Practice Incentives Program

The Practice Incentives Program (PIP) is aimed at supporting general practice activities.

The Practice Incentives Program (PIP) is aimed at supporting general practice activities that encourage continuing improvements, quality care, enhance capacity, and improve access and health outcomes for patients.

We administer the Practice Incentives Program (PIP) on behalf of the Department of Health. The PIP consists of 10 individual incentives.

Registering and applying

Practices must register for the PIP and can then choose to apply for all or some of the incentives. Practices must meet the eligibility requirements of each incentive they apply for.

Eligibility

Your practice may be eligible for PIP if it:

  • meets the PIP definition of an 'open practice'
  • is accredited or registered for accreditation against the Royal Australian College of General Practitioners Standards for general practices
    • practices registered for accreditation must obtain full accreditation within 12 months of joining the PIP
  • maintains full accreditation
  • maintains current public liability insurance
  • ensures all general practitioners and nurse practitioners, referred to jointly as practitioners, maintain current professional indemnity cover

A full list of PIP eligibility requirements is in the PIP guidelines [docx 37kb].

Additional requirements

Practice accreditation

Accreditation is available through 2 approved organisations:

Accreditation involves:

  • self-assessment against agreed standards
  • peer review surveys (practice visits) of the practice's organisation and facilities, and
  • the start of a continuous quality improvement cycle

A practice is accredited on successful completion of the peer review survey.

Practices that use the services of medical deputising services to meet their accreditation requirements and related obligations under the PIP can only do so if the medical depustising service itself is registered for accreditation, or is fully accredited as a medical deputising service as defined by the RACGP guidelines.

The practice is responsible for notifying us when they have been fully accredited.

How to apply

Practices can apply to join the PIP at any time:

Practices must read the guidelines and meet the eligibility requirements for each of the PIP incentives they wish to apply for.

Incomplete application forms may delay the application process.

Supporting documentation

Practices must provide:

  • a copy of their current accreditation, or registered for accreditation certificate and for each practice branch that provides 3,000 or more services per year

Outcome

We will assess your application and advise your practice in writing of its eligibility. We may also:

  • contact you for additional information
  • ask for evidence that your practice is continuing to meet the criteria it has initially claimed
  • make enquiries by phone
  • cross check the information you provide with other data we hold

Audits are performed annually on selected practices to verify their eligibility for PIP payments. This maintains the integrity of the program.

Incentive Programmes

Asthma Incentive

The PIP Asthma Incentive aims to encourage GP's to better manage the clinical care of people with moderate to severe asthma.

Generally, patients must meet the following criteria to be assessed as having moderate to severe asthma:

  • Symptoms on most days or
  • Use of preventative medication or
  • Bronchodilator use at least three times per week or
  • Hospital attendance of admission following an acute exacerbation of asthma

For more information, read the Asthma Incentive guidelines [docx, 28kb].

After Hours Incentive

The After Hours Incentive aims to support general practices to provide their patients with appropriate access to after hours care.

Read more about After Hours Incentive

Cervical Screening Incentive

The PIP Cervical Screening Incentive aims to encourage GP's to screen under-screened women, that is women aged between 20 and 69 years who have not had a cervical smear in the last four years, for cervical cancer and to increase overall screening rates.

For more information, read the Cervical Screening incentive guidelines [docx, 20kb].

Diabetes Incentive

The PIP Diabetes Incentive aims to encourage GP's to provide earlier diagnosis and effective management of people with established diabetes mellitus.

For more information, read the Diabetes Incentive guidelines [docx, 20kb].

eHealth Incentive

The PIP eHealth Incentive consists of 5 eligibility requirements. For guidance on how to meet these requirements, go to the implementation overview documents for each requirement on the nehta website.

The PIP eHealth Incentive aims to encourage practices to keep up to date with the latest developments in eHealth.

To be eligible to receive the eHealth Incentive, practices must:

  1. integrate Healthcare identifiers into Electronic Practice Records which consist of:
    • apply for Medicare to obtain a Healthcare Provider Identifier-Organisation (HPI-O) for the practice and store the HPI-O in a compliant clinical software system
    • ensure that each general practitioner within the practice has their Healthcare Provider Identifier-Individual (HP-I)
    • use a compliant clinical software system to access, retrieve and store verified Individual Healthcare Identifiers (IHI) for presenting patients
  2. have a standard-compliant secure messaging capability
  3. work towards recording the majority of diagnoses for active patients electronically
  4. ensure the majority of their prescriptions are sent electronically to a Prescription Exchange Service (PES), provide all GP's at the practice with access to the current editions of key electronic clinical resources as detailed in the eHealth Incentive guidelines
  5. use software that is listed on the PIP eHealth Product Register for the Personally Controlled Electronic Health (eHealth) Record system and apply to participate in the eHealth record system upon obtaining a HPI-O

This incentive has been developed in consultation with the NEHTA, and aligns with the directions set out in the Australian Government's National eHealth Strategy.

