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The following articles have the tag Medicare
GPs who breach Medicare’s 80-20 rule will be automatically deemed to have practised inappropriately under new laws expected to be passed by parliament, and which will retrospectively validate a decade’s worth of committee findings.
A GP who claimed $8000 from Medicare for a 20-minute consult is among the cases cited by the government for tightening the Extended Medicare Safety Net.
HEALTH has been front of stage in the past two budgets – this year things are different.
THE government will consider removing circumcision from the MBS as part of a planned review of paediatric surgery, in a move certain to be opposed by proponents who compare the ethics and practice of infant male circumcision to childhood vaccination.
THE bungling of incentive payments worth about $1.3 million will be the last straw for overworked country GPs, according to doctors’ groups preparing to blast the government at a Senate inquiry on Friday.
THE health department and Medicare are understood to have each blamed the other for a $1 million mistake that will force almost 300 GPs to repay thousands of dollars’ worth of incentive payments.
AN INQUIRY was due to have commenced this week into proposed legislation that would allow dentists to keep incorrectly billed Medicare payments and exempt them from investigation by the Professional Services Review.
High income earners would be financially better off paying more for their health insurance than dumping their policies when rebate means-testing starts, consumer group Choice says.
GPs have been advised to charge each patient up to $210 when preparing a shared health summary for the government’s personally controlled e-health record (PCEHR) system, which will be rolled out from 1 July.
General practice research program Bettering the Evaluation and Care of Health (BEACH) is for the first time gathering information on how much time GPs spend on patient care outside Medicare-rebatable consultations.
THE federal government should combine the Medicare and PBS safety nets to ensure those who need help most get it, the AMA said today.
THE federal government’s public sector cost-cutting drive has been slammed after a survey found people were waiting so long on hold to speak to a Medicare or Centrelink call centre operator, they were falling asleep by the time their call got through.
MEDICARE has warned doctors that charging patients an annual fee to stay on the books while bulk billing is illegal, amid reports the practice of charging so-called ‘registration fees’ may be growing.
THE proportion of GPs in Australia’s healthcare system fell significantly during the decade to 2009, as general practice lost ground to the other specialties, according to a new report from Health Workforce Australia.
THE federal government’s public sector cost-cutting drive has been slammed after a survey found people were waiting so long on hold to speak to a Medicare or Centrelink call centre operator, they were falling asleep by the time their call got through.
GPs concerned about attracting the ire of Medicare and the PSR by incorrectly interpreting MBS item descriptors will be able to rely on a recently unveiled advice service.
MEDICARE incentives for non-GP specialists to bulk bill is essential to improve access for disadvantaged Australians, a senior general practice academic has argued.
THE establishment of a national disability insurance scheme will be a significant change and will not happen overnight, Prime Minister Julia Gillard has said.
PRIMARY Health Care is edging back toward universal bulk billing at its bigger medical centres to win back business from the growing number of people who put off visiting their GP because of the cost.
After six years as PSR director, Dr Tony Webber remains determined to eradicate Medicare abuse.
THE High Court has granted leave for the government to appeal last year’s Federal Court decision that invalidated PSR findings against four GPs.
GPs, ophthalmologists and obstetricians have reacted angrily to being made examples of in an article by former Professional Services Review (PSR) director Dr Tony Webber, who claimed the Australian health system is leaking up to $3 billion annually.
FORMER PSR director Dr Tony Webber has claimed he was gagged by the health department when he raised concerns that hospitals were “cost-shifting” by pressuring GPs to order preoperative tests through Medicare.
Medicare is urging general practices to provide details of how they employ practice nurses by the middle of the year to avoid missing out on “top-up” payments for lost income under the new block payment scheme for practice nurses.
JUST days after the Greens relaunched their much-vaunted $5 billion a year universal dental scheme, Health Minister Nicola Roxon has effectively shot it down.
PSYCHOLOGISTS angry over the two-tier Medicare rebate system that provides higher rebates for clinical psychologists have taken their grievance to the ACCC after a Senate report recommended maintaining the current system.
GP BULK-BILLING rates have fallen slightly overall for the September quarter compared with the June quarter this year, the latest Medicare data released by the government has revealed.
