Calculating a payment
PIP payments are generally based on a measure of the practice size, known as the Standardised Whole Patient Equivalent (SWPE) value.
Calculating the SWPE value
The SWPE value is a calculation of practice size. It’s based on Medicare Benefits Schedule (MBS) billed care provided by all general practitioners in the practice.
The SWPE includes both Medicare and the Department of Veterans’ Affairs services provided to patients during the reference period. This is a rolling, historical, 12 month period. It starts 16 months before the payment quarter.
To work out the SWPE values, we calculate the fraction of care provided to each patient. This is based on information provided by your practice so it’s important to let us know of any changes.
The total care equals 1.0, known as the Whole Patient Equivalent.
We calculate the fraction of care provided by practices to each patient.
For example, in a 12 month period, a patient gets $100 in MBS benefits at Practice A and $400 at Practice B, a total of $500:
- Practice A is assigned with $100 ÷ $500 or 0.2 of the patient’s care
- Practice B is assigned with $400 ÷ $500 or 0.8 of the patient’s care.
This is weighted for the age and gender of each patient. The weighting recognises people have different care needs at different stages of life. The amount of care differs for males and females.
The weighting amounts below are revised each quarter.
|Patient age (years)||< 1||1 - 4||5 - 14||15 - 24||25 - 44||45 - 64||65 - 74||75 +|
Page last updated: 11 June 2021
This information was printed 15 July 2021 from https://www.servicesaustralia.gov.au/organisations/health-professionals/services/medicare/practice-incentives-program/what-are-payments/calculating-payment. It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.servicesaustralia.gov.au/individuals/site-notices when using this material.