The PIP eHealth Incentive will encourage the adoption of new eHealth technology as it becomes available, to assist practices to improve administration processes and the quality of care provided to patients.

For more information, read the eHealth Incentive guidelines [docx, 21kb].

General Practitioner Aged Care Access Incentive

The PIP General Practitioner Aged Care Access Incentive (ACAI) aims to encourage GP's to provide increased and continuing services in Australian Government funded residential aged care facilities (RACFs).

For more information, read the General Practitioner Aged Care Access Incentive guidelines [docx, 18kb].

Indigenous Health Incentive

The PIP Indigenous Health Incentive aims to support general practices and Indigenous health services to provide better health care for Aboriginal and Torres Strait Islander patients, including best practice management of chronic disease.

This incentive is a key part of the Council of Australian Governments (COAG) National Partnership Agreement on Closing the Gap: Tackling Indigenous Chronic Disease.

For more information, read the Indigenous Health Incentive guidelines [docx, 36kb].

Procedural General Practitioner Payment

The Procedural GP Payment aims to encourage GP's in rural and remote areas to maintain local access to surgical, anaesthetic and obstetric services. Payments are made to eligible practices in February and August each year.

For more information, read the Procedural General Practitioner Payment guidelines [docx, 26kb].

Quality Prescribing Incentive (QPI)

The PIP Quality Prescribing Incentive (QPI) aims to encourage practices to keep up to date with information on the quality use of medicines. The PIP QPI rewards participation by practices in a range of activities recognised or provided by the National Prescribing Service (NPS).

The NPS aims to assist GP's to achieve more effective, quality prescribing through a range of education, support and prescribing information. The NPS is a professional organisation, run independently of the Australian Government with broad GP representation and leadership.

For more information, read the Quality Prescribing Incentive guidelines [docx, 19kb].

Rural Loading Incentive

Practices participating in the PIP with a main practice location situated outside capital cities and other major metropolitan centres are automatically paid a rural loading. The rural loading recognises the difficulties of providing care, often with little professional support, in rural and remote areas. The PIP rural loading is higher for practices in more remote areas, in recognition of the added difficulties of providing medical care.

For more information, read the Rural Loading Incentive guidelines [docx, 18kb].

Teaching Payment

The PIP Teaching Payment aims to encourage general practices to provide teaching sessions to undergraduate and graduate medical students preparing for entry into the Australian Medical profession, to make sure the practitioners of tomorrow are appropriately trained and have actual experience of general practice.

Practice GP's are expected to engage in (more or less) normal consultations when the student is present. Payments are intended to compensate practices for the reduced number of consultations due to the presence of the student.

For more information, read the Teaching Payment guidelines [docx, 20kb].

Managing

Practice payments for PIP

Most payments made through PIP are made to practices, and focus on aspects of general practice that contribute to quality care.

If your practice's PIP application is successful, the practice will receive an initial PIP payment in the first payment quarter after approval. Payments will be made by electronic funds transfer in February, May, August and November each year, as long as the practice continues to meet the eligibility criteria.

We will automatically calculate entitlements for payments based on information received from the practice. This means it is important to inform us of any changes in your practice arrangements. To update your practice details use the Practice Incentives Program and General Practice Immunisation Incentive - Change of Practice Details form (IP005).

Practices can spend their payment in any way they choose, although the usual taxation rules apply. However, the PIP payment is intended to support the practice in purchasing additional equipment, upgrading facilities or offering additional payment to doctors working at the practice.