GPs have been urged to promote generic medicines after a report said Australians now pay $1 billion a year in primary healthcare out-of-pocket charges and a quarter are choosing not to fill prescriptions because of the cost. The Australia Institute paper also called for prescription software that defaults to active ingredients rather than brand names, automation of the Medicare safety net, and mandated government-supplied referral forms with estimated costs of treatment and different provider options. The research, based on a survey of 1411 Australians and available Medicare data, said Australians – ...
FORMER Professional Services Review (PSR) director Dr Tony Webber has welcomed a recommendation that the review be given the powers to “effectively pursue” corporate abuse of the MBS or PBS system so contracted GPs are not left “carrying the can”. The recommendation was one of seven contained in a Senate Community Affairs References Committee inquiry report into the PSR released today. The report comes as the government continues its efforts to challenge a Federal Court decision earlier this year that found a number of PSR rulings to be invalid. The ...
DOCTORS feel they are being victimised by Medicare and the PSR process, which fails to take account of the complexities of general practice, a Senate inquiry has been told. The claims were made in submissions to the inquiry into the operations of the PSR from medical indemnity organisations Avant, MDA National and the Medical Indemnity Protection Society (MIPS). All raised concerns that GPs felt singled out by the PSR process and have called on the government to overhaul MBS compliance measures. MIPS, in its submission, said many GPs continued to hold a view that the “Medicare ...
LAWYERS involved in a Federal Court win over the Professional Services Review (PSR) have been swamped with calls from GPs forced to pay back money to Medicare as the blame game continues over the bureaucratic failure that could invalidate a decade of committee findings.
A GROUP of GPs dissatisfied with their treatment at the hands of the Professional Services Review (PSR) have succeeded in their quest to initiate a parliamentary inquiry into its operation and outcomes. WA Coalition Senator Chris Back successfully moved yesterday to refer the matter to the Community Affairs References Committee, which will hold a wide-ranging inquiry and report back by 22 September. The news came as the PSR prepared to release a guide for practitioners called before a committee or selected for a Medicare review. The PSR has faced significant criticism since it was revealed last ...
GP registrars often struggle with the MBS, but taking advice as gospel could lead to problems.
AXE paper prescriptions from July next year: that is the call on Government from the head of one of Australia’s leading electronic prescribing service operators. Speaking at the 8th Annual Future of the PBS conference in Sydney last week, MediSecure CEO Phillip Shepherd said if the Government was serious about meeting its 1 July 2012 deadline for the introduction of a personally controlled electronic health record (PCEHR) it must get e-prescriptions working first. Mr Shepherd told MO decisive action was needed to encourage the adoption of e-prescriptions by making them the only means by which a patient ...
THE Government has reaffirmed its commitment to scrapping the Chronic Disease Dental Scheme as soon as it can muster the numbers to pass the required legislation. A spokesman for Health Minister Nicola Roxon said the Chronic Disease Dental Scheme would continue, even though the Government viewed it as a waste of money, with the Coalition having opposed Government efforts in Parliament to abolish the program. The Government announced in March that Medicare had a list of 50 GPs who would be audited based on their use of the scheme, along with a crackdown on dentists, with Human ...
A NSW GP who quit full-time practice in frustration two years ago after she was denied access to VR MBS rebates says she may finally receive justice and a chance to restart her career. Non-VR GP Dr Karen Counter said she quit her job in 2009 after Medicare denied her ongoing access to A1 rebates despite her belief she had fulfilled the necessary requirements of a rural service scheme that would have let her retain them. With the two-tier vocational register system set to be overhauled by the Federal Department of Health this year, Dr Counter told ...
MEDICARE has been granted Commonwealth powers to force GPs to hand over patient records, prompting concerns that non-medical bureaucrats will be able to lawfully inspect confidential personal information. Legislation passed by Federal Parliament last week, backed by both major parties, will increase Medicare compliance audits fivefold and will force doctors to produce requested documentation – including patient notes – when suspected of inappropriate claims. Previously, doctors have not been legally obliged to provide documents, and one in five has refused when audited, the Federal Government claims. Under the new laws, however, doctors face hefty fines for refusing ...
