For once, payroll tax might be the least of your problems.
A webinar meant to unpack recommendations from the Review of General Practice Incentives has done little to assuage fears over the role of patient enrolment and what will become of sub-specialist GPs.
Draft recommendations released last week were a mixed bag, ranging from setting up an independent primary care pricing authority to calling for incentives to be linked to MyMedicare and go directly to practices rather than doctors.
The RACGP said the draft recommendations “articulate[d] a pathway towards … capitation”, while both ACRRM and the RDAA warned that funnelling money to practices rather than practitioners would be catastrophic for rural towns.
At a webinar on Monday afternoon, members of the expert advisory panel fronted up to an audience of GPs, practice managers and other primary healthcare workers to talk through the specifics of the draft recommendations.
One participant asked the reviewers to expand on the proposed link between incentives and voluntary enrolment system MyMedicare – specifically whether the department was concerned about patients not seeing any advantage in enrolling.
The first panel member, nurse practitioner Denise Lyons, said she was unable to answer and handballed the query to fellow panel member, practice manager Tracey Johnson.
“I think that over time, we’ve got to use these changes to build continuity of care so that patients understand why it’s good to go and see the same practice and practice team – because the data is quite clear that, when they do, they get way better outcomes,” she said.
“But at the moment, there’s no real mechanisms or link to make that happen.
“Over time, as we increasingly link these things to a patient who we know, who we’ve got data on, at a practice that we can fund to do needs-based care with the team that will best support that needs based care, we’re going to get better outcomes.”
Panel chair Mark Roddam, first assistant secretary of the Department of Health and Aged Care primary care division, added that the idea of registration was to support better quality care and ongoing relationships.
“At the moment there are only a couple of programs or incentives that are tied to MyMedicare, but the panel really had [envisioned] the registration system as underpinning this new payments framework,” he said.
“If you’ve got greater need for enrolment, from both the patient’s and the practice’s point of view, then there’s a more natural take up of MyMedicare as well.”
Another question from the audience was how GPs who subspecialise and provide more episodic, niche care would be able to benefit from a system that rewarded continuity of care only.
Ms Lyons answered by saying that limited data had been a challenge for the panel group, which was making decisions looking at value-based care.
“We talked about how important those services are, that there are areas of health and patients who need special services,” she said.
“Enrolment in MyMedicare doesn’t prevent patients from accessing those services.”
Ms Johnson, who also has qualifications in health economics, said the panel had spent time modelling incentive programs that would target vulnerable patient groups before deciding against it.
“What we found is that, as we tried to slice and dice the onion, there wasn’t great data and it would create more complexity in terms of practices trying to access that money – it would be just another thing you had to comply with,” she said.
“And if you only have 20 of these patients that might fit into that bucket, and 10 patients that fit into a different bucket, would you even bother going to the effort to do this?
“We were much better off trying to come up with a needs-based funding model.”
There was a sliver of good news, however, on payroll tax.
Related
Multiple audience members asked the panel about whether GPs would have to be employees in order to access the incentive funding, given the payroll tax implications of being an employee rather than a private contractor.
“There is nothing within this report that would funnel away from what is currently a predominantly subcontractor workforce,” Ms Johnson said.
“There will potentially be changes to the contractual agreements that might be in place between a practice and the subcontractors, but I don’t see our report forcing anybody to become an employee.”
Ms Johnson also said that there was a sense within the panel that it “just need[s] to get moving” in terms of implementing reform.
“This is not an agenda that we can be delaying,” she said.
“We all recognise that primary care needs to be supported and be supported now.
“For that reason, we did not recommend extensive piloting.”
There will be a second webinar on 29 August.