Payments under the PIP Quality Stream

IncentiveAspect or activityPayment amount
Quality Prescribing IncentivePractice participation in a number of recognised activities endorsed by NPS MedicineWise. Paid annually in May$1 per SWPE
Diabetes IncentiveSign on payment: once only payment to practices that use a patient register and a recall and reminder system for the patients with diabetes mellitus$1 per SWPE
Outcomes payment: payment to practices that complete an annual cycle of care for a target proportion of their patients with diabetes$20 per diabetic SWPE per year
Service incentive payment: payment to general practitioners (GPs) for each cycle of care completed for patients with established diabetes mellitus$40 per patient per year
Cervical Screening IncentiveSign on payment: once only payment to practices that engage with the state and territory cervical screening registers$0.25 per SWPE
Outcomes payment: payment to practices where a specified proportion of women aged between 20 and 69 years have been screened in the last 30 months$3 per eligible WPE
Service incentive payment: payment of GPs for each cervical smear on an eligible under-screened woman$35 per patient per year
Asthma IncentiveSign on payment: once only payment to practices that use a patient register and a recall and reminder system, and agree to use the asthma cycle of care$0.25 per SWPE
Service incentive payment: payment to GPs for each completed cycle of care for patients with moderate to severe asthma$100 per patient per year
Indigenous Health IncentiveSign on payment: once only payment to practices that agree to undertake specified activities to improve the provision of care to their Aboriginal and/or Torres Strait Islander patients with a chronic disease$1,000 per practice
Patient registration payment: payment to practices for each Aboriginal and/or Torres Strait Islander patient aged 15 years and over who is registered with the practice for chronic disease management$250 per eligible patient per calendar year
Outcomes payment Tier 1: payment to practices for each registered patient for whom a target level of care is provided by the practice in a calendar year$100 per eligible patient per calendar year
Outcomes payment payment Tier 2: payment to practices for providing the majority of care for a registered patient in a calendar year$150 per eligible patient per calendar year

Payments under the PIP Capacity stream

eHealth Incentive

Aspect or ActivityPayment amount

Practices must meet each of the requirements to qualify for payments through this incentive

$6.50 per SWPE capped at $12,500 per practice per quarter

Teaching payment

Aspect or ActivityPayment amount

Payment for teaching medical students to a maximum of 2 sessions per GP per day

$100 per session provided before 1 January 2015
$200 per session provided after 1 January 2015

Aged Care Access Incentive

Aspect or ActivityPayment amount

Tier 1: payment to GPs for providing at least 60 eligible Medicare Benefits Schedule services in residential aged care facilities in the financial year

$1,500 per financial year

Tier 2: payment to GPs for providing at least 140 eligible Medicare Benefits Schedule services in residential aged care facilities in the financial year

$3,500 per financial year

After Hours Incentive

Aspect or ActivityPayment amount

Level 1: Participation

Practices must meet the requirements of Level 1 to qualify for payment at this level

$1 per SWPE

Level 2: Sociable after hours cooperative coverage

Practices must meet the requirements of Level 2 to qualify for payment at this level

$4 per SWPE

Level 3: Sociable after hours practice coverage

Practices must meet the requirements of Level 3 to qualify for payment at this level

$5.50 per SWPE

Level 4:Complete after hours cooperativecoverage
Practices must meet the requirements of Level 4 to qualify for payment at this level

$5.50 per SWPE

Level 5: Complete after hours practice coverage
Practices must meet the requirements of Level 5 to qualify for payment at this level

$11 per SWPE

For the purposes of After Hours:

  • standardised Whole Patient Equivalent (SWPE) is a measure of practice size and includes a weighting factor for the age and gender of patients. As a guide, the average full-time GP has a SWPE value of around 1,000 SWPEs annually
  • payments for each level are capped at a maximum of 20,000 SWPE per eligible practice

Payments under the PIP Rural support stream

For practices in Rural, Remote and Metropolitan Area classifications 3,4,5,6 or 7.

IncentiveAspect or activityPayment amount
Rural loading Incentive

Payment for a practice whose main location is outside a metropolitan area, based on the Rural, Remote and Metropolitan Area (RRMA) Classification.

Once all incentive payments are added (excluding the Service Incentive Payments), the rural loading amount is applied.

