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Proposed incentive missing the mark on quality

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

With the proposed start date of 1 March 2018 for the new Quality Improvement Incentive (QII) under the Practice Incentives Program (PIP) fast approaching, the AMA is becoming increasingly concerned that the proposed incentive arrangements are still not settled to the satisfaction of the profession.

Ideally, the QII should be taking us a step closer to rewarding quality care. However, the incentive has been short-changed of its key ingredient for supporting continuous quality improvement in general practices – funding.

The Government is not investing in this incentive, which means it is not investing in better data, quality improvement, or general practice. What it has done instead is pull $21.2 million out of PIP and sought to move existing PIP payments around. Abolishing the Quality Prescribing, Cervical Screening, Asthma, Diabetes, and Aged Care Access incentives to pay for the QII is a zero sum game and means that many practices will be financially worse off under the new incentive. In fact, for all intents and purposes, it would seem that the Government has lost its grasp of English in that an incentive is supposed to motivate or encourage someone to do something.

Practices are unlikely to implement the internal changes required to take up this incentive if the value of the incentive does not support the effort involved.

What is the Government thinking?

Through this incentive it wants data to better inform its policies and, while that is sensible, many practices are initially going to have to undertake a significant amount of work to improve the quality of their data. In addition, they will have to get up to speed on data governance to ensure that patients’ privacy is safeguarded. Patients will need to understand what data will be collected, how the data will be de-identified, what the data will be used for, and who it will be shared with.

If this work is not adequately funded, if the incentive does not provide a return on investment, practices will not take it on.

With this incentive supposedly only a few weeks away, we have no clarity on what the requirements are that practices will be asked to sign up for. We do not know what data will be extracted, whether quality improvement activities are to have a set focus, or how the quality improvement over time will be measured. We don’t even know what the dollar value of the incentive will be!

While the AMA is strong advocate for rewarding quality care, the proposed new QII is not fit for purpose. It is underfunded and critical detail is still missing. Practices should not be asked to sign up to a vague program that is likely to leave them worse off.

As the Government’s budgetary process rolls on the AMA will be continuing to make it clear to the Minister that the QII is under-funded and under-done. The solution is more time, thought and investment – something current policy settings sadly lack.

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