As dull as it might sound, a redesign of WIPs and PIPs will affect almost every medical practice in Australia.
The RACGP has been left fuming at a recommendation for the WIP and PIP payments to be replaced over time, saying the suggested pathway smacks of capitation.
A review of the Practice Incentives Program and the Workforce Incentive Program was ordered in September last year, and the Department of Health and Aged Care released a consultation briefing paper on the topic this week.
The headline recommendation was that WIPs and PIPs be phased out for a new, “simplified” GP payment architecture.
This would comprise a new baseline payment for practices that combines funding for multidisciplinary care or care coordination as well as payments for quality and innovation programs, teaching and after-hours care.
In return, GPs would have to provide comprehensive service delivery information and data.
Crucially, practices and patients would have to participate in the voluntary patient enrolment system MyMedicare.
RACGP president Dr Nicole Higgins pointed out that this requirement would threaten the voluntary premise of MyMedicare.
“Practice incentive programs are critical to the viability of general practice and continuing patient care,” she said.
“So, it is bitterly disappointing to see the review recommended the replacement of existing PIP and WIP payments over time.
“Instead, it articulates a pathway towards what sounds like capitation – the RACGP will never support this.”
Dr Higgins also pointed out that one of the things that the report doesn’t recommend is increasing general practice funding to secure high-quality, affordable patient care into the future.
“We warned the department that failure to include the GP peak bodies in the advisory panel for this consultation was a mistake,” she said.
To be fair, while there are no representatives from the colleges on the expert advisory panel, Canberra GP Dr Clara Tuck Meng Soo and rural GP Dr Paul Mara were members.
The other major recommendation was to direct all current WIP provider payments to practices rather than individual health professionals “to enable flexibility and agility in attracting, recruiting and retaining health workforce professionals”.
AMA vice president Dr Danielle McMullen said the association would be scrutinising how and where that money was directed.
“We need to make sure that we’re incentivising both the practice and the practitioner to be able to provide those high-quality services in rural and regional Australia,” she told The Medical Republic.
Another recommendation that may raise some eyebrows is the suggestion to establish a new independent primary care pricing authority.
This would provide evidence-based recommendations on payment design and MBS rebate levels, “while maintaining the principle” that general practices are able to set their own fees.
Dr McMullen said that, while there was reason to be sceptical, there was also reason to hope that this may pan out in general practice’s favour.
“The devil will be in the detail for independent pricing,” she said.
“We’ve heard time and time again that governments haven’t gotten it right in terms of how much it actually costs to deliver high quality general practice care.
“So there is the potential that independent pricing and economic analysis may help with that, so long as the answer comes out in a way that’s positive for general practice.”
Related
The consultation paper also recommends investment in enabling reforms and facilitating the change to a new payment model.
PIP and WIP reforms are just one of many reviews to have spawned from the Strengthening Medicare Taskforce, the most controversial of which has been the scope of practice review.
DoHAC is holding a public webinar on the incentives consultation on Monday 12 August.
