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Practice Incentives Program (PIP) payments and calculations

PIP Guidelines

More information on the Practice Incentives Program guidelines

Practice payments

The majority of payments made through PIP are made to practices and focus on those aspects of general practice that contribute to quality care.

If a practice's PIP application is successful, the practice will receive an initial PIP payment in the first payment quarter after approval. The practice will receive subsequent quarterly payments, providing it continues to meet the eligibility criteria. Payments are made in February, May, August and November.

Medicare will automatically calculate entitlements for payments based on information received from the practice. This means it is important to inform Medicare of any changes in practice arrangements. More information is provided in the change practice details page on our website.

Payments are made by Electronic Funds Transfer (EFT).

Practices can spend their payment as they want, though the usual taxation rules apply. The PIP payment is intended to support the practice in purchasing additional equipment, upgrading facilities or offering additional remuneration to doctors working at the practice.

Incentives Aspect or activity Payment amount
Quality stream
Quality Prescribing Practice participation in a number of recognised activities endorsed by the National Prescribing Service. Paid annually in May. $1 per SWPE
Diabetes Incentive Sign-On Payment: one-off payment to practices that use a patient register and a recall and reminder system for their patient with diabetes mellitus. $1 per SWPE
Outcomes Payment: payment to practices that complete an annual cycle of care for a target proportion of their patients with diabetes. $20 per diabetic SWPE per year
Service Incentive Payment: payment to GPs for each cycle of care completed for patients with established diabetes mellitus. $40 per patient per year
Cervical Screening
Incentive
Sign-on Payment: one-off payment to practices that engage with the state and territory cervical screening registers. $0.25 per SWPE
Outcomes Payment: payment to practices where a specified proportion of women aged between 20 and 69 years have been screened in the last 30 months. $3 per eligible WPE
Service Incentive Payment: payment to GPs for each cervical smear on an eligible under-screened woman. $35 per patient per year
Asthma Incentive
 
Sign-on Payment: one-off payment to practices that use a patient register, a recall and reminder system and agree to use the asthma cycle of care. $0.25 per SWPE
Service Incentive Payment: payment to GPs for each completed cycle of care for patients with moderate to severe asthma, payable once per year per patient. $100 per patient per year
Indigenous Health Incentive
 
Sign-on Payment: one-off payment to practices that agree to undertake specified activities to improve the provision of care to their Aboriginal and/or Torres Strait Islander patients with a chronic disease. $1,000 per practice
Patient Registration Payment: A payment to practices for each Aboriginal and/or Torres Strait Islander patient aged 15 years and over, registered with the practice for chronic disease management. $250 per eligible patient per calendar year
Outcomes Payment Tier 1: Payment to practices for each registered patient for whom a target level of care is provided by the practice in a calendar year. Tier 1: $100 per eligible patient per calendar year
Outcomes Payment Tier 2: Payment to practices for providing the majority of care for a registered patient in a calendar year. Tier 2: $150 per eligible patient per calendar year
Capacity stream
eHealth Incentive Practices must meet each of the requirements to qualify for payments through this incentive. $6.50 per SWPE capped at $12,500 per practice, per quarter
Teaching Incentive Teaching of medical students. Maximum of two sessions per GP, per day. $100 per session
Aged Care Access Incentive Tier 1—GPs must provide at least  60 eligible MBS services in residential aged care facilities (RACFs) in the financial year. $1,500 per financial year
Tier 2—GPs must provide at least 140 eligible MBS services in RACFs in the financial year. $3,500 per financial year
Rural support stream**
Rural Loading The practice's main location is outside metropolitan areas (increases with extent of remoteness) based on the Rural, Remote & Metropolitan Area (RRMA) 3–7 Classification. Once all incentive payments are added (excluding the Service Incentive Payments), the rural loading amount is applied. RRMA 1–0 per cent loading
RRMA 2–0 per cent loading
RRMA 3–15 per cent loading
RRMA 4–20 per cent loading
RRMA 5–40 per cent loading
RRMA 6–25 per cent loading
RRMA 7–50 per cent loading.
Procedural GP Payment Tier 1— A GP in a rural or remote practice provides at least one procedural service, which meets the definition of a procedural service, in the six month reference period. $1,000 per procedural GP per six month reference period
Tier 2— A GP in a rural or remote practice meets the Tier 1 requirement and provides after hours procedural services on a regular or rostered basis (15 hours per week on average) throughout the six month reference period. $2,000 per procedural GP per six month reference period
Tier 3— A GP in a rural or remote practice meets the Tier 2 requirements and provides 25 or more eligible surgical and/or anaesthetic and/or obstetric services in the six month reference period. $5,000 per procedural GP per six month reference period
Tier 4— A GP in a rural or remote practice meets the Tier 2 requirements and delivers 10 or more babies in the six month reference period or meets the obstetric needs of the community. $8,500 per procedural GP per six month reference period.

