The Practice Incentives Program (PIP) is a key driver of quality care in the general practice sector.

In the 2016/17 Federal Budget, the Australian Government announced it would work towards changing the PIP through the measure entitled, "Quality Improvement in General Practice - Simplification of the PIP".

The redesign of the PIP will introduce a new Quality Improvement Incentive which will give general practices increased flexibility to improve their detection and management of a range of chronic conditions, and to focus on issues specific to their practice population.

For further information read this handout.

General information

The intention of the Practice Incentive Program (PIP) is to recognise general practices that provide comprehensive, quality care. To qualify for the PIP practices must be accredited, or working towards accreditation, against 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 fee for service income. Payments are calculated according to various formulae that take into account factors, such as practice size and patient demographics.

All PIP payments (excluding teaching and procedural GP) are paid according to the Standardised Whole Patient Equivalent (SWPE) for the practice. The SWPE is essentially the proportion of care provided by the practice to patients attending the practice during the reference period.

Medicare Australia will automatically calculate a practice's entitlement for payments based on information provided in the application form and subsequent amendments. In some cases (such as teaching of medical students) practices need to supply additional information as it becomes available. PIP payments occur in February, May, August and November of each year.

Practice incentive payments are made to the whole practice, in contrast to Service Incentive Payments (SIP), which are made to the individual provider of the service. SIP payments are associated with the completion of the diabetes annual cycle of care, completion of the asthma cycle of care, and with cervical screening performed on under screened women (no pap smear previous 4 years).

Service Incentive Payments are paid in addition to the normal Medicare benefit for the particular items and require specific trigger MBS item numbers to be billed. SIPs are paid quarterly in February, May, August and November.

More information and a complete list of PIP payments available can be found on the Health Professional website.

Update PIP details via HPOS

PIP updating is also now available through Medicare's Health Professional Online Services (HPOS) website. Updates are immediate and can reduce the likelihood of a delay in your PIP payment. Practices that update details through HPOS have until the point in time to submit, whereas practices that submit updates via paper forms must submit the paperwork at least seven days before the relevant point in time - for example for the May quarterly payment, the point in time is 30 April.

The practice can also choose to get correspondence via HPOS –for example the practice’s annual PIP Confirmation Statement and PIP payment advices.

For individual practitioners to access PIP Online to update their own information, they need to have registered their Individual PKI certificate RA number with PIP by emailing pip@humanservices.gov.au or pnip@humanservices.gov.au

For more information on accreditation requirements, read the PIP guidelines or the PNIP guidelines.

Indigenous Health PIP

The Indigenous Health PIP commenced in May 2010 as part of the Commonwealth Government's ‘Closing the Gap’ funding.

Practices participating in PIP will need to meet specific sign on requirements, including members of staff attending cultural awareness training.

For practices to register patients for the Indigenous Health PIP and the PBS Co-payment Measure, patients must self-identify to the GP or practice staff as being of Aboriginal and/or Torres Strait Islander origin. Patients don’t need to provide evidence to support this.

GPs or practice staff should ask all patients if they identify as being of Aboriginal and/or Torres Strait Islander origin. The Australian Bureau of Statistics advises that the wording of a question influences a patient’s response. Always ask the national standard identification question “are you of Aboriginal or Torres Strait Islander origin?” For a child or a patient unable to respond, ask an accompanying responsible adult, “is (person’s name) of Aboriginal or Torres Strait Islander origin?”

For more information on the three components to the Indigenous Health PIP, read the Indigenous Health Incentive Guidelines, visit the Department of Human Services website, or contact our Indigenous Health Consultants located at each of our offices in Warrnambool, Ballarat, Horsham and Geelong.

Digital Health PIP

The PIP Digital Health Incentive was announced as part of the 2008-09 Budget, and started in August 2009. The incentive aims to encourage use of electronic health systems in PIP practices, 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.

Western Victoria Primary Health Network will assist new practices to apply for the Digital Health Incentive and support existing Digital Health PIP practices to achieve compliance. If you have any concerns that your accredited GP site does not meet the Digital Health incentive requirements, please contact the Digital Health team for assistance.

Requirements for Digital Health PIP Compliance:

Requirement 1 - Integrating Healthcare Identifiers.
The practice must:
1. Apply to Human Services to obtain a Healthcare Provider Identifier - Organisation (HPI-O) for the practice, and store the HPI-O in a compliant clinical software system.
2. Ensure that each general practitioner within the practice has their Healthcare Provider Identifier (HPI-I) stored in a compliant clinical software system.
3. Use a compliant clinical software system to access, retrieve and store verified Individual Healthcare Identifiers (IHI) for presenting patients.

Requirement 2 - Secure Messaging Capability
The practice must have a standards compliant secure messaging capability to electronically transmit and receive clinical messages to and from other healthcare providers, use it where feasible and have a written policy to encourage its use in place.

Requirement 3 - Data Records and Clinical Coding
Practices must ensure that where clinically relevant, they are working towards recording the majority of diagnoses for active patients electronically, using a medical vocabulary that can be mapped against a nationally recognised disease classification or terminology system. Practices must provide a written policy to this effect to all GPs within the practice.

Requirement 4 - Electronic Transfer of Prescriptions
The practice must ensure that the majority of their prescriptions are sent electronically to a Prescription Exchange Service (PES).

Requirement 5 - Personally Controlled Electronic Health (Digital Health) Record System
The practice must:

  1. Use compliant software for accessing the personally controlled electronic health (eHealth) record system, and creating and posting shared health summaries and when available, event summaries.
  2. Apply to participate in the eHealth record system upon obtaining a HPI-O.
  3. Upload a shared health summary for a minimum of 0.5% of the practice's standardised whole patien equivalent (SWPE) count of patients per PIP payment quarter.

Resources

Questions and Answers by the Department of Health: eHealth Practice Incentive Program (ePIP) compliance letters

Contact

For more information about the PIP eHealth Incentive, go to the Medicare Australia website.
Email: pip@humanservices.gov.au
Tel: PIP enquiry line 1800 222 032 (8:30am to 5pm Australian Central Standard Time)

For help contact the Digital Health team at Western Victoria Primary Health Network on 5222 0800 or by email.

Aged Care Access PIP

The Aged Care Access Incentive is a payment designed to encourage GPs to provide increased and continuing services in Residential Aged Care Facilities(RACFs). GPs participating in the PIP will be eligible for incentive payments if they meet Qualifying Service Levels (QSLs) for the provision of care in RACFs in a financial year.

There are two payment levels under the Aged Care Access Initiative and annual payments are capped at $5000 per provider per financial year. The incentive has two payment tiers as follows:

Tier 1 - $1500 on reaching QSL of 60 MBS items claimed in the financial year.
Tier 2 - $3500 on reaching QSL of 140 MBS items claimed in the financial year (an additional 80 items after reaching Tier 1).

Aged Care Access Guidelines.

Practice Nurse Incentive Program

The Practice Nurse Incentive Program (PNIP) commenced on 1 January 2012 and provides incentive payments to practices to support an expanded and enhanced role for nurses working in general practice.

Resources

PNIP Business Tools and Scenarios
More information about the PNIP is available by contacting Medicare Australia
Email: mailto:pnip@medicareaustralia.gov.au
Phone: 1800 222 032 (between 8.30am – 5.00pm)