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A LACK of administrative support and market inflation have been blamed as possible reasons for a drop in the number of GPs participating in financial incentive schemes in a new study.
Professor Mark Harris, director of the Centre for Obesity Management, Prevention and Research Excellence in Primary Health Care at the University of NSW, told MJA InSight there was evidence that well designed financial incentives can improve the quality of care.
“However, the administrative burden needs to be lower, especially for smaller practices.”
Professor Harris was commenting on research published this week in the MJA which examined the uptake of financial incentive payments in general practice. (1)
The authors used data from the Medicine in Australia: Balancing Employment and Life (MABEL) survey of doctors from 2008 to 2011. Outcomes measured included income received by GPs from government incentive schemes and grants, as well as individual GP and practice-related factors associated with the likelihood of claiming the incentives.
The authors found that 47% of GPs reported receiving income from financial incentives in 2008, which had fallen to 43% by 2011. The study showed considerable movement into and out of the incentives schemes, with more GPs exiting than taking up payments.
GPs in larger practices with greater administrative resources, GPs practising in rural areas and those who were principals or partners in practices were more likely to use grants and incentive payments.
The authors said their research indicated that administrative support available to GPs was an increasingly important predictor of incentive use, suggesting the burden of claiming incentives was large and not always worth the effort.
They said market conditions could also influence participation in incentives schemes, and recommended that all schemes be reviewed regularly.
“The impact on patients, their care and their health also warrants investigation in any evaluation of the role of financial incentives”, they said.
Professor Harris said it was difficult to estimate the exact cost of the administrative burden incurred by general practice clinics, but it did involve several hours of extra staff time per quarter.
“It is an additional task first to register for the incentive and then to claim it, and for many of the incentives this is a fixed cost. Thus the additional staff time is roughly the same regardless of the number of patients it is being claimed for.”
Professor Harris said that while the administrative requirements behind incentive schemes were just as critical as making bulk-billing claims to Medicare, it had not been incorporated into practice management to the same extent.
Practice nurses had a particularly important role to play in fulfilling these administrative requirements, he said.
Australian Association of Practice Management national president Danny Haydon told MJA InSight that a key incentive not included in the study was the practice nurse incentive program, which provides payments to support an expanded role for nurses working in general practice. (2)
Mr Haydon said the MJA research also highlighted a growing economic dilemma for general practices across Australia.
The business viability of many practices was reliant on incentive payments to sustain the level and range of services they are able to provide. However, as the payments were not indexed, “their relative value to the practice is eroded over time by inflationary cost increases”.
Mr Haydon said this underlined the need for “the implementation of successful change management strategies to ensure practices are able to take full advantage of these incentives in a cost-effective manner.”
In a statement to MJA InSight, Dr Frank Jones, the Royal Australian College of General Practitioners (RACGP) president, agreed that inflation had been the primary cause of the dwindling value of incentives in general practice.
Dr Jones said these incentives needed to be refocused to align with “quality care and evidence, and support the associated administrative requirements”.
It was also important for incentives to be targeted to those bearing the brunt of the administration burden, meaning “if the practice does the work, they are supported, and if the practitioner does the work, they should be supported”.
The RACGP was currently advocating for a complete overhaul of practice incentive payments (PIPs), he said. (3)
It wants payments that provide better support to GPs and their practices to deliver a broad range of services, provide continuous care for their patients and operate in areas where they are most needed, Dr Jones said.
1. MJA 2015; 202: 488–492
2. Practice Nurse Incentive Programme
3. RACGP vision for a sustainable health system
(Photo: KPG Ivary / Shutterstock)