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May 2009

We are running a regionally focused and targeted communication campaign to promote Medicare electronic claiming to Medicare cardholders. If your practice is in one of the targeted areas, you will receive a letter to inform you about the messages we are delivering locally.

For more information about patient claiming through Medicare Online and Medicare Easyclaim call 1800 700 199 to talk to one of our Business Development Officers.

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Practice Incentives Program (PIP)

What is the Practice Incentives Program (PIP)?

The PIP delivers financial incentives with the aim of recognising general practices that provide comprehensive, quality care, who are either accredited or working towards accreditation for the Royal Australian College of General Practitioners' (RACGP) Standards for General Practices.

The PIP is part of a blended payment approach for general practice. Payments made through the program are in addition to other income earned by the general practitioners and the practice, such as patient payments and Medicare rebates.

The PIP aims to compensate for the limitations of fee-for-service arrangements. Under these arrangements, practices that provide numerous quick consultations receive higher payment than those that take the time to look after the ongoing health care needs of their patients. High throughput of patients can be associated with unnecessary prescribing, tests and referrals.

Medicare Australia assesses all applications from general practices for participation in the program. The Department of Heath and Ageing manages the program policy development, including eligibility criteria. In line with the Practice Incentives Program Review Group recommendations, access to the PIP is available only to practices that are fully accredited or new practices that are registered for accreditation and must be fully accredited within 12 -months of joining.

PIP payments are mainly dependent on practice size, in terms of patients seen.The basis for the PIP payment formula was developed in consultation with the General Practice Financing Group (GPFG). The GPFG is a negotiating body comprising the Royal Australian College of General Practitioners, Australian Medical Association, Rural Doctors Association of Australia, Australian Divisions of General Practice, and the Australian Government. More information is provided in the Formula section of this site.

Payments focus on aspects of general practice that contribute to quality care, including:

the use of Information Management/Information Technology (IM/IT)
provision of after hours care
student teaching and better prescribing
paying a rural loading to practices in rural and remote locations.

Practices may spend their payment as they wish, though the usual taxation rules apply.

There are eleven broad elements to the payments:

1. Information Management/Information Technology (IM/IT)
A payment is available for PIP practices maintaining electronic health records and implementing secure IM/IT practice systems which facilitate effective and widespread information transfer and storage. The PIP eHealth Incentive will replace the existing PIP IM/IT Incentive and is due to cease from August 2009.

IM/IT documents

2. After hours care

PIP payments are available for ensuring that regular patients of the practice have either access to or the provision of 24 hour care.

3. Practice Nurse Incentive (PNI)

The PIP PNI aims to encourage general practices and Aboriginal Medical Services (AMS) in rural and remote areas to employ practice nurses and/or Aboriginal health workers. Practices in urban areas of workforce shortage can employ allied health workers such as physiotherapists, dieticians and occupational therapists instead of, or in addition to, practice nurses and/or Aboriginal health workers. The incentive is not intended to cover the full employment costs.

The payment to PIP practices is based on a minimum of two sessions per week over the payment quarter.

PNI documents

Guidelines for Practice Nurses and/or Allied Health Workers for urban areas of workforce shortage [PDF, 118Kb]

4. Quality Prescribing Incentive (QPI)
The Quality Prescribing Incentive is available to assist PIP practices to remain current with information on the quality use of medicines.

5. Teaching
An incentive payment is available for PIP practices that host undergraduate students for teaching placements.

6. Rural loading
Rural loadings are payable to a PIP practice depending on the geographical size of the region of the practice location and the remoteness of the practice, according to the Rural, Remote and Metropolitan Area classification (RRMA) 3-7.

7. Cervical Screening Incentive
The Cervical Screening Incentive consists of the following components;

Sign-on Payment: One-off payment to PIP practices that engage with the state/territory Cervical Screening Registers.
Outcomes Payment: Payment to PIP practices where a specified proportion of women aged between 20 and 69 years has been screened in the last 30 months
Services Incentive Payment: A payment to practitioners working within a PIP practice for screening women between 20 and 69 years, who have not had a cervical smear within the last four years.

8. Asthma Incentive
The Asthma Incentive consists of the following components;

Sign-on Payment: One-off payment to PIP practices that implement a cycle of care for patients with moderate to severe asthma.
Service Incentive Payment: Payment to practitioners working within a PIP practice who complete an asthma cycle of care for patients with moderate to severe asthma, payable once per year per patient.

Asthma Cycle of Care: Completing the Asthma Cycle of Care — A guide for General Practitioners [PDF, 204Kb]

9. Diabetes Incentive
The Diabetes Incentive consists of the following components;

Sign-On Payment: One-off payment for notifying the Australian Government that the PIP practice uses a diabetes register and recall/reminder system.
Outcomes Payment: Payment to PIP practices that complete an annual cycle of care for a target proportion of their patients with diabetes.
Service Incentive Payment: Payment to providers working within a PIP practice for each annual cycle of care for a patient with diabetes, payable once per year per patient.

