General practices that wish to receive incentive payments for quality improvements from August 1 need to choose areas to focus on and be ready to supply de-identified data to their Primary Health Networks every quarter.
The Health Department says the Practice Incentives Program – Quality Improvement, which is worth up to $12,500 quarterly per practice, is “a move away from process-based funding towards outcome-focused funding”. It is also a large data collection exercise for the purpose of service planning and the tracking of trends.
To be eligible for the PIP QI, a practice may choose to focus on 10 measures suggested by the federal Health Department that represent “key health priority areas”, including chronic conditions that make up a large part of the burden of disease in Australia, and their associated risk factors.
These measures have been adapted from the Aboriginal and Torres Strait Islander National Key Performance Indicators, which are already used to measure population health improvement under the Indigenous Australians Health Program.
The 10 measures are: the proportion of patients with a current HbA1c result, smoking status, weight classification and alcohol consumption status; the proportion of patients over 65 or with COPD or with diabetes who have been immunised against influenza; the proportion of female patients with up-to-date cervical screening; the proportion of patients with risk factors assessed to enable CVD assessment; and the proportion of diabetic patients with a blood pressure result.
There are no set targets to reach under these measures.
Practices can choose alternatives, as long as they are “informed by their clinical information system data and meet the needs of their practice population”.
The improvement measures aren’t for the assessment of practices or individual practitioners, the department says, but to “support a regional and national understanding of chronic disease management in areas of high need”.
Each practice will have to submit data from its clinical information system, using secure third-party data extraction tools, to its PHN every quarter, in accordance with the PIP Eligible Data Set Data Governance Framework. This sets out rules around privacy, content, collection, use and access, aggregation and security.
The PIP QI imposes no extra privacy and security requirements on doctors but relies on their existing professional obligations.
Practices must file their PIP data within the submission period for a given quarter, which closes two weeks before the quarter’s end. For example, the data submission period for the August 1 to October 30 quarter is August 1 to October 15, and payment for that quarter is made in November.
Practices need to keep documentation for six years in case they’re chosen for an audit by the Health Department.
The Department of Human Services, which will administer the program on behalf of Health, “may recover payments if practices can’t provide evidence of meeting the eligibility requirements or evidence to substantiate claims”.
Apply at humanservices.gov.au/hpos using your Provider Digital Access account.