You can’t have your cake and eat it too

You can’t have your cake and eat it

The Practice Incentive Program is shrinking but the government expects new quality improvement systems and general practice data.

Most GPs were underwhelmed, to say the least, when they heard about the changes (read: cuts) to the Practice Incentive Program (PIP). Cutting the funding for nursing home visits is a hard sell for the Department of Health and the Federal Health Minister.

This is the wrong message at a time when there are more elderly people with complex chronic health problems in need of appropriate medical care, preferably in the community.

I have heard about various ‘fixes’, including improvements to the Medicare Benefits Schedule (MBS) schedule (good idea) and introducing nurse practitioners (not necessarily a good idea) – but nothing has been confirmed and it all sounds a bit like policy on the run, not a planned and coordinated strategy.

Quality improvement

The scrapped incentives, including the aged care service incentive payment (SIP), will be used to set up a quality incentive payment system (QI–PIP) in GP practices. There are certainly arguments for supporting an enhanced quality improvement system in general practice, but was it the right decision to sacrifice the aged care payments?

We need practice data to review and improve patient care. I agree with the RACGP position that the development of a QI–PIP should assist general practices to undertake quality improvement activities.

However, the RACGP has also indicated that it will not support measuring performance against key performance indicators (KPIs) or so-called ‘quality indicators’ in combination with performance payments. There is just not enough evidence that this will significantly improve care in the long-run, but there is evidence of harm, including detrimental effects on the doctor–patient relationship and practitioner burnout.

Although we have had verbal assurance from the Department of Health that the new QI–PIP – to be introduced in May next year – will not be a pay-for-performance system, the longer-term plans are unclear. This has raised many concerns and it will hinder business planning for general practices.

Data deal

In return for the quality improvement payments, practices will be required to hand over their patient data to Primary Health Networks (PHNs) under the current proposal. From there, the data will flow to other agencies but – just like the My Health Record data – we have not yet heard for what purposes it will be used, and what the implications will be for individual GPs within practices. Many GPs have indicated that they are not prepared to hand over data to their PHN or the Government.

Another big issue is the eHealth Practice Incentive Payment (ePIP), which was originally introduced to strengthen practice IT systems, but is now used to make practices – often practice nurses – upload shared health summaries to the My Health Record. As we are moving to a My Health Record opt-out system later this year, the time may have come to review the ePIP and make it more meaningful for general practice.

Lastly, the practice incentive funding was introduced in the 1990s and has never been indexed. In 2016, $21 million was earmarked for removal and used to partially fund the Health Care Home trials.

It all sounds like another example of the Government wanting more for less. You can’t have your cake and eat it, too.

This article was originally published on newsGP.

6 thoughts on “You can’t have your cake and eat it too

  1. Pay for performance is a slippery slope that will lead us to a British NHS like disaster.
    Gaining access to practice data is the first step in the Government monitoring what happens in our consulting rooms.
    The key issues remain the appallingly low MBS rebates that are paid to GP’s and the number of item numbers now being taken from us.
    Some of us still remember the Relative values Study which showed how poorly GP’s were rebated and how it was quickly forgotten by government when the ugly truth became apparent.
    Always remember Medicare is a Health Insurance scheme -with a mandated 3rd payer.
    Our customer and purchaser of services remains the patient
    Our ultimate duty lies to them not to Government

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  2. The Relative Values Study was hatched by then AMA president Bill Glasson and his mate the then MOH, Tony Abbott, while on a promotional bike ride. But when the recommended increase in GP rebates was to come at the expense of specialist rebates the whole idea was dropped, as it was in the USA. There its originator Prof Hsieu of the Harvard School of Public Health, found that GPs should be paid 60% more and eye doctors 40% less.

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  3. Another part of the issue around QI-PIP Edwin is that for practices already ahead of the curve and being innovative and using their data for quality care will be hugely disadvantaged under the proposed system.
    Those with little room for improvement = lower PIP. Not so exciting for GP practices doing things well.

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  4. Pingback: You can’t have your cake and eat it too | Dr Thinus' musings

  5. I’d like to understand your comment around the use of Nurse Practitioners. Do you have experience working with NPs? Can you cite evidence that this model will not work? Perhaps using a collaborative model in aged care is a way to maximise funding since NPs earn less than GPS under the MBS schedule.

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  6. Yes – once you agree to sell some of your data the rest will follow. The Digital Heath Agency is getting some expert advice from Tim Kelsey who knows how to do this, with the support of the Pharmacists who are also keen for access. However the high bulk billing rates are not helping any resistance to these changes

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