10. Rural and Remote Procedural GP Payment
This initiative acknowledges that general practices in rural and remote areas are often required to deliver a wide range of services such as obstetrics, surgery and anaesthetics which in urban areas are typically the province of a specific referral based specialty.

For a practice to be eligible for the payment it must participate in the PIP, be located within the target area Rural, Remote and Metropolitan Area classification (RRMAs) 3-7, and have at least one GP that provides one or more of the procedural services described in the definition of a procedural general practitioner.

Procedural GP Documents

11. Domestic Violence Incentive
The Domestic Violence Incentive aims to support PIP practices in RRMAs 3-7 that act as a referral point for domestic violence support services for people experiencing domestic violence.

Domestic Violence Documents

New incentives

Aged Care Access Incentive

As part of the 2008-09 Federal Budget, the Government announced the restructure of the Aged Care GP Panels Initiative and the introduction of the Aged Care Access Initiative from July 2008 to focus on increasing primary care service provisions for residents of aged care facilities.

The Aged Care Access Initiative has two separate components:

An incentive payment through the PIP to encourage general practitioners (GPs) to provide more services in Residential Aged Care Facilities (RACF). The PIP payments will be administered through Medicare Australia
A payment for clinical care provided by allied health professionals in RACFs, where these services are not currently covered by Medicare or other government funding arrangements. This component will be managed by State based organisations in each state and territory which may purchase allied health services directly or through contractual arrangements with Divisions of General Practice.

GPs in PIP practices will be eligible for the service incentive payments if they meet Qualifying Service Levels (QSLs) for provision of care in RACF in a financial year.

There are two Service Incentive payment levels under the GP Aged Care Access Incentive component:

Tier one provides a payment of $1 000 when the QSL1 of 60 Medicare Benefits Schedule (MBS) services is claimed in 2008-09.
Tier two provides a payment of $1 500 when the QSL2 of 140 MBS services are claimed in 2008-09

The maximum payment any one GP can receive in one financial year is $2,500.

Medicare services provided from 1 July 2008 will count towards the QSLs. Medicare Australia will calculate entitlements based on Medicare claiming records and commence incentive payments to eligible GPs in conjunction with other PIP payments from February 2009. Medicare Benefits Schedule (MBS) items that count towards QSLs include attendances in RACF, Comprehensive Medical Assessments, and contributions to Care Plans, Case Conferences, and Residential Medication Management Reviews.

The MBS items that count towards the incentive include:

20, 35, 43, 51, 92, 93, 95, 96, 712, 731, 734, 736, 738, 775, 778, 779, 903, 5010, 5028, 5049, 5067, 5260, 5263, 5265, 5267.

This list may be revised to include other items.

GPs do not need to apply to participate in the incentive. However, Medicare Australia will request bank details from GPs eligible to receive payments, once they have reached one of the QSLs.

A full set of the Aged Care Access Initiative program guidelines can be accessed at the Department of Health and Ageing website.

The guidelines also contain information about the allied health services component of the program which is to be delivered through the Divisions of General Practice network.

Further enquiries about the GP Aged Care Access Incentive can be directed to the PIP Enquiry line on 1800 222 032 (8.30am – 5.00pm CST).

eHealth Incentive

The PIP eHealth Incentive was announced as part of the 2008-09 Budget, and will start from August 2009. The incentive aims to encourage use of electronic health systems in PIP practices. The PIP eHealth Incentive will replace the existing PIP IM/IT Incentive, which will cease in August 2009.

This new incentive aims to encourage general practices to keep up to date with the latest developments in eHealth.

The eHealth Incentive will be incorporated into the PIP payments with a payment level of $6.50 per Standardised Whole Patient Equivalent (SWPE).

Payments will be capped at $12 500 per practice per quarter, up to a maximum of $50 000 per year.

Glossary

AGPAL: Australian General Practice Accreditation Ltd
DVA: Department of Veterans' Affairs
DVI: Domestic Violence Incentive
FTE GP: Full Time Equivalent General Practitioner
GPA PLUS: General Practice Accreditation Plus
GPFG: General Practice Financing Group
GPSRG: General Practice Strategy Review Group
GPII: General Practice Immunisation Incentives
IM/IT: Information Management / Information Technology
MBS: Medicare Benefits Schedule
NPS: National Prescribing Service
PIP: Practice Incentives Program
PNI: Practice Nurse Incentive
PNAHW: Practice Nurse / Allied Health Worker/Aboriginal Health Worker
QAS: Quality Assurance Services
QPI: Quality Prescribing Initiative
QSL: Qualifying Service Levels
RACFs: Residential Aged Care Facilities
RACGP: Royal Australian College of General Practitioners
RCTI: Recipient Created Tax Invoice
RRMA: Rural, Remote & Metropolitan Area
SWPE: Standardised Whole Patient Equivalent
WPE: Whole Patient Equivalent

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Last updated: 1 April, 2009