GPs are set to come under additional scrutiny from Medicare with those who have referred patients to the Chronic Disease Dental Scheme now in the spotlight after investigations found 59% of dentists audited over their use of the scheme had bent the rules. The findings prompted Human Services Minister Tanya Plibersek to announce the investigations would be dramatically expanded to another 400 dentists and the GPs who made the referrals. The latest crackdown follows the recent announcement that Medicare was to begin targeting GP prescribing of narcotics after the Minister cited a significant rise in the levels ...
After ongoing criticism of its slow progress on the rollout of the personally controlled electronic health record (PCEHR), the Federal Government has now come under fire for “jumping the gun” with a tender process to find an independent evaluator for the project. The criticism is the latest blow to the $467 million project, with Medicare recently forced to revise Individual Healthcare Identifier contracts with medical software providers after they were deemed unworkable. Despite Health Department claims that an evaluation framework was crucial during the program’s development, Health IT consultant Dr David More questioned the logic behind commencing ...
MEDICARE watchdog the Professional Services Review (PSR) has suspended all operations of its peer review committees following revelations of irregularities in the appointment of panel members. A spokesperson for the PSR has confirmed that 40 matters before the PSR had been deferred after every panellist – understood to be almost 100 – was asked to resign and apply for reappointment. The move follows news that the Department of Health had failed to seek the necessary AMA approval for the appointment of an unknown number of panellists, as required by the legislation governing the PSR’s operations. “The ...
GP CARE plans will continue to be targeted by Medicare’s National Compliance Program with its latest report revealing the key focus areas for monitoring in the coming year. According to the report, GP care plans, compliance with Practice Incentive Program (PIP) incentive payments, bulk billing incentive payments, and the monitoring of up-coding of procedural items are to be targeted by Medicare in the coming year. Ordering of diagnostic imaging and pathology tests are also to come under greater scrutiny following the PSR’s recent warning in its annual report of doctors inappropriately using tests for screening purposes. ...
MEDICARE watchdog the Professional Services Review (PSR) has been forced to seek the resignation of all of its medical practitioner panellists following revelations regarding irregularities in their appointments. AMA vice-president Dr Steve Hambleton has confirmed that many pending cases before the PSR had been put on hold after every panellist was asked to resign and reapply for their position. However, he questioned News Limited reports indicating the PSR’s work had been “suspended”. The move follows revelations that the Department of Health had failed to seek the necessary AMA approval for the appointment of an unknown number of ...
THE uptake of Aboriginal health checks has been “shamefully low” according to a new report, with fewer than 12% of the eligible population receiving their check-up. Just 47,000 Indigenous Australians received a preventive health check in 2009-2010, despite more than 400,000 being eligible. Menzies Centre for Health Policy foundation fellow Dr Lesley Russell, who conducted the research, said the policy introduced by the Howard government in 1999 for Indigenous preventive health checks had failed and was in need of urgent review. With rebates of $175-$200 available through the MBS for carrying out the checks, Dr Russel ...
A GOVERNMENT proposal to restrict the ordering of tests for certain vitamin levels has met with opposition from doctors, who warn such a move could prove a risk to patient health. The Australian Association of Pathology Practices (AAPP) fears that requests for vitamin D, B12, iron and folate tests have been earmarked for cost-cutting under the ongoing Medical Benefits Reviews Task Group, which has been charged with finding economies within the MBS. At recent meetings of the Pathology Review Consultation Committee, which reports to the task group, the Federal Health Department flagged a sharp rise in vitamin ...
LABOR has promised to establish Medicare rebates for online consultations if returned to government this weekend, with an announcement today it will allocate $250.5 million over the next four years. The new funding would be shared “across a range of specialties”, according to a Labor statement, along with an additional $56.8 million in financial incentives that would be available to GPs and specialists who participated in delivering online services. The latest election promise, which Labor estimated would provide about 495,000 additional services to Australians in remote, rural and outer metropolitan areas, has been welcomed by GP groups. ...
A STALEMATE has emerged between Medicare and software vendors over who will be held liable for errors within the healthcare identifiers (HI) service. The Medical Software Industry Association has advised members not to sign the HI developer agreement proposed by Medicare, arguing that it may leave vendors or their GP clients liable for errors. Their refusal to sign up is set to further slow the HI rollout. “The biggest sticking point is where the liability lies,” said MSIA president Dr Geoffrey Sayer (PhD). “If vendors implement software with the HI service and Medicare does something to affect ...
