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MyMedicare - General Practice Aged Care Incentive (GPACI)

Approximately 200,000 older Australians reside in aged care, with some experiencing higher rates of complex medical conditions, frailty, and cognitive impairment compared to those living in the community.1 Aged care residents also face increased risks of hospital presentations, complications, and mortality.

Continuity of care for aged care residents is critical to ensuring good health outcomes, reduced morbidity and mortality and creating a more integrated health experience in the aged care sector.2

Positive collaboration between general practice and Residential Aged Care Homes (RACHs) can foster a proactive, preventative, and person-centered approach to support the health, wellbeing, and quality of life for residents and reduce preventable hospitalisations.

The General Practice in Aged Care Incentive (GPACI) forms part of the Australian Government’s Strengthening Medicare Reforms, responding to the recommendations of the Taskforce. Practices and primary care providers registered for MyMedicare can enrol in GPACI. The GPACI scheme aims to improve access to quality, proactive primary care for older people who live in aged care homes through incentivising proactive visits, regular planned reviews and coordinated care planning.

The GPACI QI Toolkit empowers primary care practices to utilise GPACI to address barriers to care delivery, strengthen continuity of care, and implement sustainable changes tailored to the unique needs of aged care settings.

Lived experience matters

Watch this video to hear from Childer’s Family Medicine and Forest View Care on their collaboration in implementing.

This activity builds on the My Medicare – Voluntary Patient Registration QI Toolkit. We suggest your practice starts there if appropriate. 

Improve access to continuous quality care for residential aged care patients through GPACI.

To achieve this goal, you can access a range of resources:

  1. General Practice in Aged Care Incentive program guidelines 2024 provides advice on the service requirements, payments, assessments and appeals process.
  2. General Practice in Aged Care Incentive – FAQ for GPs and practices
  3. Visit CCQ’s MyMedicare GPACI webpage for key resources such as the GPACI MBS User Guide and the Monitoring and Tracking Tool.
  4. Watch these series of short videos on GPACI from the perspective of a GP:
  5. Listen or watch the vodcasts about GPACI from the Department of Health, Disability and Ageing.
  6. Access MyMedicare eLearning from Services Australia, this includes a module on GPACI.

Kickstart your quality improvement activity by bringing together a quality improvement team. Together, you’ll identify the key challenges and come up with innovative solutions, ensuring you all share a clear understanding of the improvement objectives and strategies.

  1. Engage with your Primary Health Coordinator from CCQ; they can offer tailored support, resources and guidance to enhance your QI efforts wherever you are in your QI journey. Your Primary Health Coordinator can support your practice to:
    • Bring a QI team together to decide on an improvement idea
    • Plan, start and finish a QI activity
    • Facilitate QI meetings
    • Create practice-wide systems improvement
  1. Gather data and information. Review current practice data and processes for delivering care in residential aged care homes.
  2. Identify and discuss any common barriers to care for residential aged care patients. Consider using process maps, flow charts or driver diagrams to generate change ideas and improve processes.

What data might you need? You’ll need data to understand the problem and measure your outcomes. We suggest you start with:

  1. Primary Sense can provide insight, detailed reports, and targeted guidance on improving data quality. The following report is available within Primary Sense:
    • Voluntary Patient Registration: Identifies patients who would benefit from enrolment and aged care residents
  2. Clinical software: Ensure your data quality practices are up to date, including diagnostic coding and active/inactive patients.

To achieve your goal, you can consider several improvement ideas such as:

  1. Utilise the Primary Sense report ‘Voluntary Patient Registration’ to identify aged care residents within your practice population to register with MyMedicare. It may be beneficial to coordinate with the RACH to streamline enrolment and provide any extra assistance required.
  2. Develop accurate patient registers of people living in residential aged care, including a process for identifying in the patient file if they are a residential aged care patient. The GPACI monitoring and tracking spreadsheet may be a helpful tool.
  3. Coordinate improvement efforts by collaborating with your local RACH. This might look like conducting ‘ward rounds’ with a RACH clinical staff or the use of clinical rooms available on site to improve coordination of care. Consider starting by establishing a foundational relationship first with the RACHs you service, utilise CCQ’s Primary Health Coordinators and Healthy Ageing Coordinators to facilitate connection.
  4. Review historical use of MBS items for RACH patients and use the GPACI MBS User Guide to identify new improvements the practice can make to billing and care practices.
  5. Plan care for your residential aged care patients 3 – 6 months ahead by booking appointments for residential aged care visits each month using the Example Annual Cycle from the GPACI MBS user guide as a template. Consider how you can group visits to a residential aged care home in your practice booking system to maximise the efficiency of clinician time.

Remember to self-report your QI project as a CPD activity. QI is a great tool for measuring tangible outcomes and demonstrating improvement in patient care!

Share your results with your CCQ practice support team and with your patients. Ensure you document your quality improvement activity to meet PIP QI guidelines and for CPD purposes.

References

  1. Chiswell K et al. (2022) Australian Health Review 46(4), 414–420.
  2. Maarsingh, O. R. et al (2016). Continuity of care in primary care and association with survival in older people: a 17-year prospective cohort study. The British journal of general practice.
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