Reblogged from HotDoc 15 July 2019
PIPQI stands for the ‘Practice Incentive Program – Quality Improvement’. It’s an incentive payment given to general practices once a quarter for demonstrating that they are providing continuous quality care. The incentive commences August 1, 2019, with the first quarterly payment being issued November 1.
There has been a lot of talk about what exactly the new PIPQI is and what this means for practices. To clear up some of the confusion, we talked to Katrina Otto, Managing Director of Train IT Medical. The following is a Q&A with Katrina.
What is happening on August 1, 2019
“As of August 1, there will be 8 incentive payments. PIPQI is the new one starting then. The 4 existing incentive payments that will cease are diabetes, asthma, cervical screening and quality prescribing.”
What are the PIPQI measures that clinics need to adhere to?
“There are 10 measures for the new PIPQI incentive payment. Those measures are:
- Proportion of patients with smoking status recorded
- Proportion of patients with alcohol status recorded
- Proportion of patients with weight recorded
- Proportion of patients with up-to-date cervical screening
- Proportion of patients with diabetes with blood pressure recorded
- Proportion of patients with diabetes with current HbA1c result
- Proportion of patients with diabetes immunised against influenza
- Proportion of patients COPD & immunised against influenza
- Proportion of patients over 65 immunised against influenza
- Proportion of patients with necessary risk factors to enable
CVD assessment
“A common question I get asked is, ‘What are the targets?’ The answer to this is there are no targets. This is hard for many in healthcare to understand because we’re so used to accreditation targets, but really the idea is that we just need to be engaged with continual, formal improvements as a practice team.
I really like the sentence that came from the government that said, ‘Practices may focus their quality improvement activities on areas, which are informed by their clinical information system data and meets the needs of their practice population.’
For some practices, their data might tell them that they have a really high proportion of patients who have kidney disease or Hepatitis C. For others, it might be bowel or breast screening.
So the idea is to use your own data to help determine what your improvement focus should be.
We know that for many reasons, we’re not always going to achieve 100% data recorded or 100% improvement in a specific outcome. So, I think removing the focus on targets right now is actually very helpful.
Providing a payment for entering coded diagnoses, observations and measurements in the patient record, and having a focused approach on improvements for data related to chronic condition management and prevention is a very positive step.
We know if a patient has diabetes, their blood pressure should be taken, their HbA1c tracked etc. And the way we know if it’s been done is recording that coded data in the correct place.”
What if a clinic’s data is already good on these measures?
“Yes, some people have said, ‘Our data is already very good. Will we be penalised? Should we make our data look bad so we can show a more significant improvement?’
To that I say, ‘No, absolutely not.’ Practices with high quality data, who may have already been engaged with their PHN (using Pen CS or POLAR) to improve their data related to these 10 measures are in a fabulous position. They will receive the PIPQI payment, and can decide on their own which improvements they would like to make based on the needs of their practice.
The point is to let your data inform you as to what your improvements are going to be. But, if you’re at the stage where you don’t yet have blood pressure, HbA1c, smoking, alcohol, immunisations etc recorded as per the ‘Eligible Data Set’ then that is where you should start.”
How will the payments be calculated?
“Eligible practices can receive up to $12,500 per quarter, based on $5 per ‘Standardised Whole Patient Equivalent,’ to a maximum of $50,000 per year”.
What should clinics do to ensure they are satisfying their requirements?
“For practices who aren’t engaged with their PHN, starting that conversation is obviously a very big first step. This begins with signing, or reviewing, a formal ‘data sharing agreement’.
The PHN will then help with other essential steps, like getting PRODA installed so practices can register via HPOS on August 1, and also getting either Pen CS or POLAR data analytic tools installed. They can also facilitate all the necessary training and support clinics need to extract and analyse their own practice data.
Practices can then look at their own data and identify any necessary improvements they think they can make. They will then engage their team and start to implement these formal quality improvement activities.
You wouldn’t be surprised hearing this from me, but my focus when training PIPQI is not about the money, but instead ensuring the good work clinicians do is being documented in the correct place and that there is a team approach to supporting improvements.
I have a saying, ‘I like doctors to do what only doctors can do.’ We need to protect them because they’re precious. This shouldn’t all be on the doctor. It’s a team effort.
I mean, practice managers like me are often very bossy. We’ll say, ‘We need to improve the recording of blood pressure for our patients with diabetes. Okay. That’s it. Every patient who has diabetes, you’ve got to enter their blood pressure into the software.’
Well, that’s not a solution. There’s a reason why it’s not being done now. So, it’s better to first ask why isn’t this being recorded now? Is it a time factor? What are the challenges? And, then you ask the team for ways the process can be improved.
I am constantly amazed at how many fabulous ideas can come from a team meeting. I did a PDSA with a group recently and I thought I had 3 ideas that would work but the group came up with another 10! It really is a team effort.”
How exactly will PIPQI be monitored?
“In order to receive a payment, general practices need to submit their data at least once during the data submission period for that quarter. ACCHS and other IAHP organisations will provide nKPI data within their existing arrangement with the Department of Health.
A big part of PIPQI is the engagement of a practice with their Primary Health Network. For many practices, that relationship obviously exists now.
Usually, the PHN will extract the entire de-identified database and provide feedback. Many PHNs have been doing this for a long time already. They aggregate the data and give meaningful reports back to practices – benchmarking the data and showing where improvements are being made. They also offer a comparison to other practices.
I work with many PHNs across Australia and, honestly, the support I see them providing, especially in regard to data, technology and practice management is incredible.
It’s worth noting that while the PHN obtains the de-identified practice data, they don’t give this to the government. They merely advise that the practice is participating and fulfilling requirements for PIPQI.
Practices, however, are the ones that could be audited and have to prove they did meet the eligibility requirements for PIPQI, so they need to keep proof of their quality improvement activities in case they are ever audited.”
What are some of the barriers clinics are likely to face with these changes?
“Sharing data with the government is a massive one. I’ve had a doctor say to me, ‘This is the government getting into my practice, into my business.’ And, I’ve had others who don’t want to work with their PHN.
I don’t know if anybody likes my response, but my response is we already share data so we may as well make it correct data, because decisions are being made from it. The government already has PBS and MBS data for a start.
We need to look at our own data as more than just a reporting tool for the government. Sharing data and getting feedback helps us improve our businesses, and it benefits our clinicians and our patients too.
This said, practices should have a policy in place in regards to what data they collect from patients, how they collect it, why they collect it, and what they’re using it for.
Both Pen and POLAR have posters for waiting rooms that clinics can use to advise patients of their de-identified data sharing agreement with the PHN.
It’s very rare that I find patients object to sharing their de-identified data, but if they do, their data can just be removed from the extract.”
Register for our PIPQI Webinar on August 28
Do you have any final tips for clinics?
“A big piece when working on quality improvements is to keep focused on why we’re doing this – for improved chronic condition management and prevention, and to improve patient outcomes.
I would also like to stress for practices that while a formal CQI (continuous quality improvement) is required, it doesn’t have to be complicated. PHNs will provide formal templates, often called ‘PDSAs’ – which stands for Plan, Do, Study, Act – but we can make our own quality improvements very simple.
I always say, don’t make your goals too big or complicated. You don’t have to update the whole patient database at once. If we just say, ‘Okay, we’re going to improve 5%’ or ‘We’re going to increase the number of people who have alcohol recorded by 5 people within the next month.’ That is an improvement.
Take small manageable steps, make the progress visible so staff can see their success, and as a team, celebrate success because working in medical practice is hard work.”