NEW research revealing that female GPs earn 25% less than their male equivalents has again sparked debate over how the MBS remunerates doctors for their time. The research, based on an analysis of data collected as part of the Medicine in Australia: Balancing Employment and Life (MABEL) survey, showed that the gender pay gap in general practice was even greater than the 20.7% gap that existed in the general population. Researchers compared the pay packets of more than 2000 GPs and found the gap existed even when data was adjusted to consider number of hours worked. ...
AN extra 50 PBS medicines are to be added to the streamlined authority list, under new measures announced today by the Gillard Government. Health Minister Nicola Roxon has announced that criteria for “authority required” medicines will be expanded, meaning doctors will no longer have to seek telephone or written approval from Medicare before prescribing a particular PBS medication. Medicines used to manage short-term conditions are expected to be on the list. The number of streamlined authority medicines is likely to increase from 110 to 160. The changes meant GPs would be able to spend more time ...
THE AMA has upped the ante in the long-running push to introduce point-of-care testing (PoCT) into general practice. With the Federal Health Department still delaying any formal decision, the AMA has introduced four PoCT items onto its recommended list of medical services and fees and is now encouraging GPs to bill the items privately. Dr Brian Morton, chair of the AMA council of general practice, said the benefits of PoCT were clear and GPs shouldn’t be bound by the need for a rebate. “We decided PoCT wasn’t going anywhere... there were all sorts of delays and ...
WITH speculation rife that Prime Minister Julia Gillard will call a snap federal election, questions still hang over key planks of the Federal Government’s health reforms. While the landmark Council of Australian Governments deal struck early this year will see new monies flow to health services around the country, a sudden election could see key pieces of health reform legislation delayed. The National Health and Hospitals Network Bill – which includes provisions for the controversial diabetes scheme – remains before the House of Representatives. While it is expected to pass through the Lower House, an easy passage ...
THE rollout of a national e-health system has been stalled again, after it was revealed last week that just three medical software companies had signed on to deliver Individual Healthcare Identifiers. According to Medical Soft-ware Industry Association president Dr Geoffrey Sayer (PhD), the stark lack of interest was due to an unworkable developers agreement. The agreement was drafted by Medicare – which will operate the health identifiers service – but failed to detail full specifications that would be required of software companies. It also permitted Medicare to make changes to specifications at any point. “I was ...
GPs fed up with ongoing ambiguities in the MBS can take heart from a recent Medicare survey showing strong health professional satisfaction with its audit processes. A recent Medicare survey of almost 200 health professionals who had undergone compliance audits has found that 93% agreed or strongly agreed they were treated in a professional manner. More than three-quarters found the information provided during the process to be helpful to them in correctly interpreting the MBS. Queensland GP Dr Scott Masters isn’t one of them. His recent attempts to secure a definitive description of a Level C consultation saw ...
PRACTICE owners could find their business structures and rental arrangements under a new level of scrutiny, as more details emerge about the scope of Medicare’s investigation into pathology kickbacks. The investigation was recently announced by Human Services Minister Chris Bowen, however more details have since come to light about how it will work. A Medicare Australia spokesperson said the spotlight would fall on practices whose commercial arrangements “encourage unnecessary requests to pathology providers”. “Examples are company structures designed to create payments and incentives to requesting providers through distribution of profits, [and] lease arrangements set outside proper market ...
BETTER and more timely communication and data sharing between dietitians and GPs is needed to improve the overall management of diabetes, according to new research. The study, based on questionnaires completed by 356 dietitians assessing Medicare’s existing Chronic Disease Management (CDM) program, also found that the limit on the number of services funded under the scheme was a major barrier to better care. Study author Dr Robyn Cant (PhD), research fellow at the Monash University school of nursing and midwifery, found the limited weekly hours worked by private practising dietitians and a reliance on paper-based communication with ...
A NEW investigation into kickbacks and collusion between pathology providers and healthcare professionals has sparked fresh concerns among doctors. Last Thursday, Human Services Minister Chris Bowen announced that a Medicare Australia taskforce had been established to look at inducements offered to healthcare professionals in exchange for pathology referrals. “Medicare Australia intelligence indicates a small minority of providers may be offering health professionals benefits such as free or discounted rent, shares or cash payments to encourage requests for their services,” Mr Bowen said. “The Government will not tolerate this prohibited practice, which may result in patients undergoing ...
