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From 1 October 2017, practices in certain locations across Australia commenced participation in the Health Care Homes program. For more information on Health Care Homes, please visit the Health Care Homes webpage.
WIP – Doctor Stream and Health Care Homes
As the Health Care Homes model replaces fee-for-service billing with bundled payments for the management and care of enrolled patients with chronic conditions, this may result in some activity no longer being captured by the Department of Human Services (Human Services), for the purposes of WIP – Doctor Stream eligibility assessment and payment calculations.
See the WIP Guidelines for full details of the eligibility and how payments are calculated.
Who may be impacted?
Medical practitioners who are participating in the Health Care Homes program in a Modified Monash (MM) 3-7 location, and who may be eligible for a WIP – Doctor Stream Central Payment System (CPS) payment, could be impacted. These are medical practitioners who bill the Medicare Benefits Schedule (MBS) for eligible services and receive automated WIP – Doctor Stream payments.
Payments will only be affected where practitioners generally bill less than the $30,000 per quarter maximum activity threshold, or where their participation in Health Care Homes brings them below this threshold.
See the WIP Guidelines for more information about the CPS.
Will medical practitioners who apply under the Flexible Payment System (FPS) be affected?
No. Medical practitioners who require assessment under the FPS for eligible non-MBS services will not be affected. Medical practitioners applying through the FPS are required to account for all time spent providing WIP – Doctor Stream eligible services, regardless of whether the services were MBS billed. This will include services to Health Care Homes patients.
More information about the FPS is available on the Department's website.
What do affected medical practitioners need to do?
For medical practitioners billing the MBS for services and accessing WIP – Doctor Stream payments only through the CPS, who consider their payment has been affected by their participation in Health Care Homes, there is a simple opt-in review mechanism available to ensure that a medical practitioner’s Health Care Home services are included in WIP – Doctor Stream eligibility assessments and payment calculations.
Medical practitioners can complete a simple form that self-reports the number of hours per week, on average, that they spend providing eligible primary care services from all MM 3-7 locations, across the relevant quarters. After having this form signed off by their employer or practice manager, medical practitioners will need to submit it to the Department of Health via WIP@health.gov.au. Information provided on this form will be assessed, and if the medical practitioner is deemed eligible for a full payment or a ‘top-up’, the Department of Health will request that Human Services make a payment directly to their nominated bank account.
For further information please refer to the WIP Guidelines.
Health Care Homes Review Form
Please note this form requires handwritten signatures and is therefore intended to be paper based. The Printable PDF version is the recommended document for medical practitioners to download, print, complete and submit.
For further information please refer to the WIP Guidelines. For enquiries relating to the impact of Health Care Homes on WIP – Doctor Stream payments, please contact WIP@health.gov.au.