Eligibility for ePIP will require uploads to My Health Record

General practices wishing to continue to receive payments under the eHealth Practice Incentives Program (ePIP) will need to upload a small number of shared health summaries to the My Health Record system beginning in May this year, with a broader “tiered” performance-based approach to follow later in the year.

According to a December 24 email from the Department of Health, general practices will be required to upload a shared health summary for 0.5 per cent of the practice’s standardised whole patient equivalent (SWPE) to be eligible for the ePIP payment.

This equates to about five shared health summaries per full-time equivalent GP per quarter, or for a practice with five full-time equivalent GPs, it would equate to 25 uploads per quarter.

The changes will begin in May and will be reflected in the August 2016 payment quarter.

A DoH spokeswoman told Pulse+IT that the new eligibility requirements could be met by one GP rather than each working in the practice, meaning the payment is tied to the practice rather than the practitioner. This was a cause for concern in numerous submissions to a discussion paper on the proposed changes issued last year.

“The new eligibility requirements could be met by one GP within a general practice uploading the required number of shared health summaries per quarter to meet the numbers required of the practice,” the spokeswoman said.

The department will also undertake a round of consultations about introducing a tiered performance-based incentive arrangement later in the year.

"Under a tiered performance-based approach, incentive payments would be linked to levels of use of the system, for example numbers of shared health summaries uploaded," the email says.

The DoH spokeswoman said this proposal would be "the subject of further consultation with the general practice community”.

“The new payment structure [based on SWPE] will take effect from the May-July 2016 reference period for the August 2016 payment quarter,” she said.

“Subject to the outcome of consultations with the general practice community a tiered arrangement would take effect at the earliest from the August to October 2016 reference period for the November 2016 payment quarter, noting that the nature of the tiered arrangement is yet to be designed and consulted on.”

She confirmed that the eligibility criteria for the other four requirements of the ePIP remain unchanged. These criteria include having a secure messaging service, having electronic transmission of prescriptions (ETP) capability and using software that is compatible with the My Health Record system, formerly known as the PCEHR.

The department has also been in discussions with the practice incentives program advisory group (PIPAG) to look at ways to streamline the transition of existing ePIP recipients to the new arrangements, including those practices that do not wish to continue. (Department of Human Services figures show that 4876 practices were registered for the ePIP in 2014-15.)

“General practices will be advised of the administrative arrangements they will need to follow to continue to participate in the ePIP program following the changes announced on 24 December 2015,” the spokesperson said. “These are currently being finalised.”

In its submission to the department on the proposed changes last year, the Royal Australian College of General Practitioners (RACGP) rejected tying the ePIP to practitioner uploads to the PCEHR. The college said it could not support mandatory requirements for the uploading of a specified quota of clinical documents.

Both the RACGP and the Australian Medical Association agreed that the system need to be made fundamentally useful before GPs would use it.

CEO of the Australian Association of Practice Management (AAPM), Gillian Leach, said the criteria of uploading shared health summaries on a SWPE basis was achievable, but the association was concerned abut the timing of the measure and the lack of connection with the anticipated chronic disease reforms.

In its submission on the proposed changes last year, the AAPM argued that changing the ePIP requirements was premature in light of the many reviews currently taking place, including the review into the MBS, the Primary Healthcare Advisory Group review and the trials of opt-out models for My Health Record.

While the discussion paper mentioned linking the uploading of shared health summaries to demonstrating use of the MyHR for patients with a chronic disease, the AAPM did not want to see this linked to the ePIP.

It argued that a more effective means of increasing the active and meaningful use of the system would be to change the Medicare descriptors for chronic disease, health assessment and mental health MBS items, to include the requirement for uploading of a shared health summary.

With little detail on the proposed tiered model the AAPM could not comment, but did say that it believed a seamless transition of existing ePIP practices to the new system would be essential.

“The system will get better take up if the government addresses the lack of interoperability for secure messaging,” Ms Leach said. “Without this a key benefit of eHealth – ie access to patient information by different health professionals – cannot be achieved.”

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