Practice Incentives Program Guidelines—
December 2013
Introduction
The Practice Incentives Program (PIP) is aimed at supporting general practice activities that encourage continuing
improvements and quality care, enhance capacity and improve access and health outcomes for patients.
Definition of a General Practitioner (GP)
For the purposes of the PIP, GPs include general practitioners and/or non-specialist medical practitioners, known
as other medical practitioners, who provide non-referred services but are not GPs. GPs include Fellows of the
Royal Australian College of General Practitioners (RACGP) and the Australian College of Rural and Remote
Medicine (ACRRM), vocationally registered general practitioners and medical practitioners undertaking approved
training.
Definition of a Nurse Practitioner
For the purposes of PIP, a nurse practitioner is someone who is endorsed as a nurse practitioner by the Nursing
and Midwifery Board of Australia. Registration requirements for nurse practitioners can be found at the Nursing
and Midwifery Board of Australia website at www.nursingmidwiferyboard.gov.au
Definition of an Open Practice
For the purposes of the PIP an open practice is when one or more registered medical practitioner(s) provide face to
face medical or health services to patients at a physical location. That location must be the practice location
registered or used for the PIP. Where exceptional circumstances cause a practice to close for a period of time, for
example natural disasters, practices may apply in writing for an exemption.
Applications in relation to exceptional circumstances must be made in writing and sent to the Practice Incentive
Program at:
Mail:
Incentive Programs
Department of Human Services
GPO Box 2572
ADELAIDE SA 5001
Fax:
1300 587 696
The Department of Human Services (Human Services) will consider each request on a case by case basis and
determine whether or not it is deemed to be an exceptional circumstance and whether an exception will be
granted.
Eligibility
To be eligible to participate in the PIP, a practice must:
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meet the PIP definition of an ‘open practice’
be accredited or registered for accreditation against the Royal Australian College of General Practitioners
(RACGP) Standards for general practices
if the practice is registered for accreditation, full accreditation must be obtained within 12 months of joining
the PIP. Practices must ensure their accreditation is up-to-date at all times
maintain current public liability insurance
make sure all general practitioners and nurse practitioners (referred to as practitioners) maintain current
professional indemnity cover.
The RACGP Standards for general practices (The Standards) define a ‘general practice’ as the provision of patientcentred continuing, comprehensive, coordinated primary care to individuals, families and communities. The
Standards are wholly relevant to general practices which meet this definition.
Applying
Practices can apply to join the PIP at any time:
• through Health Professional Online Service (HPOS), at humanservices.gov.au/HPOS By using HPOS your
application will be submitted immediately and you will receive a return acknowledgement message that your
application has been received, or
•
by completing the PIP application form, and sending it along with the required supporting documentation,
to:
Mail:
Incentive Programs
Department of Human Services
GPO Box 2572
ADELAIDE SA 5001
Fax:
1300 587 696
Practices applying for the PIP must read these guidelines.
Practices must include the name and contact details of their authorised contact person(s). The contact person(s)
must be authorised by the current owner(s) of the practice to advise Human Services of any changes within the
practice. All correspondence or enquiries will be made to the current owner(s) or authorised contact person(s).
Each participating practitioner must complete the Individual General Practitioner and Nurse Practitioner Details
and Declaration section of the application form. This form includes consent to use their Human Services and
Department of Veterans’ Affairs’ service data to calculate the practice’s PIP payments. Practitioners joining the
practice after approval to participate in the PIP has been provided must also complete one of these forms.
If a practitioner does not consent, or does not sign the relevant part of the application form, their service data
will be excluded from the calculation of the practice’s PIP payments. Practitioners can consent at a later date to
have their service data included by writing to Human Services. The service data will then be included in the
calculation of the practice’s payments from the next payment date.
Human Services will assess applications and advise applicants in writing of their eligibility.
PIP online system
Human Services manages an online system where practices can:
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apply for the PIP and/or individual PIP incentives • maintain and update practice and practitioner details
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receive updates from Human Services.
Practice owners, authorised contact persons and practitioners who have a Public Key Infrastructure (PKI)
Individual Certificate can access the system if their PKI Individual Certificate is linked to the practice. Details of
the PKI Individual Certificate’s unique 10 digit Registration Authority (RA) number, for practice owners,
authorised contacts and practitioners at the practice, must be sent to Human Services to have access to the
system.
To register for a PKI Individual Certificate go to humanservices.gov.au/healthprofessionals then For new
software vendors > Public Key Infrastructure or call the eBusiness Service Centre on 1800 700 199 (call charges
may apply).
If you already have a PKI Individual Certificate and need help with installation, access, or technical difficulties, call
the eBusiness Service Centre on 1800 700 199.
Eligibility for individual PIP incentives
Practices must also read the guidelines and meet the eligibility requirements of each of the PIP incentives they
wish to apply for.