GP bulk-billing rates have plateaued at 79.6% in the first quarter of 2010, unchanged from the final quarter of 2009. This comes against a backdrop of a 0.6 of a percentage point rise in bulk billing for all types of medical services, including GP services. In the March quarter 2010, a total of $3.7 billion was paid in Medicare benefits for 73.9 million services, representing a rate of 3.3 services and about $165 in benefits for each Australian. Compared to the same quarter in 2009 bulk-billed non-referred GP attendances rose by 0.2% overall. NSW remained ...
PRACTICES continue to take on the Medicare Easyclaim system despite cessation of the incentives paid to practices to use it. Under a transitional support package, practices were being offered up to $1000 to install the system and 18 cents for each Medicare claim processed via Easyclaim. The incentives ended on 31 December, but the number of claims being processed via Easyclaim has continued to climb. During March 2010, 8490 healthcare providers transmitted a patient claim via Medicare Easyclaim compared with 7684 providers in December 2009. James Bishop, practice manager at the Longevity Medical Centre in Victoria, ...
MEDICARE has come under fire from a Queensland Senator for attempting to “downplay” a system error that could have affected up to 22,000 patient records. The accusations come after it emerged that a glitch in Medicare’s online patient verification system potentially caused patient records at 2700 GP practices to be incorrectly updated. Test results, it has been revealed, may not have been matched to the correct patient record. Medicare is writing to practices potentially affected. A Medicare spokesperson said most practices would not have to check more than five patient records, however a small number might have ...
The Federal Government has again come under fire for its controversial GP super clinics initiative, after the announcement of the winning bid for the $10 million Wanneroo super clinic. Following direct negotiation with the Government, Perth’s Edith Cowan University will be charged with establishing the super clinic. But the local division says it will not improve access to GP services. The university does not have a medical school, but offers courses for nurses and nurse practitioners. Osborne GP Network chair Professor Alistair Vickery said the agreement would see Government-backed clinics set up in competition to local ...
GROWING discontent over a lack of transparency in the Medicare and Professional Services Review systems has led a group of GPs to take unprecedented measures to highlight their concerns. GPs participating in a national Internet mailgroup community have signalled their intent to decrease their bulk-billing rates and, in some cases, to stop assigning MBS item numbers to their consultations. The move comes after members’ continued frustration over securing a definitive description of a Level C consultation, that they could be assured would be accepted by both Medicare and the PSR ( MO , 2 April). Recent ...
Can you identify a doctor shopper? And what are your obligations when it comes to prescribing drugs of addiction? Caroline Brettingham-Moore asks the experts.
Can you identify a doctor shopper? And what are your obligations when it comes to prescribing drugs of addiction? Caroline Brettingham-Moore asks the experts.
THE Rudd Government has been handed its second double-dissolution trigger after the contentious private health insurance Bill was defeated in the Senate for a second time. The Fairer Private Health Insurance Incentives (Medicare Levy Surcharge) Bill 2009 aimed to introduce means-testing for the 30% private health insurance rebate, and reduce it for individuals earning more than $75,000 a year and couples earning more than $150,000 a year. Under the plan, the wealthier would also be hit with a higher Medicare levy surcharge if they opted out of private cover. The changes were expected to reap the ...
Government efforts to clarify Level C and D item descriptors appear to have failed according to an MO poll, with less than a third of GPs saying they felt adequately informed of MBS changes due to take effect on 1 May. Half of the 150 GPs surveyed by Cegedim Strategic Data on behalf of Medical Observer said they did not feel they had been given enough information or time to consider how the new descriptors for C and D items will impact on their practice. The results reflect ongoing confusion among GPs over claiming ...
MEDICAL defence organisations have voiced fears that doctors may have just 24 hours to register with the new national medical board when it begins taking registrations on 30 September. As part of the national registration and accreditation scheme, doctors will need to register with the new Medical Board of Australia. But while the board will give doctors a 28-day grace period before considering them unregistered, Medicare has not yet agreed to such an extension. According to Avant legal manager Helen Turnbull, Medicare might consider doctors unregistered the day after, leaving them unable to access the MBS. ...
