PIPs redesign raises hackles

A looming redesign of general practice incentive payments could pressure clinics to cut services, the AMA has warned

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The AMA has warned that a looming redesign of general practice incentive payments will disrupt cash flows and could pressure clinics to cut services.

The government intends to cease PIPs for five service areas as of May 2018.  They are asthma, cervical screening, diabetes, aged-care access and quality prescribing.

Instead, it will introduce the new QI incentive, which is supposed to encourage improvement in three less well-defined areas – access to care, detection and management of chronic conditions, and quality, safety performance.

Practices must also commit to sharing de-identified general practice data, although the scale, frequency and other details of the data-sharing are unknown.

AMA Vice President Dr Tony Bartone said the loss of a specific PIP for aged-care access would be “a huge sting in the tail” with consequences for patients.

“It’s the wrong message, the wrong time, the wrong place.”

The Melbourne GP said efforts to maintain high-quality practices, with the demands of labour, technology, and infrastructure, needed to be recognised.

“Quality is not easy to achieve, especially in an environment where you have had four years of the Medicare rebate freeze and the bulk-billing rebates bear no resemblance to the cost of maintaining good-quality care,” he added.

The PIP program, introduced in 1998, is worth an estimated $300 million a year to general practice.

Despite earlier assurances that the redesign would not disadvantage practices, the AMA clearly suspects the outcome may be different.

Individual clinics could lose several thousand dollars, further undermining viability at a time when many were already doing it hard, Dr Bartone said.

The government deferred commencement of the plan from 2016 but appears still not to have finalised its modelling.

The AMA has urged Health Minister Greg Hunt to provide new investment for the proposed “quality-improvement” incentive for GPs, rather than stripping funds from the existing PIPs.

“Essentially, it’s moving money from one side of the ledger to the other,” Dr Bartone told The Medical Republic. 

“If you’re doing that, you really aren’t investing in general practice.”

The RACGP and the rural doctors’ movement have also criticised the proposal.

Queensland Dr GP Evan Ackermann said thinking on quality in general practice had “moved on” from the outline the government was using.

Quality-enhancing steps could include support for continuity of care, complexity of services and new areas such as antimicrobial stewardship and opioid use, he said.