PCEHR set-up payments still in doubt
CONFUSION is lingering among GPs and doctor’s groups in the wake of Health Minister Tanya Plibersek’s announcement yesterday that MBS consultation items would be available for ‘nominated providers’ creating electronic shared health summaries.
[UPDATE 30-03-12 12:40pm - Dept of Health response below]
The news was welcomed by the RACGP and AGPN but AMA president Steve Hambleton and readers responding to the story on the MO website said there was nothing new in the minister’s announcement.
A spokesperson for the minister confirmed to MO this morning that a GP making what would normally be a level B consultation would be entitled to claim a level C if the extra work involved in creating a shared health summary made the consultation longer than 20 minutes.
But Dr Hambleton said the association’s understanding based on consultation with the health department yesterday was that the MBS descriptors would not be changed and GPs would not be entitled to claim the longer consultation.
“Sources in the department have confirmed if the content of the consultation was going to be a level B and the length of the consultation was extended – to create or curate the shared health summary – that would not justify claiming a level C,” Dr Hambleton said.
“The level C and D consultations are for complex conditions and you have to demonstrate that in your notes when the PSR comes knocking.
“The department will take a dim view if it is clearly a level B consultation and the GP is claiming a level C.”
MO has asked the health department for clarification and will publish the response when it arrives.
In her speech yesterday to the Health-e-Nation conference on the Gold Coast, Ms Plibersek said MBS consultation items would be available to GPs “if they are creating or adding to a shared health summary on an e-Health record which involves taking a patient’s medical history”.
“The use of the longer consultation items will be seen as appropriate by [Medicare and the PSR] in circumstances where there is clear evidence of patient complexity and there is documentation of a substantial patient history,” Ms Plibersek said.
Dr Hambleton said the profession needed clarification urgently.
“We need to know what the heck is going on,” he said.
A survey carried out by Cegedim on behalf of MO last month found more than three in four GPs still had concerns about the lack of remuneration offered by the government to compensate ‘nominated providers’ for creating and curating the shared health summaries (MO, 24 February).
Primary Health Care general manager medical centres Henry Bateman said the best way to compensate GPs for their work on e-health records while providing confidence and consistency would be "to create a specific item number for use when claiming under Medicare".
“We are concerned that without a clear separate item number, GPs will not feel comfortable charging a level B, C or D consultation, for fear of it being seen as inappropriate," he said. "There is already a great deal of confusion amongst GPs about when they are entitled to claim for a long consult.
UPDATE 30-03-12 12:40pm
The department has issued this clarification around the use of MBS items by GPs in relation to the PCEHR.
From a spokeswoman for the Dept of Health and Ageing:
GPs will be able to use existing MBS consultation items B, C, and D, if, as part of a consultation, they are creating or adding to a shared health summary on an eHealth record which involves taking a patient’s medical history.
If a patient presents to a GP with a health issues/s, as part of the consultation GPs will be able to factor in the creation of, or addition to, a shared health summary on an eHealth record when making a judgment about which MBS item to bill – B, C or D.
Time is one factor to consider, but just as important is evidence of substantial patient complexity and history. GPs currently exercise professional judgment about which item to bill, including about the time involved in taking medical histories - and that would apply here too.
In circumstances where there is clear evidence of patient complexity and there is documentation of a substantial patient history GPs, using the longer MBS consultation items would be considered appropriate by Medicare Australia Practitioner Review Process and the Professional Services Review.
It follows that GPs would consider using the higher level items for longer consultations where there is substantial patient complexity and history.
Where evidence exists to support this, then that’ll be OK with the bodies that regulate Medicare claims by doctors – the Medicare Australia Practitioner Review Process and the Professional Services Review.