXC30 modifiers that are included?

Your situation may be unique. On average, Family Medicine physicians in the community have payments from CMGP and CMXC30 modifiers around 21% of gross payments.'

Time-based payment

In the PCCM, direct care, indirect care, and practice management time are paid at $105.00/hour and after-hours direct care time is paid a premium of $87.74 (i.e., paid $192.74/hour after-hours). The after-hours premium is paid up to a maximum of 20% of total direct care, indirect care, and practice management time.

Average hours of direct and indirect care for panel patients
(At any time of day; on-call time is not paid)

Your situation may be unique with an above average number of average weekly hours of direct and indirect care. On-call time is not paid in the PCCM.

Of the above hours, how many are after-hours direct care in clinic?
(After-hours direct care includes weekdays between 17:00-23:00, any time on weekends, and any time on holidays)

Average hours of practice management
(The PCCM automatically pays practice management as 10% of direct and indirect care)

Total average hours of work

Patient panel payment

In the PCCM, the physician panel size is determined from CPAR. The panel payment is computed based on the complexity of each patient using a simplified risk grouper from CIHI. There is no negation if a panel patient sees another physician. A minimum panel of 500 patients is required to join the PCCM.

Number of patients on CPAR PCCM panel

Your situation may be unique. The majority of family physicians providing longitudinal, community-based care have a panel under 1500 patients.'

Estimated average annual payment per panel patient

Coming in January 2025: the AMA member dashboard will include the estimated number of patients on your CPAR panel and the average annual payment per panel patient. A panel of 'average' complexity is estimated to receive an average panel payment of $70.25 per patient per year (ranging from $32.87 to $136.73). A physician might not have this same average depending on the overall complexity of their panel.

Estimated PCCM total

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Payment component

per

per year

PCCM encounter payments

PCCM time-based payments

PCCM patient panel payments

PCCM grand total

A typical practice with these parameters would receive annual gross community fee-for-service payments of $ (including BCP) and the PCCM represents an estimated annual of $ (%).

This tool is designed to estimate PCCM payments based on average practice characteristics. Individual results may vary. Please review the PCCM regulations and seek legal advice prior to making business decisions.

Alberta Medical Association