PIP eHealth Incentive Targets – what happens if you fall short?
The Department of Health has advised that it will be writing to general practices who have not met their Shared Health Summary (SHS) target uploads from 1 May 2016 to 31 January 2017 under the PIP eHealth Incentive before the end of April.
What happens will be dependent on the degree to which a practice has not met the upload requirement and whether it is eligible for an exemption from the requirements for circumstances beyond its control.
Practices who experienced issues outside their control, which prevented them from meeting the requirements of the incentive, may qualify for an exemption and should contact the Department of Human Services on 1800 222 032 or firstname.lastname@example.org to discuss.
Practices that may not have met the SHS target uploads, and who do not qualify for an exemption, fall into three categories:
- Practices where the Department of Health has been unable to match their PIP identity to their My Health Record identity. These will be asked to provide their Healthcare Provider Identifier - Organisation (HPI-O) number - so that the department can determine if they met the SHS upload requirement.
Practices who do not provide their HPI-O will be withdrawn from the incentive. Once the HPI-O has been received, if it is determined the practice has not met the upload requirement, it will be treated in accordance with the relevant option outlined below.
- Practices that did not upload any SHS will be ineligible for the incentive and required to return the relevant incentive monies paid to date. These practices will also be withdrawn from the incentive to prevent them from accruing further debt. Should they wish to be included in the ePIP at a future date, they will be able to re-register.
- Practices that uploaded at least one SHS but may have fallen short of their target will be treated as follows:
- Those practices that achieved less than 50% of their target upload volumes over the 9 months will be asked to return incentive funds paid to date, although where they uploaded enough SHS to meet their targets for any particular quarter, they can retain the payment received for that quarter.
- Those practices that achieved 50 to 99% of their upload volumes over the 9 months will be asked to return funds proportional to the percentage of the target they didn’t meet.
This will be a once off approach and will apply only to the temporary extension period to 31 January 2017. In the future practices will need to meet each quarter’s requirement in full.
In the first instance, those practices that are required to make a repayment will be asked to do so through a voluntary acknowledgement of incorrect payment form, rather than though a formal debt notice.
Practice A has a SHS upload target of 10 per quarter. It uploaded a total of 8 SHS (27% of its total upload volume):
Practice A has not uploaded enough SHS to meet the requirements for any quarter and will be asked to repay all ePIP funds paid for the last three quarters.
Practice B has a SHS upload target of 15 per quarter. It uploaded a total of 21 SHS (47% of its total upload volume):
Practice B has uploaded less than 50% of the total target but has uploaded enough SHS to meet the requirements for the third quarter and will be asked to repay ePIP funds paid for two of the three quarters.
Practice C has a SHS upload target of 20 per quarter. It uploaded a total of 45 SHS (75% of its total upload volume):
Practice C will repay 25% of the ePIP funds paid across the last three quarters.
The AMA strongly opposed the decision to link SHS uploads to the eHealth incentive when it was first announced, as did other GP groups. Given the Government’s clear intent, the AMA secured a number of concessions including lower SHS targets, a delay in the introduction of the arrangements as well as an extension of time for practices to comply with the new requirements.