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 your practice.

The SWPE includes both Medicare and the Department of Veterans’ Affairs services provided to your 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. 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 +
Female 0.5723 0.8761 0.5103 0.8378 1.0472 1.1062 1.4366 2.1298
Male 0.6165 0.9499 0.5221 0.5457 0.6903 0.8938 1.2920 1.941

Page last updated: 13 February 2020