Guidelines are available online at humanservices.gov.au/healthprofessionals then Incentives and allowances >
Practice Incentives Program, or by calling the PIP enquiry line on 1800 222 032 8.30 am to 5.00 pm, Monday to
Friday, Australia Central Standard Time (call charges may apply).
Practices with multiple locations
Practices with multiple locations can apply to join the PIP as a single practice, provided the eligibility requirements
set out below are met. Practices must nominate the main practice location when completing the PIP application
form. The main practice location should be the one that provides the highest number of Medicare Benefits Schedule
(MBS) services each year. For the purposes of the PIP, additional practice locations are known as practice branches.
Eligibility requirements
To be eligible for PIP as a practice branch:
• MBS services must be provided from the practice branch
• one or more GPs must provide MBS services at the main practice and the practice branch
• the practice branch must maintain current public liability insurance
• all practitioners at the practice branch must maintain current professional indemnity cover.
Accreditation requirements
Practice branches providing less than 3,000 services per annum do not need to be accredited in their own right to be
eligible for the PIP. The MBS services of these practice branches will be automatically included in the calculation of
the practice’s PIP payments, regardless of accreditation status.
Practice branches providing 3,000 or more services per annum must maintain full accreditation, or be registered
for accreditation in their own right, for services to be included in the calculation of the practice’s PIP payments.
Practices must ensure their accreditation is up-to-date at all times. Practices registered for accreditation are
required to achieve full accreditation within 12 months of joining the program. If a practice is unable to achieve
full accreditation before the expiry of the registration certificate, a request can be made with the relevant
accreditation body seeking an extension. Practices must ensure registration for accreditation covers the entire
period until full accreditation is achieved, to avoid PIP payments being withheld.
PIP payments
Types of payments
Practice Payments
The majority of payments through the PIP are made to practices and focus on those aspects of general practice
that contribute to quality care.
PIP practice payments are intended to support the practice to purchase new equipment, upgrade facilities or
increase remuneration for GPs working at the practice.
Service Incentive Payments
Service Incentive Payments (SIPs) are generally made to GPs to recognise and encourage the provision of
specified services to individual patients.
Rural Loading Payments
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 will be calculated based on the main
practice’s location using the Rural, Remote and Metropolitan Areas (RRMA) Classification, 1991 Census Edition
(Department of Primary Industries and Energy and Department of Human Services and Health, November 1994).
More information on the rural loading is provided in the PIP Rural Loading guidelines available online at
humanservices.gov.au/healthprofessionals then Incentives and allowances > Practice Incentives Program.
Calculation of payments
PIP practice payments are based on a measure of the practice size known as the Standardised Whole Patient
Equivalent (SWPE) value. The SWPE value is calculated using 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 commences 16 months prior to the payment quarter. For example, payments received in the August quarter
are calculated using practice size data for the 12 month period ending 31 March of that year.
MBS services provided by both GPs and nurse practitioners are included in the SWPE value of a practice.
Calculating the SWPE value
The SWPE value of a practice is the sum of the fractions of care provided to practice patients, weighted for the age
and gender of each patient. As a guide, the average full-time GP has a SWPE value of around 1,000 SWPEs annually.
The SWPE value of a practice is calculated in three steps:
1. Calculation of the Whole Patient Equivalent of each patient
The fraction of care provided by the practice to each patient is calculated (see above). For example, in a 12 month
period, a patient has $100 in MBS benefits at Practice A and $400 at Practice B, to a total of $500.
• Practice A would be assigned $100/$500 or 0.2 of the patient’s care.
• Practice B would be assigned $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 Whole Patient Equivalent (WPE). The WPE is
based on practitioner 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 factor recognises
that people generally require different amounts of care at different stages in their life, and that the amount of
care differs for males and females. The weighting factors are routinely updated and are available on the
humanservices.gov.au/ healthproviders then Incentives and allowance > Practice Incentives Program > Practice
Incentives Program payments and calculations.
3. Total the individual SWPE values
The individual SWPE values are added together to determine the SWPE value of the practice.
Practices without a historical SWPE value
Payments to practices without an historical SWPE value (e.g. newly established practices) will not reflect the
current patient load of the practice. As a practice’s historical SWPE value is established, payments will increase
over time to the full value of the practice’s entitlement. It will take approximately six payment quarters from the
time of joining the PIP to establish a full SWPE value.
The Service Incentive Payments (SIPs) for the GP Aged Care Access, Cervical Screening, Asthma, and Diabetes
Incentives; and payments for the Procedural GP Payment, Indigenous Health, and Teaching Incentives are not
affected by the lack of an historical SWPE value.