GPs were last week hamstrung in their efforts to care for patients, after the Medicare authority prescription line shut down for nearly three days. Doctors attempting to access the line say they were met with delays of up to five minutes only to be advised the service was down and to call back later. Sydney GP and Doctors Action president Dr Adrian Sheen, who tried repeatedly to access the hotline, said he was forced to ask a patient to return the next day to collect a prescription. “I had to tell the patient it will either ...
IN a rare role reversal, GPs who have undergone a Medicare audit will soon have the opportunity to provide an honest opinion on the “fairness and professionalism” of the organisation’s personnel and procedures. Beginning this month, Medicare will mail out a compliance activity survey to a sample of health professionals who have recently come under scrutiny. Findings from the survey – which can be completed anonymously – will be used to inform the training and development of compliance officers, and the continual improvement of auditing processes. However, in a move that has drawn criticism from the profession, ...
GP bulk-billing rates fell by a whole per cent in the last quarter, according to the latest Medicare statistics, and are now sitting at 78.8 per cent. Despite the significant drop, however, GP bulk-billing rates are still sitting 0.2% higher than the same period last year, and 0.8% higher than the same period in 2007. According to Dr Rod Pearce, chair of the AMA council of general practice, the drop was a reflection of the Federal Government’s ongoing failure to invest in grassroots general practice. “If the Government does not invest in the average GP practices, ...
INTERNATIONAL medical graduates (IMGs) have called for an independent inquiry into the RACGP’s role in assessing their qualifications amid accusations of inconsistencies in college assessment processes. The request follows the recent publicity over the case of ACT-based Canadian IMG Dr Susan Douglas, who had her pre-1992 qualifications rejected for fellowship by the college and has since had her Medicare provider number revoked for failing to attain her FRACGP. The RACGP only recognises Canadian family medicine qualifications completed from 1992 as being equivalent to FRACGP. However, the Australian Doctors Trained Overseas Association and Dr Douglas, who completed ...
THE head of the National Health and Hospitals Reform Commission has defended proposals to introduce a social insurance system against critics who claim such a move would weaken Medicare. The proposed Medicare Select initiative hands the Government the ability to reduce Medicare benefits, effectively creating a two-tier health system, according to a new discussion paper from independent think-tank The Centre for Policy Development. Under the Medicare Select proposal, all Australians would sign up to one of a range of health and hospital plans, run by the Government or private organisations. Each plan would receive Commonwealth funding ...
AN IMG who gained national media attention after her Medicare provider number was revoked has been told she may regain access to MBS rebates. Canadian Dr Susan Douglas, a GP working in a designated area of need and also a senior lecturer in general practice at ANU, recently had her provider number cancelled due to an expired visa, despite having attained residency in August 2008 ( MO , online, 9 October ). Dr Douglas complained to Medicare that she had not been informed of the requirements for IMG permanent residents to claim MBS rebates. She told ...
THE added cost of meeting Medicare Australia’s new compliance auditing processes, and the uncertainty it poses to income streams, will force GPs to raise their fees or consider dumping bulk-billing altogether, experts have warned. AMA vice-president Dr Steve Hambleton criticised the burden that the pending expansion of Medicare’s compliance powers would place on practices, saying doctors might turn their backs on bulk-billing in response. The warning follows the recent introduction to Federal Parliament of legislation allowing Medicare to fine providers who make incorrect or fraudulent claims dating back two years ( Medical Observer , 25 September ...
NEARLY one in four GPs has made incorrect Medicare claims for nurse items, according to Medicare Australia, which has announced it will scrutinise this area in the coming year. Care plans for patients with only one or no prior visits will also be brought under the microscope, it says, with more audits planned to target these items. Releasing the National Compliance Program 2009-2010, a spokesperson said 23% of doctors contacted through Medicare Australia’s auditing program had lodged incorrect claims on nurse items. But AMA council of general practice chair Dr Rod Pearce (pictured) said GPs had ...
Is choosing the most efficient electronic claiming option easier than it looks? Leigh Parry reports. ELECTRONIC claiming – or point-of-care rebating – is here to stay, but Easyclaim remains a hard sell for the Federal Government. Around 80% of all GP services in 2008-09 – both bulk-billing and patients claiming the rebate – were processed electronically, according to Medicare Australia statistics. However, of that 80%, 76% were made through Medicare Online and just 4% through Easyclaim, which allows practices to refund rebates directly to patients’ bank accounts via EFTPOS. Easyclaim has come under ...