RRMA 3 - 15% loading
RRMA 4 - 20% loading
RRMA 5 - 40% loading
RRMA 6 - 25% loading
RRMA 7 - 50% loading
Procedural GP PaymentTier 1: Payment for a GP in a rural or remote practice who provides at least 1 procedural service, which meets the definition of a procedural service, in the 6-month reference period$1,000 per procedural GP per 6 month reference period
Tier 2: Payment for a GP in a rural or remote practice who meets the Tier 1 requirement and provides after-hours procedural services on a regular or rostered basis (15 hours per week on average) throughout the 6-month reference period$2,000 per procedural GP per 6 month reference period
Tier 3: Payment for a GP in a rural or remote practice who meets the Tier 2 requirements and provides 25 or more eligible surgical, anaesthetic or obstetric services in the 6-month reference period$5,000 per procedural GP per 6 month reference period
Tier 4: Payment for a GP in a rural or remote practice who meets the Tier 2 requirements and delivers 10 or more babies in the 6 month reference period or meets the obstetric needs of the community$8,500 per procedural GP per 6 month reference period

Calculation of payments

PIP payments are generally based on a measure of the practice size, known as the Standardised Whole Patient Equivalent (SWPE) value. The SWPE value is calculated using Medicare Benefits Schedule (MBS) claims by patients attending the practice during an historical 12-month period, known as the reference period. The reference period is a rolling 12-month period that begins 16 months before the payment quarter.

Payments are calculated using Medicare and Department of Veterans' Affairs data that are linked to the provider numbers specified on the practice's application form and any subsequent amendments. If, for example, you do not provide us with details of new practitioners, you will not receive payment associated with the services provided by those practitioners.

Data will be excluded if any of the practitioners in a practice refuse consent to the use of their data for the purposes of calculating the practice's payment when completing the Practice Incentives Individual general practitioner or nurse practitioner details form (IP003). If practitioners would like their data to be included at a later stage, they must advise us in writing.

Calculating the SWPE value

The Standardised Whole Patient Equivalent (SWPE) value of a practice is the sum of the fractions of care provided to practice patients, weighted for the age and of each patient. As a guide, the average full-time general practitioner (GP) has a value of around 1,000 each year. For more information on the calculation of payments and the SWPE value, see the PIP guidelines [docx 37kb].

The total care for each patient equals 1.0 and is known as the Whole Patient Equivalent (WPE). It is based on GP and other non-referred consultation items in the MBS, and uses a weighting value rather than the number of consultations per patient.

The weighted fractions of patient care are then added together, giving the SWPE value for the practice.

The table below gives the values used in weighting for age and sex for May 2015. Weightings are subject to quarterly adjustments.

Weighting factors for Whole Patient Equivalents, May 2015

Patient age (years)< 11 to 45 to 1415 to 2425 to 4445 to 6465 to 7475 +
Female

0.5318

0.8361

0.5117

0.8294

1.0201

1.1104

1.4883

2.2241

Male

0.5786

0.9097

0.5217

0.5351

0.6789

0.9097

1.3445

2.0502

Types of payments

There are 3 types of payments under PIP

  1. Practice payments are made to practices and focus on aspects of general practice that contribute to quality care
  2. Service incentive payments are generally made to GPs to recognise and encourage the provision of specified services to individual patients. The Cervical Screening, Asthma and Diabetes incentives have service incentive payment components, and the Aged Care Access Incentive is a service incentive payment only
    Service incentive payments are automatically paid to a nominated GP's account. If the GP's banking details are not available, we will send a service incentive payment banking details form to the GP's main PIP practice location. Service incentive payments are calculated on GPs' Medicare Benefits Schedule billing information, so it is important to bill for the correct item numbers under each incentive
  3. Rural loading payments are made automatically to practices whose main practice location is outside a capital city or other major metropolitan centre

When payments are made

To qualify for payments, practices must be participating in the PIP and meet the eligibility requirements of the incentives at a point in time date. The point in time date is the last day of the month before the next PIP quarterly payment.

Payments are made by electronic funds transfer to the account nominated by the practice, and do not attract Goods and Services Tax.

The quarterly payment months, point in time dates and reference periods are provided in the table below.

Quarterly payment monthPoint in time assessment of eligibilitySWPE value reference period
February31 January1 October to 30 September
May30 April1 January to 31 December
August31 July1 April to 31 March
November31 October1 July to 30 June

For more information on when payments are made, refer to the PIP guidelines [docx 37kb].

Resources

Forms for PIP

PIP statistics

Practice Incentives Programme statistics are available on the corporate site.

Incentives News Update

Read Incentives News Update - August 2015 [docx, 21kb]

Archived versions of the Medicare and Department of Human Services sites including Incentive News Update/PIP news can be searched at the National Library of Australia using the term ‘Practice Incentive Programme quarterly news updates’

This information was printed from humanservices.gov.au It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.