* For practices in rural, remote and metropolitan areas 3-7 only.

†Whole Patient Equivalent (WPE)

Calculation of payments

PIP payments are generally based on a measure of the practice size known as the Standardised Whole Patient Equivalent (SWPE) value. The SWPE value is calculated using Medicare Benefits Schedule (MBS) claims by patients attending the practice during a historical 12 month period known as the reference period. The reference period is a rolling 12 month period that commences 16 months prior to the payment quarter. See Table 2.

Payments are calculated using Medicare and Department of Veterans' Affairs (DVA) data that are linked to the provider numbers specified on the practice's application form and any subsequent amendments to Medicare. If for example, you do not provide Medicare with details of new GPs, you will not receive payment associated with the services provided by the new GPs. More information is given in the change practice details page on our website.

Data will be excluded if any of the GPs in a practice refuse consent to the use of their data for the purposes of calculating the practice's payment when completing the Individual GP details form. If GPs would like their data to be included at a later stage, they must advise Medicare in writing.

Calculating the SWPE value

The Standardised Whole Patient Equivalent (SWPE) value of a practice is the sum of the fractions of care provided to practice patients, weighted for the age and gender of each patient. As a guide, the average full-time GP has a SWPE value of around 1000 SWPEs annually. For more information on the calculation of payments and the SWPE value, refer to the PIP guidelines (4512) [PDF, 323Kb]PDF reader required.

The total care for each patient equals one (1.0) and is known as the Whole Patient Equivalent (WPE). The WPE is based on GP and other non-referred consultation items in the MBS and uses a weighting value rather than the number of consultations per patient.

The weighted fractions of patient care are then added together, giving the SWPE value for the practice.

Table 1 gives the values used in weighting WPEs for age and gender for November 2014. (Weightings are subject to quarterly adjustments).

Table 1

Weighting factors for age and gender of patients
Sex Patient age (years)
<1 1 - 4 5 - 14 15 - 24 25 - 44 45 - 64 65 - 74 75 +
Female 0.5274 0.8322 0.5137 0.8219 1.0137 1.1096 1.5034 2.2363
Male 0.5685 0.9041 0.524 0.5308 0.6781 0.911 1.3562 2.0651

When payments are made

To qualify for payments, practices must be participating in the PIP and meet the eligibility requirements of the incentives at a 'point-in-time' date. The 'point in time' date is the last day of the month prior to the next PIP quarterly payment. The quarterly payment months, 'point-in-time' dates and reference periods are provided in table 1. For more information on when payments are made, refer to the PIP guidelines (4512) [PDF, 323Kb]PDF reader required.

Table 1

Quarterly Payment Month 'Point-in-time' assessment of eligibility SWPE value reference period
February 31 January 1 October to 30 September
May 30 April 1 January to 31 December
August 31 July 1 April to 31 March
November 31 October 1 July to 30 June

Appealing a Medicare decision

The PIP has an established appeals process. To request a review of a decision, your practice’s authorised contact person or owner of the practice must write to Medicare within 28 calendar days of the date of the letter informing the practice of the decision.

The request must include the following details:

  • the name and address of the person requesting the review
  • the name and PIP practice identification number of the practice
  • the decision to be reviewed
  • the grounds for requesting the review

Medicare will reassess its decision in accordance with the PIP eligibility requirements and/or payment formula used to make the original decision and advise the practice in writing of the outcome of the review.

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Last updated: 19 November, 2014