When payments are made
To qualify for payments, practices must be participating in the PIP and meet the eligibility requirements of the
incentives for the entire quarter including the ‘point in time’ date. The ‘point in time’ date corresponds to the last
day of the month before the next PIP quarterly payment. (See Table 1 for the quarterly payment months, ‘point in
time’ dates and reference periods).
Table 1
Quarterly payment
month
Quarterly payment period
‘Point in time’ assessment of
eligibility
SWPE value reference period
February
November to 31 January
January
October to 30 September
May
February to 30 April
April
January to 31 December
August
May to 31 July
July
April to 31 March
November
August to 31 October
October
July to 30 June
Practices that are eligible for a PIP incentive will be paid in the first payment quarter after application, provided
Human Services receives their application 7 days prior to the relevant ‘point in time’ date (see Table 1). From then
on, the practice will be paid quarterly in February, May, August and November each year, provided the practice
remains eligible.
As payments are not made pro rata, practices must meet the eligibility requirements for the entire quarter including
the ‘point in time’ date.
PIP payments are not payable where a practice is closed prior to a quarterly ‘point in time’.
For the purposes of the PIP a ‘closed’ practice is when – “all registered medical practitioners cease to provide face
to face medical or health services to patients at a physical location. That location must be the practice location
registered or used for the PIP.”
How payments are made
PIP payments are made by Electronic Funds Transfer (EFT) to the bank account nominated by the practice on the
application form. PIP payments do not attract a Goods and Services Tax (GST).
Withheld payments
Payments to practices are sometimes withheld by Human Services. Payments may be withheld for a number of
reasons including, but not limited to:
• a change of practice ownership
• non-compliance
• expiry of accreditation status
•
incomplete or inaccurate practice details.
Further information may be required by Human Services when a payment is withheld. Practices have up to three
consecutive ‘point in time’ dates (see Table 1) to provide the required information to Human Services. Once the
required information is received and the practice is assessed as eligible for payments, Human Services will make the
payment(s).
If the practice remains ineligible for payment(s) at three consecutive ‘point in time’ dates (see Table 1), the
practice will be ineligible to claim any withheld payment(s) and will be withdrawn from the PIP. The practice will
need to complete a new application form to re-join the PIP.
Practices registered for accreditation are required to achieve full accreditation within 12 months of joining the
program. If a practice is unable to achieve full accreditation before the expiry of the registration certificate, a request
can be made with the relevant accreditation body seeking an extension. Practices must ensure registration for
accreditation covers the entire period until full accreditation is achieved, to avoid PIP payments being withheld. If full
accreditation is not obtained after 12 months, the practice will not be eligible for any further payments until full
accreditation is achieved. Payments will then commence from the payment quarter following the date of
accreditation.
The practice will be withdrawn from the PIP if the practice does not have full accreditation by the third consecutive
‘point in time’ date (see Table 1) after the initial 12 month period ends. If a practice receives an extension on their
registration for accreditation, payments will be withheld until proof of accreditation is provided.
Where a practice’s accreditation has expired, payments will be withheld until confirmation of re-accreditation is
received. The full payment(s) will only be released if the practice was accredited for the full period that payments
were withheld. The practice will be withdrawn from the PIP if the practice has not provided evidence of reaccreditation by the third consecutive ‘point in time’ date (see Table 1) after the accreditation expired.
In all cases where a practice is withdrawn from the PIP, any withheld payments will be forfeited.
Recovery of payments
Where PIP payments have been made as a result of an administrative error or inappropriate claiming, Human
Services may seek to recover those payments.
Maintaining and changing practice information
Notification of changes
Practices must advise Human Services of any changes in practice arrangements that may affect their eligibility for
the PIP and/or individual PIP incentives.
Relevant changes include, but are not limited to:
• practitioners leaving or joining the practice (please note, the Individual General Practitioner and Nurse
Practitioner Details form will need to be sent for each new practitioner that joins the practice)
• changes to the authorised contact person(s) for the practice
• changes to the practice’s bank account for PIP payments
• changes in accreditation status, such as the practice becoming fully accredited or accreditation lapsing
• changes in eligibility or level of activity for individual incentives (e.g. less procedural services)
• changes to the practice location, ownership or structure
• lapses in the practice’s public liability insurance or an individual practitioners professional indemnity cover
• changes in provider numbers for any practitioners.
How to notify changes
Practices can advise of all changes:
Online
• via Health Professional Online Service (HPOS), at humanservices.gov.au/HPOS. Changes made via HPOS are
immediate and therefore can be made up to and on the relevant point-in-time date, or
Offline
• by completing the PIP Change of Practice Details form at humanservices.gov.au/ healthprofessionals then
Incentives and Allowances > Practice Incentives Program >
• Forms and guidelines, or
• via a letter, signed by the authorised contact person, on the practice’s letterhead.
