News

Overhaul of Practice Incentives Program delayed until May 2019


Amanda Lyons


2/03/2018 3:28:21 PM

The RACGP has welcomed the delay of the Federal Government’s proposed Practice Incentives Program Quality Improvement Incentive, as an opportunity to ensure that it is designed correctly and works for general practice.

Dr Edwin Kruys believes it is important to get the introduction of a Quality Improvement Incentive right for general practice.
Dr Edwin Kruys believes it is important to get the introduction of a Quality Improvement Incentive right for general practice.

‘We are very pleased that the government has postponed the introduction of a Quality Improvement Incentive as it is important that we get this right,’ Dr Edwin Kruys, GP representative for the RACGP on the Practice Incentives Program Advisory Group, told newsGP.
 
The proposed restructure of the Practice Incentives Program (PIP) was announced by the Federal Government as part of the 2016–17 Budget and involved scrapping a number of incentives including the procedural general practitioner payment, the general practice aged care access incentive and service incentive payments for diabetes care, asthma care and cervical screening. Funding would instead be redirected to the implementation of a new quality improvement practice incentive (QI PIP).
 
The RACGP and its members had expressed concern about aspects of the proposed QI PIP, such as the requirement that general practices send de-identified data from their practice software to their Primary Health Network (PHN).
 
‘The RACGP is certainly not opposed to data-driven quality assurance and sharing data appropriately, but we are concerned about practice data being directly provided to PHNs for several reasons,’ Dr Kruys said.
 
‘First, there are large variations between PHNs regarding their capacity, capability, workforce and readiness to undertake the type of data aggregation and data analysis that may be required. Second, PHNs may not exist as ‘Continuous Quality Improvement providers’ long-term, limiting their capacity or interest in developing internal expertise to undertake data analysis.’
 
The RACGP has also been concerned the QI PIP will operate as a pay-for-performance-based incentive program rather than encouraging practice-led quality improvement activities.
 
‘There is very little evidence that performance indicators tied to funding have a significant, long-lasting positive effect on quality of care – but there are reports of harm,’ Dr Kruys said. ‘For example, doctors or practices may be tempted to focus on performance indicators instead of the needs of their patients. There are also worrying indications that these schemes lead to loss of professional satisfaction and wellbeing.’
 
In addition, Dr Kruys observes that some of the value incurred within general practice can be very difficult to quantify.
 
‘For example, the value of general practice often occurs when GPs choose not to order a test or start a treatment, but how do you measure this?’ he said.
 
‘We have to be very careful with outcome-based indicators and may have to look at better process-oriented alternatives.’
 
RACGP members have also been concerned about the cuts to other PIP incentives as part of the restructure, especially the General Practitioner Aged Care Access Incentive.
 
‘The proposed removal of the General Practitioner Aged Care Access Incentive will result in a $3000– 5000 loss for GPs providing care to patients in residential aged care facilities,’ Dr Kruys said.
 
‘This is bad news for Australians currently living in these facilities. The incentive must be retained until there is a suitable alternative that ensures support for GPs to provide care to our elderly patients.’
 
Dr Kruys is hopeful that the delay of the implementation of the QI PIP will allow time for the RACGP to continue advising on its development and ensure any changes to incentives add value to delivery of care in general practice, rather than reducing it.
 
‘The PIP has been a key driver in quality GP care over the years and we will continue the conversation with the Department of Health to further strengthen quality assurance systems in general practice,’ he said.



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