The key to unlocking the true value of your general practice

Concerning reports have continued to emerge of general practices struggling to stay afloat due to a lack of investment in primary care and the ongoing effects of the Medicare freeze.
 
But according to Abbie Hunt, National Practice Incentive Manager at IPN Medical Centres, there are a number of financial opportunities that practices can take advantage of, namely the Practice Incentive Program (PIP) and Workforce Incentive Program (WIP).
 
Understanding SWPE and its impact on the PIP
During her presentation ‘How to unlock the value of your general practice’ at the RACGP’s Practice Owners National Conference, Ms Hunt said the first step to maximising profitability is understanding how the Standardised Whole Patient Equivalent (SWPE) functions through the MBS.
 
‘[It] is a result of a patient’s Medicare card number being linked to services that are provided under your provider number and, most pivotally, that your provider number is then linked to your practice number,’ she said.
 
‘We have the three main incentives – the eHealth incentive, the quality improvement [QI] incentive, and the after-hours incentive – they are all funded based on practice SWPE.’
 
This means, if a GP’s provider number has not been linked to the practice’s profile, none of their patient interactions will contribute to Medicare’s assessment of the practice’s size.

Ms Hunt, who has streamlined and administered the PIP and WIP programs across 185 practices, says this is an oversight she often sees, particularly when it comes to locum doctors and general practice registrars.
 
‘Anytime that you’re not linking, you’re simply missing out on all the patients they’re capturing,’ she said.
 
‘Not only could we potentially be missing out on those activities from a practice point of view, but we’re also limiting the SIP [service incentive payment] that’s available to those GPs because, in a similar way, where we don’t have a GP provider number linked to a practice, it also deprives that GP of any PIP associated service incentive programs.’
 
This is particularly important to keep in mind, Ms Hunt said, with the first COVID-19 PIP QI incentive payments expected to start coming through in July.
 
‘Those payments will be made at $10 per completed schedule. So your patient needs to have both dose one and dose two MBS items billed [at the same clinic],’ she said. ‘If any of your GPs, your registrars or your locums are not linked to your practice profile, the billing of those MBS items may not be linked through to your practice and your COVID PIP may suffer.
 
‘What I would ideally suggest is that you start utilising, if you’re not already, HPOS [Health Professional Online Services] to look at making sure you’re linking or adding your GPs to your profile.’
 
Workforce Incentive Program
Ms Hunt says this is another scheme worth looking into.
 
To receive a workforce incentive, practices are required to report the hours and level of nursing each quarter. But with different support rates available for enrolled nurses (EN) compared to registered nurses (RN) and nurse practitioners, Ms Hunt says it can be worth taking the time to consider any changes in the roster.
 
‘We could have a 4000 SWPE practice, which Medicare indicates would be a practice of around four FTE [full-time employees],’ she said.
 
‘[If] we have two part-time nurses, an RN that works 16 hours a week and an EN that works 24 hours a week, that practice receives just under $20,000 less per annum in WIP funding than a practice down the road of the same size that has a full-time nurse.
 
‘If your EN was to go on leave and your RN takes up some sessions over that time, that will actually change the mix of nurse hours for you for that quarter. So rather than reporting 16 hours of RN for that quarter, you may very well be able to report an average payment of 20 hours.
 
‘What we commonly see is people just confirming the same hours because there is a standard roster, and perhaps neglecting to take the five minutes to … really look at what went through the payroll because there can be a few thousand dollars there that will actually help offset that for you.’


Abbie Hunt, right, with fellow presenters from IPN Medical Centres, Director of Business Development Elise Taylor, centre, and Chief Medical Officer Dr Gun Soin, left. 

Maximising the PIP for small practice groups
Throughout her experience, Ms Hunt noted that it is common for practice owners who go on to acquire 2–3 clinics to register them as ‘branch practices’ that share one database.
 
While this approach can streamline processes, she says it can be ‘extremely financially disadvantageous’.
 
Using a case study of a three-branch practice group with 12 FTE GPs, and a SWPE of 7000 at the main practice, Ms Hunt says the caps on quality improvement activity and the WIP mean the group is limited to receiving $237,000 in funding per year.
 
‘It sounds nice, it sounds lovely – I know I’d be quite happy to take $200,000 a year. But it’s not much in a 12-doctor practice,’ she said.  
 
‘If we look at being really effective in our administration and we break those practices up on paper with Medicare with the incentive funding programs, you can retain your same database, you can retain all of the other mechanisms that you utilise.
 
‘The only difference is you’re going to have different identifiers, you’re going to be reporting them separately through to PIP, and you’re also going to have to provide some additional reports to evidence your eHealth claiming, your shared health summary uploads.’
 
By doing so, practices are able to draw on the capacity of their SWPE count, and in the example of the case study increase the annual funding they are eligible for from $237,000 to $400,000.  
 
‘You have a think about the number of patients … that need to walk through your doors for that $160,000,’ she said. ‘I’m sure you’d agree, in terms of setup, this is one of the biggest flaws that I see in terms of funding.’
 
Other incentives and upcoming changes
In addition to the main incentives, Ms Hunt encourages practice owners to actively engage in offering different services that can benefit both the community and practices themselves.
 
‘There is significant funding that’s available both in the Indigenous health area and also in student teaching,’ she said.
 
‘Certainly, it’s very worthwhile looking at Indigenous health. Contact your PHN if you’re looking for somewhere to start. It can quite easily add $500 each year for every Indigenous patient over the age of 15 with a chronic disease. That’s in addition to the annual health assessment that every single Indigenous patient that walks into our practice is entitled to receive.’
 
For those already involved in this space, practices will be required to register Aboriginal and Torres Strait Islander patients eligible for the PBS co-payment measure via HPOS from 1 July.
 
Meanwhile, as part of the Federal Government’s push for GPs to return to aged care, there will be a payment increase from $5000 per financial year to $10,000.
 
‘The tier levels are increasing,’ Ms Hunt said. ‘But I think it’s a really nice way to recognise general practice’s involvement in aged care.
 
‘I encourage you to go home and pull out one of your PIP statements and have a look at … what you’re participating in.
 
‘I know how hard as practice owners it can be to take your practice through accreditation; it’s a fabulous risk-management strategy in terms of having a quality practice. But we also want to make sure that with the effort of accreditation, we can ensure that we’re having the best return on investment and we are able to obtain the funds that we rightly can as a result of the program.’
 
Recordings of live sessions from the 2021 RACGP Practice Owners National Conference will be made available online by Friday 25 June 2021.
 
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