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Invest in quality improvement: Have doctors got the PIPs?

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BY DR RICHARD KIDD, CHAIR, AMA COUNCIL OF GENERAL PRACTICE

While having tried to play a constructive role to date, growing concerns at level of funding that will be available for the Practice Incentives Program (PIP) Quality Improvement Incentive (QII) has seen the AMA Federal Council decide that the AMA cannot support the current cost neutral approach to the introduction of the incentive.

The AMA has delivered a blunt message to the Health Minister – the AMA’s support for this initiative is in peril unless the PIP receives a significant boost in funding.

While the AMA has backed the concept of an incentive to support practices in their quality improvement journey, we have consistently opposed the idea that some practices could finish up worse off. Instead of properly funding the new incentive, the Government has decided to rob Peter to pay Paul. Worthy incentives will be lost including the quality prescribing, cervical screening, asthma, diabetes and the Aged Care Access Incentive (ACAI).

The value of the ACAI must be considered in more than just monetary terms. The results of the recent AMA Aged Care Survey indicated that more than a third of doctors currently providing services to residential aged care facilities (RACFs) would either cut back or cease their visits over the next two years. I don’t think it is a stretch to suggest that the impending loss of the ACAI is a contributing factor.

For general practices struggling to remain viable in the face of seemingly unending cuts and the lingering impact of the MBS freeze, PIP is a vital funding source for general practices. The AMA estimates that an injection of about $44million per annum to the PIP is required to support a meaningful PIP QII so it can deliver on its objectives.

The AMA wants to see practices embrace the QII because it has potential to improve current funding arrangements by recognising the value of quality improvement. Value for the health system, value for the practitioners, value for the patient, and value to the population through better outcomes.

Our data is the key driver to meaningful quality improvement activities. We must collect it, understand what it tells us, and use it to inform our decisions about the quality initiatives that would most benefit our patients. Data-driven quality improvement is the second building block in the Bodenheimer’s 10 building blocks of high-performing primary care. By focusing on this area, we can strengthen the delivery of care to our patients and demonstrate the value of general practice in the health care system.

Good policy requires real foresight and, in cases like this, real investment. Continuing to short change the most cost-effective part of the health system will inevitably lead to downstream costs to the health system. The PIP QII is a good idea, but it is being poorly executed by a Government and Department that needs to stop paying lip-service to the importance of general practice and put their money where their mouth is.

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