Passing general practice accreditation now comes with higher stakes – but smaller clinics have more to lose.
One of Australia’s four approved GP accreditation agencies claims the cross-subsidisation payment model used to keep accreditation fair has now “clearly broken down”, with smaller practices and rural practices effectively “discriminated against”.
Quality Practice Accreditation (QPA), founded by prominent rural GP Dr Paul Mara, put out a discussion paper last week which argued that GP practices should no longer pay directly for accreditation.
Instead, it proposed that accrediting agencies be reimbursed from the annual Practice Incentive Program (PIP) budget.
The paper itself outlined the history and purpose of GP accreditation, contending that two of the core principles were that practices should not be discriminated against financially or otherwise and that accreditation should remain under the control of the profession.
“The principle of non-discrimination required the implementation of a community rating pricing model, where fees from larger practices would effectively cross-subsidise the costs of accreditation in smaller and more remote practices,” the discussion paper read.
“A consultancy commissioned by the then Department, recommended that the number of full time equivalent GPs (FTEGPs) be used as a basis for calculating practice accreditation fees, with a recommended amount of $1,200 per FTEGP applying.
“The rationale for a cross-subsidisation convention was further reinforced when accreditation became required in 2002 for practices to receive Practice Incentive Program payments, which were more financially rewarding for larger practices.”
In recent years, the QPA paper argued, the introduction of MyMedicare and the sizeable bulk billing PIP – both of which were linked to accreditation status – had compounded this effect.
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While the RACGP and the Australian Commission for Safety and Quality in Health Care still had official statements which asked that practices not be discriminated against or disadvantaged because of location or size, QPA said that this was no longer the case.
“Smaller and more remote practices are potentially discriminated against by higher fees, cherry picking and denial of service,” the accreditation agency said.
“Larger practices are provided discounts by some agencies that provide considerable financial benefits for large practice networks or corporate groups, again effectively discriminating against smaller and more remote practices.
“Some agencies use a fixed pricing formula, others apply minimum fee structures. Some agencies bundle in travel and accommodation for surveyors, others reserve the right to charge more where the costs to service a practice are high.
“While it may be argued that smaller practices or those in rural and remote areas are still being serviced and accredited, they are in effect being financially discriminated against by virtue of location and size.”
Not only was there active discrimination within the current business models, QPA said, but the entire scheme was now compromised: “If a large practice or group can command a significant discount, what else becomes negotiable?”
One solution, QPA said, would be to simply remove practices from the economic equation.
“What is required is a structural change that shifts the structures and imperatives from a lower price strategy to a value-based strategy,” it wrote.
“Implementing centralised pricing arrangements would remove any price based market incentives, provide greater opportunity for quality assurance and improvement and remove many of the systemic risks associated with accreditation systems.
“Practice choice of accrediting agency would be based on service and support.”
Moreover, QPA believed this could be cost neutral for the overall PIP budget.
“This is a true cross-subsidisation model,” it said.
“The proposal would ensure that accrediting agencies are adequately resourced, but with greater responsibility to provide an impartial, robust, high quality assessment to practices regardless of location or size.
“Removing price competition and having a central funding mechanism would provide the basis for greater accountability for agencies to defined outcomes.”
Read the full discussion paper here.
