PNIP Frequently Asked Questions
Below are some frequently asked questions APNA has received from members regarding the Practice Nurse Incentive Program (PNIP). More questions will be added to these throughout the coming months.
If you have a question regarding the impact of the PNIP upon your role as a nurse, or upon nursing services in your practice, please email firstname.lastname@example.org.
Detailed information on the PNIP is available from the Medicare website at www.medicareaustralia.gov.au/provider/incentives/pnip.jsp#guide.
What is the purpose of the PNIP payments? Do they cover nurses’ salaries?
The PNIP provides funding to practices/services that employ either practice nurses or Aboriginal Health Workers (AHWs) or both. The funded site can use these funds for any purpose, including offsetting the salary/wages of their nurse or AHW. The aim of the policy is to offset costs rather than fully meet them.
The PNIP is a simplification of the previous incentive scheme. That scheme provided payments for certain activities. This new program provides more freedom in the range of activities that can be undertaken and provides the opportunity for practice nurses to work to their full scope, releasing them from the particular clinical practice and tasks associated with item numbers. Nurses can undertake a more varied role, and thus be engaged differently in meeting the clinical and financial demands on the practice.
Which MBS practice nurse item numbers are being removed?
From 31 December 2011, the following MBS practice nurse items covering immunisation, cervical smears, and treatment of wounds will no longer be available:
- Immunisation – Item 10993
- Wound Management – Item 10996
- Pap & preventive check – Item 10994
- Pap > 4 yrs and preventive check – Item 10995
- Pap Smear – Item 10998
- Pap smear > 4 yrs - Item 10999
All other MBS item numbers for services that can be undertaken by a GP and practice nurse are remaining, including:
- Chronic Disease Check - Item 10997
- Healthy Kids Check - Item 10986
- Antenatal Check - Item 16400
- Aboriginal Health Check - Item 715
- Health Check Follow Up - Item 10987
- GPMP - Item 721
- TCAs - Item 723
- GPMP & TCA Reviews - Item 732
- Health Assessments -
- Brief – Item 701
- Standard - Item 703
- Long - Item 705
- Prolonged- Item 707
- Spirometry - Item 11506
- ECGs - Item 11700
Will the role of the practice nurse be de-valued through the removal of MBS practice nurse item numbers?
The PNIP provides opportunities for practices to undertake broader nursing services and maximise their nurse’s scope of practice. It allows practices to engage their practice nurses in a more strategic, diverse and less task-oriented way. Practice nurses can continue to provide existing services such as immunisations, pap smears, wound management and the like – the PNIP changes the funding mechanism, rather than the value of the services. It provides the opportunity for nurses to branch out into other nursing services if it is in the practice’s interests to do so.
What if my practice receives less under the PNIP?
It is important to firstly calculate the current funding your practice receives from:
- the Medicare item numbers that are being removed,
- Medicare items billed because work/clinical capacity is ’freed-up’ when nurses undertake other MBS-billed activities, and
- any PIP payments received because of the direct role of nurses.
The total of these payments is what you should compare to the total PNIP payments you expect to receive (see the Medicare Australia Ready Reckoner to assist you in calculating your PNIP payments).
If there is a shortfall, then your practice will be eligible for grandfathering arrangements so that the practice will be no worse off until the end of these arrangements. If you determine that there is a shortfall there may be opportunities to ‘re-engineer’ the practice/service’s work to address this.
APNA has developed a business case tool that might assist – available here.
Because APNA will be advocating for appropriate arrangements in both the short and long-term (after the grandfathering ceases), we want to know about your problems. We are keen to understand the extent and breakdown of any shortfall.
For example – for what reason(s) is there such a shortfall? Does your practice undertake a relatively high number of immunisations and pap smears that attract MBS funding for example? Why is this so? Is it a result of the population/community requirements? Is it a result of the structure of your practice that has focused on these services in the past?
We want to understand the implications of the change for your patients. For example, is the rate of immunisation likely to drop? Why wouldn’t your practice/services doctors do it; and what if they did – would there be other problems?
When we understand the nature and pattern of any problem, we can seek to have it addressed.
What incentive is there for practice nurses to maintain their skills in areas where they previously received MBS payments e.g. immunisations, wound management, etc?
APNA encourages practices to continue undertaking pap smears, immunisations and other important services should it be a recognised need in their community. These services are fundamental and form an important part of nurses’ scope of practice.
The PNIP can absolutely be used, and should be used where appropriate, as an incentive for nurses to maintain their skills in such areas.
We are keen to understand the specific circumstances of your practice in relation to the number of and reason why you see these services as important for your patients.
Is the practice nurse incentive payment calculated per nurse?
The PNIP payment is calculated according to the practice's SWPE (standardised whole patient equivalent) and the total number of hours per week for which the practice employs eligible staff. The PNIP Guidelines contain a guide to the minimum number of nurse hours per 1000 SWPE that are required to receive the maximum incentive payment.
For example, a practice with a SWPE of 1000 might employ one registered nurse for 14 hours per week, or alternatively may employ one registered nurse for 8 hours per week and another registered nurse for 6 hours per week. For the purposes of calculating this practice's PNIP incentive, the total number of registered nurse hours per week will be 14 hours in either case.
The Medicare PNIP Ready Reckoner provides an estimate of the incentive payment a practice may be eligible for under the Practice Nurse Incentive Program. When using the Ready Reckoner, under the section entitled Current Practice Nurse Details, enter the total number of hours for which Registered nurses are currently employed in the practice, and the total number of hours for which Enrolled nurses are currently employed in the practice.
The PNIP Ready Reckoner is available from http://www.medicareaustralia.gov.au/provider/incentives/pnip/calculator.jsp.
Previously our practice could receive a Cervical Screening Service Incentive Payment which was triggered by claiming a practice nurse MBS item 10995 or 10999. How does Medicare organise the PIP payment for pap smears when there is no longer an item number for us to inform them that a nurse has performed a pap smear?
With the removal of the Practice Nurse Cervical Screening Service Incentive Payment (SIP) items10995 and 1099, practice nurses will no longer be able to trigger a cervical screening SIP themselves.
However, practice nurses may assisting a medical practitioner in providing a Pap smear service under MBS items 2497-2509 and 2598-2616, which still trigger a Cervical Screening SIP for underscreened women.
For advice on the Cervical Screening SIP please contact the Medicare PNIP hotline on 1800 222 032 or email email@example.com.