The Australian General Practice, Practice Incentive Program (PIP) has been in operation since 2001. In this program accredited General Practices are provided with financial incentives to reach various performance targets. The PIP grew out of the Better Practice Program in response to a series of recommendations made by the General Practice Strategy Review Group (GPSRG) that reported to the Government in March 1998.
Payments are made on the basis of a factor termed the Standardised Whole Patient Equivalent (SWPE) which is an estimate of the level of practice complexity and activity based on information gathered by Medicare Australia during its payment processing for Medicare funded services.
The typical General Practice will be about 800 – 1600 SWPEs per full time doctor – e.g. a 4 man practice will have a SWPE of about 4000. The statistically average FTE GP sees 1,000 SWPEs annually according to Medicare Australia.
The overall program is by no means trivial having cost $250+ Million in 2005/06.
One component of the PIP focuses on the deployment and use of Information Technology in General Practice.
The IM/IT PIP program used to cover three areas until it recently was updated – with different requirements for payment eligibility – in November, 2006.
In the earlier version the payments were as follows:
Tier 1 - Providing data to the Australian Government - $3.0 per SWPE
Tier 2 - Use of bona fide electronic prescribing software to generate the majority of scripts in the practice - $2.0 per SWPE
Tier 3 - The practice has on site and uses a computer/s connected to a modem to send and/or receive clinical information - $2.0 per SWPE
Thus to receive $7000 a year per practitioner a practice essentially had to fill in a few practice profile forms, utilise prescription printing software that could be obtained very cheaply or free from HCN Ltd and have a modem to pick up results electronically from a local pathology provider.
Given the economic life of a PC is about three years this amounts to a very substantial payment for a PC and a printer. Even if a networked environment for three to four practitioners was deployed $60,000 - $80,000 would be more than enough to fully fund the system, its installation and a considerable profit!
It should also be remembered that prescription printing – and most especially repeat prescription printing - is one GP computing function that has been demonstrated to save GPs time and thus money. Despite this we (the public) paid them to start using it!
Under the new payment scheme the criteria have been updated.
For Tier 1 the practice has to record electronically the allergies of a majority of their active patients and to have in place adequate internet and anti-virus security measures. This gets the first $4.0 per SWPE.
For Tier 2 the practice must record major diagnoses and current medications in the patient’s electronic record. This generates an addition $3.0 per SWPE.
On the basis that there are a little over 4000 practices are signed up for the IM/IT PIP payments, and that they have an average of three practitioners each, this is costing approximately $84 Million per annum. A non trivial sum I would suggest.
What is actually going on here is that the Government via Medicare Australia is paying GPs to undertake the most basic parts of electronic patient record keeping and setting the expectations so low that only minimal benefits are likely to flow.
Were there requirements to actually code diagnoses and medication so useful practice statistics could be generated and issues such as tracking ADE’s for newly introduced medicines could be undertaken there would possibly be some real value.
Additionally coding would enable basic clinical decision support relating diagnosis and treatment to be achieved – a major benefit.
Also it seems the software requirements of the present program could be, clumsily, met using a simple spreadsheet or database program with no ability to be improved and extended to deliver more benefit. That there is no requirement for certification of the functionality and safety of the software used by GPs to obtain PIP payments is appalling and a major policy failure.
For the money to be claimed there should be quality, functionally rich software supporting advanced clinical support insisted upon and used. Anything less is really risible.
As a concerned citizen I believe we should all expect more certainty of benefit for our GP computing money.
When we combine these funds with other Commonwealth funding of programs such as Broadband for Health (BfH), which is funded to as much as $40 Million per annum, as well as other smaller initiatives such as the Eastern Goldfield's Project, we really have the federal Government throwing a lot of money at GPs in an amazingly profligate fashion.
It seems to me, just as there is a need for strategic clarity from NEHTA, there is an equally strong case for the same from DoHA in terms of clear objectives and evaluation of the expenditure.
Simple, relatively inexpensive, proven to be effective, initiatives such as replicating the NSW Health Department’s Clinical Information Access Program (CIAP) nationally for GPs and specialists would be likely candidates for investment as would the sponsorship of the development of quality, certified clinical systems for clinical use.
I wonder, has a business case to justify all this spending ever been developed or has there ever been a retrospective review of the impact of the spending?
To quote Mr Abbott from a press release of December 2005 which was based on a speech entitled: Better records make better doctors
A speech by Minister for Health and Ageing, Tony Abbott, to the Australian Medical Association E-Health Forum, Canberra, 8 December 2005.
“Five years ago, the Health Ministers' Council first committed all Australian governments to the development of an integrated IT-based health record system. Over the past decade, the Commonwealth Government has paid some $600 million in IT-linked GP Practice Incentive Payments. Over the past 18 months, the government has committed $60 million to the Broadband for Health initiative, designed to ensure that every general practice and pharmacy has access to business-grade connectivity. So far, the government has committed more than $110 million to developing HealthConnect, including $9 million in half-funding the National Electronic Health Transition Authority which aims to standardise usage and facilitate inter-operability of federal, state and private health IT systems.”
See: http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health
-mediarel-yr2005-ta-abbsp081205.htm?OpenDocument&yr=2005&mth=12
This is almost $780 Million in all over the decade. I wonder what benefits we have really received for all this investment?
I am sure any other program of this scale would have to have been rigorously evaluated. Has anyone seen the report?
David.
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