In his 20 September 2018 blog, Dr Edwin Kruys, former Vice President of the Royal Australian College of General Practitioners (RACGP), writes of the increasing consolidation of Australian health data and its analysis within the Federal Department of Health.
May 1st 2019 will see changes to the Australian Government’s Practice Incentive Scheme, with the abolition of practice incentives for asthma, cervical screening, diabetes, quality prescribing and aged care access. While the exact nature of the replacement is not known, the previous plan was shelved just prior to the May 2018 Budget. It envisioned an all encompassing Quality Improvement payment and this remains the most likely basis for the new system.
Primary Health Networks (PHNs) will play an important role under these new arrangements. The QI program will require upload of de-indentified data forthe local PHN to assess whether practices are complying with the requirements of the program. The aggregated data may in turn be uploaded to the Federal Department of Health. The Department is looking at Key Performance Indicators (KPIs) for the program. These are likely to apply at PHN, practice and possibly intra-practice level. It looks like KPIs all the way down.
Like the My Health Record, patients will have no control over their aggregated de-identified data. Analysis may be undertaken at the Federal and PHN levels and possibly by the practices themselves. Despite their requests, the AMA and the RACGP, organisations representative of the profession, will be shut out of the process. Following the defunding of the BEACH (Bettering the Evaluation and Care of Health) program in 2016 this further consolidates control of the national health data within the Department.
KPIs have had a chequered past in primary health care. If they are directed at disease measures and outcomes, the focus moves from care tailored to the patient to achieving the target. The more cynical might even be tempted to change their practice demographics to improve their stats. “Buffing the chart” is actually an accepted part of medical practice in some countries.
The current crisis in the aged care sector is partially related to the deskilling of the nursing and pharmacy workforce. The loss of the aged care access component of the practice incentive payment may cause more GPs to drop nursing home visits, a fact bemoaned by Dr Frank Jones, former president of the RACGP on Dr Kruys’ blog.
One approach that the Department might be considering is defining quality practice as caring for the patient from the cradle to the grave. Larger practices of GPs with diverse interests may prove to be better able to provide this level of care. It would however represent another major change to the structure of general practice.
If the QI pip does not provide sufficient incentives or if practices are concerned about the process in general, the financial impact of opting out will be high for many general practices. In conjunction with the Medicare freeze of the last six years the PIP loss will result in further deterioration in the status of general practice and push more young doctors into specialty areas. This will be a poor outcome if patient centredness is considered a worthwhile attribute as described by Drs Lembke and Jammal recently on LIfe Matters.