Referral and Reimbursement Policies

Patient eligibility

Community Physiotherapy Clinics (CPCs) may be considered bundled providers and request funding from the Middlesex Hospital Alliance (MHA) when their patients meet the following criteria:

The patient underwent

• an elective primary knee or hip replacement surgery
• an elective primary or revision shoulder replacement surgery, total, hemi or reverse
• The patient satisfies the Quality Base Procedure (QBP) eligibility criteria.

Please note: Bundled Care funding does not apply to the following:

• Revision surgeries for hip and knee replacements.
• Emergency surgeries, the surgery must be elective meaning pre-scheduled and the reason for admission to hospital.
• Diagnosis cannot be related to cancer or trauma
• Cases covered under WSIB

NACRS Lite Reporting

Ambulatory rehabilitation clinics/providers providing services to Bundled Care patients are required to report on these services through the NACRS Clinic Lite tool administered by the Canadian Institute for Health Information. Clinics must request a unique master number from the MOH by emailing: bundledcare@ontario.ca. Please see https://www.cihi.ca/en/nacrs-clinic-lite for more information from CIHI.

Referral Acceptance Requirements

By accepting the referral for rehabilitative care of the patient, the service provider / Community Physiotherapy Clinic (CPC) agrees to deliver care aligned with the Rehabilitative Care Alliance (RCA) Best Practice Guidelines, including the following terms:

Total Hip Replacement

• Outpatient rehabilitation should begin within 2 to 4 weeks post discharge – SMGH preference is 2 weeks.
• Treatment should be offered with an average of 6 visits over 16 weeks.
• Frequency of treatment depends on achievement of goals but recommended no more than once per week.
• Duration of treatment is based on achievement of functional goals of independence or a plateau in progression.

Total Knee Replacement

• Outpatient rehabilitation should begin within 7-10 days post discharge.
• Treatments should be offered with a minimum of 1 to 2 times per week for the first 6-7 weeks post-operatively with a minimum of 6 visits over 12 weeks.
• Rehabilitation for knee replacement patients includes intensive treatment to achieve range of motion and function. Duration is based on the achievement of functional goals of independence or a plateau in progression.

Total Shoulder Replacement

• Outpatient rehabilitation should begin within 2 to 3 weeks post discharge – SMGH preference is 2 weeks.
• Treatments should be offered with an average of 8-12 over 16 weeks.  
• Frequency of treatment depends on achievement of goals but recommended no more than once a week.  
• Duration of treatment is based on achievement of functional goals of independence or a plateau in progression.   

Pricing

Effective April 1, 2026, the MHA will reimburse bundled care providers at the following rates per episode of care:

Important Notes:

• These are per-case, all-inclusive rates covering the full scope of the rehab episode.
• Prices are non-negotiable and based on Ministry of Health guidance.
• Invoices submitted with alternate amounts will be returned for correction.
• Prices may be adjusted in the future with prior notice provided.

Reimbursement Process and Polices

In order to proceed with payment, please complete the MHA invoice templates and the electronic funds transfer form.

• SMGH Invoice template – Bundled Care Hip & Knee
• SMGH Invoice template – Bundled Care Shoulder
• Vendor EFT Form

Bundle provider will issue an invoice to bundledcare@mha.tvh.ca using the MHA invoice template provided for the services and will include the following information:

• Patient name
• Health card number
• Date of birth
• Date of surgery
• Master Ambulatory number
• Type of procedure (e.g. primary unilateral hip replacement or knee replacement, shoulder replacement, shoulder hemiarthroplasty, reverse shoulder replacement, revision of shoulder replacements)
• Type of Regulated Health Professional providing the care and a listing of services provided
• Dates and durations of each visit
• Initial and discharge Patient Reported Outcome Measures
• For Hips and Knees – Lower Extremity Functional Score (LEFS)
• For Shoulders – Upper Extremity Functional Index (UEFI)
• Confirmed discharge date

Additionally, please note:

• Invoices must be received no later than 3 months after rehab completion.
• Invoices must be emailed to bundledcare@mha.tvh.ca.
• To ensure patient data safety please password protect the file.
• Please send password in a separate email with the same subject line.

Bundle Care Partners

To sign on as an MHA Bundled Care Clinic partner, contact bundledcare@mha.tvh.ca.

Where can I have my bundle care therapy after my joint replacement?

You may attend any clinic you want for your therapy. Clinics listed on the link below have an agreement to provide therapy to MHA patients under the bundled care model.

You may contact a clinic not listed on the appendix and inquire if they provide bundled care. If the clinic does not provide bundled care and you still wish to receive your care at this clinic, you will need to pay for their services or use your private insurance. Please confirm when booking your appointment if they offer bundled care or not.

Bundled Care clinics may limit the number of appointments covered under the bundled care model – confirm this prior to booking your appointment.
See Appendix 1 for list of Bundled Care Physiotherapy Clinics. This list is reviewed and updated every April 1st.

Can I change the physiotherapy clinic after I have started with one?

The MHA has agreements with many outpatient physiotherapy clinics to provide for your post-surgical therapy at no cost to you. Due to the funding formula and these agreements, the MHA will only pay one partnered clinic per qualifying surgery. If you attend a non-partnered clinic or begin treatment at one clinic and then change to another (partnered or not), the cost of the second clinic therapy will be at your own expense. Some exceptions may apply.

What is the PROMS survey and when do I have to do it?

Patients across Ontario, who are having either a total hip or knee replacement, are being asked, at four different times, to complete a short survey about how they are feeling before and after their surgery. The survey referred to as Patient-Reported Outcome Measures (PROMs), takes about 5 minutes to complete. Your hip and knee PROMs survey tells your healthcare team about your: pain functional status (how well you are able to do your normal daily activities) the overall quality of life

Orthopedic care

The same survey is completed each of the four times.

• At the Rapid Access Clinic prior to seeing your surgeon
• At the hospital – when you come in for your pre-admission visit prior to surgery
• Online at home on any device that has connection to the internet (computer, laptop, smartphone, tablet, etc.)
• 3-4 months after the surgery
• 1 year after your surgery

For Shoulder replacement surgeries, we are currently not collecting PROMS information from patients in the same way. However, your Physiotherapist will be collecting and submitting the results of a specific outcome measure completed during your initial assessment and during your discharge assessment. These Initial and discharge Patient Reported Outcome Measures are:

• For Hip and Knee Replacements – Lower Extremity Functional Score (LEFS)
• For Shoulder Replacements – Upper Extremity Functional Index (UEFI)