General Practice prepares for the new PIP Quality Improvement

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The Practice Incentives Program (PIP) supports general practice activities that encourage continuing improvements; quality care; enhancing capacity; and improving access and health outcomes for patients. A new redesigned program begins 1 August 2019.

All practices that receive PIP incentive payments should be aware of the upcoming changes and start to take steps now and be ready for the transition.

The PIP will be simplified by combining four existing incentives into one Quality Improvement (QI) incentive.

The four incentives that will cease on 31 July 2019 are: Asthma Incentive; Quality Prescribing Incentive; Cervical Screening Incentive; Diabetes Incentive. The Australian Government has decided to retain the General Practitioner Aged Care Access Incentive.

The following incentives will continue: eHealth Incentive; After Hours Incentive; Rural Loading Incentive; Teaching Payment; Indigenous Health Incentive; Procedural General Practitioner Payment and General Practitioner Aged Care Access Incentive.

Incentive components

A general practice will need to meet two components to qualify for a PIP QI incentive payment:

  1. Participation in continuous quality improvement activities
  2. PIP Eligible Data Set

The QI PIP will give practices more flexibility to focus on the needs of their practice population, including vulnerable and high-risk groups, in partnership with their Primary Health Networks (PHNs). Practices will be encouraged to use their practice data; the local PHN health needs assessment; and benchmark reports from some PHNs to identify needs-based population health quality improvement opportunities, called Improvement Measures. For example, a practice may consider whether their patients marked in clinical software with a diagnosis of depression or anxiety disorders have been regularly recalled or followed up for reviews of their mental health treatment plans, and reissue referrals to mental health professionals if warranted. Or it may be that a clinician has a specific interest in improving respiratory health of patients and looks at the number of patients with a chronic respiratory illness and how the practice’s service delivery model could be improved. For example, practice data may provide evidence that supports a business case for a chronic disease management nurse clinic.

Practices will no longer be directed to focus on predetermined specific diseases.

Since the redesign was announced, the Department of Health has been working with the Practice Incentives Program Advisory Group (with representatives from the RACGP, the Australian Medical Association, the Australian College of Rural and Remote Medicine, the Rural Doctors Association of Australia, the Australian Association of Practice Managers and the National Aboriginal and Community Controlled Health Organisations) to ensure the redesigned PIP is agile for different contexts, avoiding the potential negative aspects of rigid ‘pay for performance’ initiatives, where providers who care for the poorest and sickest people tend to be penalised (e.g. it may be easier to achieve specific diabetes targets for people in Toorak or Bulimba, than in Dandenong or Cunnamulla).

Quality improvement measures data

Practices will need to meet eligibility criteria to receive the QI incentive, including accreditation against the RACGP Standards for General Practices. The new incentive also requires practices to share aggregated and de-identified data extracted from their clinical software with their local PHN, based on the following ten quality Improvement Measures:

  1. Proportion of patients with diabetes with a current HbA1c result
  2. Proportion of patients with a smoking status
  3. Proportion of patients with a weight classification
  4. Proportion of patients aged 65 and over who were immunised against influenza
  5. Proportion of patients with diabetes who were immunised against influenza
  6. Proportion of patients with COPD who were immunised against influenza
  7. Proportion of patients with an alcohol consumption status
  8. Proportion of patients with the necessary risk factors assessed to enable CVD assessment
  9. Proportion of female patients with an up-to-date cervical screening
  10. Proportion of patients with diabetes with a blood pressure result.

This information will be collated at the local level by the PHNs to assist in supporting improvement and understanding health needs. However, practices of course need good quality data to get the most out of this PIP for their patients. Larter also helps individual practices to analyse their data to support both financial sustainability and quality improvement (though we do not seek to replicate the work of PHNs).

For example, with Medicare rebates not keeping up with inflation for five years, it’s never been more important for practices to know what they are entitled to claim. Larter can support general practice with an audit of practice revenue sources, including claims for the PIP and recommend how a practice may increase its revenue. Practices will be eligible for up to $12,500 per quarter through this incentive program.

Larter can provide general practices with practical support and training to ensure they are ready for the change. Contact us.

More information about the new PIP Quality Improvement is available in the draft Guidelines and Improvement Measures.