Offline changes must be provided to Human Services no later than 7 days prior to the relevant point-in-time date, to:
Mail:
Incentive Programs
Department of Human Services
GPO Box 2572
ADELAIDE SA 5001
Fax:
1300 587 696
This will ensure that changes to practice arrangements are taken into account to accurately calculate the practice’s
next quarterly PIP payment. When inaccurate information is used in the calculation process, the practice may not
receive all of their entitled incentive payments and any overpayments may be recovered by Human Services.
Practices must check that their PIP quarterly payment advice is accurate, particularly for the practitioners listed at
the practice and the incentives the practice is participating in.
As some incentive payments are affected by changes in the practice’s SWPE value, it is important that practices
regularly check their SWPE value to check their ongoing eligibility for these payments.
Transferring the SWPE value of a practice
Background
SWPE is a calculation of a practice size and is independent of PIP eligibility.
The SWPE value is calculated from the sum of fractions of MBS billed care provided to practice patients by all GPs
and nurse practitioners in the practice and then weighted for the age and gender of each patient.
The SWPE value is calculated using a rolling historical 12 month reference period, which commences 16 months
prior to the payment quarter.
When a GP joins or leaves a practice, their provider number is added or ended on the practice profile. The start and
end dates of individual GPs working in the practice determine the MBS services included in the practice’s SWPE
calculation.
When an established practice joins the PIP its historical MBS service level will be used to calculate its SWPE value.
As newly established practices will not have historical MBS billing, the SWPE value will be calculated over time as
MBS service provision history is established. Initially the SWPE value of a newly established practice will not reflect
the current patient load of the practice.
In this document ‘Practice’ refers to an open practice, which is when one or more registered medical practitioner(s)
provide face to face medical or health services to patients at a physical location (see Definition of an Open Practice).
It is the responsibility of the practice owners to consider the below in any sale or relocation of the practice.
Transferring a SWPE Value
A SWPE value can be transferred in the following situations.
The practice is sold and remains open in the original physical location. In this situation the SWPE value will transfer to
the new owners and remain at the original location regardless of if the original owners establish a new practice in
the same local area.
The practice is not sold but is relocated to a different physical location within the same local area. In this situation
the SWPE value will be transferred to the new physical location.
When two or more practices from the same local area amalgamate. In this situation the SWPE of the amalgamated
practice will equal the sum of the SWPE values for each original practice.
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 receive PIP payments.
When SWPE values are transferred, the receiving practice is not eligible for any sign-on payments that have
previously been paid.
A local area will be defined by Human Services on a case-by-case basis according to several factors including
physical distance, rurality and practice distribution.
Confirmation of practice information
Human Services conducts an annual confirmation statement process to confirm practice details. In May each year
practices participating in the PIP are sent a confirmation statement and are required to confirm details either
online via HPOS or by returning the confirmation statement to Human Services.
Practices must also comply with requests for information, at any time, from Human Services to continue receiving
payments.
Practice Incentives Program audits
Human Services conducts both targeted and random audits of PIP practices each year to make sure that practices
are meeting their eligibility requirements. Audits may include practice visits or a review of practice
documentation. If requested, practices must provide documentary proof to support their eligibility and claims for
payment.
For the purpose of Human Services audit programs, practices must retain practice documentation dating from
the time of their participation in the PIP for a period of 6 years. If a practice is unable to provide evidence to
verify that it meets the eligibility requirements or substantiate its claims for payments, Human Services may seek
to recover past payments.
Obligations of the practice
The practice must:
• prove its claims for payments, including documentary proof
• provide information to Human Services as part of its ongoing audit program to prove that the practice meets
the PIP eligibility requirements
• make sure accurate information is sent to Human Services
• write to Human Services about any changes to practice arrangements (see How to notify changes).
On joining the PIP, the practice must name an authorised contact person(s), who must verify on the practice’s behalf,
any changes to information sent for PIP claims and payments.
Appeals process
The PIP has an established appeals process. To ask for an appeal, the authorised contact person or the owners of
the practice must write to Human Services within 28 days of the date of the decision. Human Services will review
the decision and advise the practice in writing of the outcome.
More information
Online humanservices.gov.au/healthprofessionals then Incentives and Allowances > Practice Incentives Program
Email:
pip@humanservices.gov.au
Call:
1 800 222 032** between 8.30am to 5.00pm
Monday to Friday Australian Central Standard
Time.
*Call charges apply.
**Call charges apply from mobile and pay phones only.
Disclaimer
These guidelines are for information purposes and provide the basis upon which PIP payments are made. While it
is intended that the Australian Government will make payments as set out in these guidelines, the making of
payments is at its sole discretion. The Australian Government may alter arrangements for the Practice
Incentives Program at any time and without notice. The Australian Government does not accept any legal liability
or responsibility for any injury, loss or damage incurred by the use of, reliance on, or interpretation of the
information provided in these guidelines.