Standardised Whole Patient Equivalent

The Standardised Whole Patient Equivalent (SWPE) value of a practice is the sum of the fractions of care provided to practice patients. This is weighted for the age and gender of each patient.

Calculating the SWPE value

The Standardised Whole Patient Equivalent (SWPE) is a calculation of a practice size and is independent of Practice Incentives Program (PIP) eligibility.

We work out the SWPE using both Medicare and the Department of Veterans’ Affairs (DVA) services provided to patients attending the practice during the reference period. A weighting for the age and gender of each patient is then calculated. The SWPE is calculated using a rolling historical 12 month reference period, which starts 16 months before the payment quarter.

Services provided by both GPs and nurse practitioners are included in the SWPE value of a practice.

If a practitioner uses the provider number of another practitioner when billing these services (known as a payee provider), the payee provider details must be registered in PIP at the practice location the services are being provided, for the services to be included in the SWPE for that practice.

When a practitioner joins or leaves a practice, their provider number is added or ended on the practice profile. The start and end dates of individual practitioners working in the practice determine the services included in the practice’s SWPE calculation.

The SWPE value of a practice is calculated in 3 steps.

1. Calculating the Whole Patient Equivalent (WPE) of each patient

The fraction of care provided by the practice to each patient is calculated.

For example, in a 12 month period, a patient has $100 in MBS benefits at Practice A and $400 at Practice B, a total of $500:

Practice A would be assigned with $100 ÷ $500 or 0.2 of the patient’s care

Practice B would be assigned with $400 ÷ $500 or 0.8 of the patient’s care

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

2. Weighting of the WPE

The WPE is weighted for the age and gender of each patient to become the SWPE. The weighting recognises people need different amounts of care at different stages in their life and the amount of care differs for males and females. The weighting factors are routinely updated.

The table gives the values used in weighting WPEs for age and gender for November 2017. Weightings are subject to quarterly adjustments.

Patient age (years)

 <1

 1 - 4

 5 - 14

 15 - 24

 25 - 44

 45 - 64

 65 - 74

 75 +

Female

0.5358

0.8287

0.5109

0.8349

1.028

1.1028

1.4579

2.2118

Male

0.5794

0.9034

0.5234

0.5389

0.6822

0.9003

1.3178

2.0218

3. Total the SWPE

The individual SWPE values are added together to determine the SWPE value of the practice.

Practices without an historical SWPE

Payments to practices without an historical SWPE - for example, newly established practices - will not reflect the current patient load of the practice.

As the practice establishes a SWPE value, payments will increase.

It takes about 6 payment quarters from the time the practice joins the PIP to establish a full SWPE value.

The lack of an historical SWPE value doesn’t affect some payments:

  • service incentive payments (SIPs) for the GP Aged Care Access, Cervical Screening, Asthma, and Diabetes incentives
  • payments for the Procedural GP Payment, Indigenous Health, and Teaching Payment incentives

Transferring a SWPE value

A SWPE value can be transferred if you:

  • change ownership
  • relocate your practice in the same local area, or
  • amalgamate 2 or more practices

In all other situations practices will need to apply for the PIP as a new practice and establish a new SWPE value.

In all circumstances practices must continually meet all PIP requirements, including accreditation, to remain eligible to get PIP payments.

When SWPE values are transferred, the receiving practice isn’t eligible for any sign-on payments that have previously been paid.

Change of ownership

If a change of ownership of a practice has happened, and it remains open in the original physical location, the SWPE value will transfer to the new owners. This only occurs if the accreditation is included in the sale of the practice. This lets the new practice owners use the historical SWPE value of the practice.

This happens even if the original owners establish a new practice in the same local area.

Relocation of a practice

If the practice relocates to a different physical location in the same local area but isn’t sold, the SWPE value will transfer to the new physical location.

You can only transfer the SWPE value to the new location if:

  • another practice isn’t operating from the original location
  • the patients and all patient records stay with the relocated practice

If the relocated practice doesn’t meet these requirements, it will need to apply for the PIP as a new practice and establish a SWPE value. We won’t pay the original practice for the quarter in which the practice relocation occurs.

Amalgamation of a practice

If 2 or more practices in the same local area amalgamate, the SWPE of the amalgamated practice will be the sum of the SWPE values for each original practice. There mustn’t be another practice operating from any of the original locations after the amalgamation.

If the amalgamated practice doesn’t meet these requirements, it will need to apply for the PIP as a new practice and establish a SWPE value.

We won’t pay the closed locations for the quarter in which the practices amalgamate.

If 1 or more of the amalgamating practices is outside the local area, the practice originally on site at the final location will maintain its SWPE value.

Page last updated: 16 November 2017