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Wanting more for less: You can’t have your cake and eat it too


Dr Edwin Kruys 30/04/2018 3:19:56 PM

The Practice Incentive Program is shrinking, but the Government expects new quality improvement systems and GPs’ data, Dr Edwin Kruys writes for newsGP.

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Dr Kruys believes the Federal Government is seemingly making ‘policy on the run’ in addressing changes to the Practice Incentive Program.

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.
 
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.
 
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 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.


THE AUTHOR:


general-practice-fundingPIPpractice-incentive-program

David Dahm
I guess the profession needs to come up with a sustainable solution that the Government will entertain. The High Court of Australia has made it clear bulk billing GP's work for free. It is a 'gratuitous' payment. The Australian Government chooses to pay them what they want and a bulk billing GP. Bulk billing GP's have no contractual rights to funding or claims to their charitable work. Stop bulk-billing is a start.

Peverill vs HIC where the judges said “bulk billing” Doctors do not have proprietary rights to the monetary compensation and that it is a “gratuitous payment” which basically can be altered by the Commonwealth anytime depending on the Country’s financial and social needs.
8/05/2018 8:00:56 AM

Donald Rose
Very good summary of the current state of play. The reason GPs don't want to release data is they know their patients have enough to worry about without having to make decisions about what to release etc. We run private practices and the patients insurer can try and buy data but its going to need to do a lot more work to even get to square one.
2/05/2018 11:15:37 PM

Elly ( Petronella) Slootmans
You are so right Edwin!! Why is it that the sector which most improves the healthcare of Australians overall ( GP's and this has been proven by data not just my word ) are always targeted for savings measures by the Federal Government!!
Fund General Practice properly and overall Healthcare spending WILL improve.
They should target other interventions which have not been proven to carry overall benefit.
General Practice is a hard sell for newly qualified doctors trying to decide if they should become GP's or pursue another specialist pathway.
1/05/2018 3:26:36 PM

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