And beware of ‘geographical narcissism’.
Changing the funding model leaves us back at square one if it remains underfunded, according to the rural GP college.
Last September, the Department of Health and Aged Care ordered a review of the Practice Incentives Program and the Workforce Incentive Program.
Last month, the department released a consultation briefing paper on the topic.
The core recommendation was a “simplified” blended GP payment model to replace WIPs and PIPs.
This would involve a new baseline payment for practices combining funding for multidisciplinary care or care coordination and payments for quality and innovation programs, teaching and after-hours care.
In exchange, GPs would provide comprehensive data on service delivery. Practices and patients would also need to participate in the so-labelled “voluntary” patient enrolment system MyMedicare.
In its submission to the review, ACRRM supported “the principle of a system shift to a blended payments framework for general practice” but added that it would need to “flexibly enable healthcare team models that can optimally deliver care in rural and remote areas”.
Speaking to The Medical Republic, Health Services Daily’s sister publication, ACRRM president Dr Dan Halliday said moving to a blended funding model was all well and good, but the systemic issue of underfunding remained.
“Shifting the split of fee for service versus background or core funding for these services doesn’t necessarily impact on the current level funding that is [allocated to general practice],” he said.
“There’s already a Medicare underspend in our rural and remote communities to the tune of nearly $6 billion a year on a per capita basis.”
Dr Halliday said it was important that new models didn’t undermine the current, well-established models of practice that already served the rural community well, particularly those facilitating team-based care.
He also said the term “multidisciplinary” was commonly being misused used to fragment care, and that the review should specify that collaborative, team-based care arrangements should be incentivised.
He added that it was important to remain “cognisant of the potential for geographical narcissism”, which could inadvertently adversely impact rural and remote communities, when considering major changes in the funding structure.
According to ACRRM’s submission, rural GPs were not supported within the new architecture.
“The college notes that as named, the review was intended to identify mechanisms to incentivise general practice,” it read.
“However, there is no detail at this stage to guarantee that any of the incentives will necessarily be directed to general practice or general practitioners, rather as described they will be directed to the broader primary care designation.”
The other major review recommendation was to redirect all current WIP provider payments to practices rather than individual health professionals “to enable flexibility and agility in attracting, recruiting and retaining health workforce professionals”.
The college flagged its “serious concern” that the WIP payments were no longer set to incentivise rural doctors.
“WIPs are widely recognised as critical to maintaining rural workforces,” the college’s submission said.
“They are also currently the key incentive to reward attainment of advanced rural generalist skills which are vital to provision of the full scope of necessary medical services in rural and remote areas.
“This proposal will remove the guarantee that all or any of this incentive will be passed on to practitioners.
“We see this as likely to have an immediate negative impact on vital rural and remote medical workforce provision.”
ACRRM added that it was unable to make an “informed assessment” of the longer-term impacts of the proposed changes in the absence of details of funding attached to the proposals and “the timeframes, order of roll out, and capacity for checks and contingencies will be, in the transition to the new payment’s structures”.
The review also recommended the establishment of a new independent primary care pricing authority.
This would provide evidence-based recommendations on payment design and MBS rebate levels, “while maintaining the principle” that general practices are able to set their own fees.
ACRRM said the authority should include an explicit brief to consider the value and appropriate incentivisation price point for the GP workforce, and specifically those in remote and rural areas.