PRICE hikes on cigarettes and alcohol to improve population health have won broad support from the medical profession, but GP groups and academics say doctors will need far more support to take on preventive health. Released just one day after the draft National Primary Health Care Strategy , the 307-page National Preventative Health Strategy outlines a series of measures to tackle illness associated with obesity, alcohol and smoking. While much of the strategy focuses on population-wide health measures, GPs have also been asked to take a greater role in preventive ...
BULK-BILLING rates hit their highest point ever in the past financial year, now standing at 73.9 per cent of all Medicare services. According to the latest figures, this represents an increase of 0.5% compared to the 2007/08 financial year. In the June quarter of 2009, bulk-billing rates for non-referred GP attendances stood at 78.9 per cent, an increase of 0.6% when compared with the same period last year. All states and territories reported varying increases in bulk-billing rates for GP attendances, except for NSW where the rate remained stable at 84.8 per cent. The biggest increase was ...
THE Federal Government is paying GPs less than a fifth of what it costs practices to install and operate the Medicare Easyclaim system and frustrated doctors say it’s time to redress the disparity. While practices are being paid just 18 cents for each Medicare claim processed via the Easyclaim system, the Australian Association of Practice Managers (AAPM) estimates the true cost of the task is at least five times higher. “Two minutes is the minimum amount of time it would take [to process a claim],” said AAPM president Marina Fulcher. “If you are paying staff around ...
EXPERTS have welcomed the release of draft proposals for patient and professional identifier numbers, but have argued key information is missing from the government plan. Released by the Australian Health Ministers’ Advisory Council, the proposals outline the creation of 16-digit identifiers for each individual, healthcare professional and healthcare organisation in the country. The system, developed by the National E-health Transition Authority (NEHTA), has been lauded by the authority and the Federal Government as a means to improve patient care and reduce preventable errors, such as incorrect prescribing. The Government plans to roll out the identifiers – ...
AS Medicare Australia begins scrutinising nearly 200 allied health professionals as part of its ramped-up auditing activities, the Federal Government has flagged new plans to have them answer to the Professional Services Review (PSR) as well. Podiatrists, physiotherapists, chiropractors and dietitians are among those earmarked for audits, which will examine MBS services provided between February and August last year. Only a limited number of allied health professionals can currently be referred to the PSR; however, legislative changes will see the body able to peer-review all allied health professionals with access enhanced primary care item rebates. A ...
How are GPs coping? Helen Signy finds out. WINTER 2009: surgeries are flooded with patients thinking they have swine flu, the global financial crisis is making practice management more challenging, and the Government’s plans for primary care are leaving GPs feeling uncertain and undervalued. If you’re feeling more stressed than ever, you’re not alone. The MO Stress Test , an exclusive Medical Observer survey of nearly 500 GPs conducted by Julie Dang & Associates, found more than 50% reported worrying stress levels, with 4% saying their stress was unmanageable. And things ...
GPs have renewed calls for specialists to be brought under the same level of scrutiny as general practice through fairer targeting of Medicare audits across the health professions. AMA council of general practice chair Dr Rod Pearce said despite Medicare’s efforts to introduce such parity, GPs were still disproportionately audited and subsequently referred to the Professional Services Review (PSR). A 2007 review of the PSR found that fewer than 5% of all practitioners referred to the body between 1999 and 2007 were specialists ( MO , 5 October 2007 ), despite the fact that they accounted ...
THE Federal Government has missed its 1 July deadline to introduce a simplified MBS intended to ease the burden of red tape on GPs. Promised in the lead-up to the 2007 federal election and announced in December last year, the simplified schedule was to clarify Level C and D item descriptors, and streamline item numbers for health checks and chronic disease management. However, a spokesperson for Federal Health Minister Nicola Roxon last week confirmed GPs would have to wait for the changes, which were still being considered by the Government. The delay has drawn fire from ...
Doctors’ arrangements with pathology and imaging providers are under new scrutiny, but how can you avoid the Medicare microscope? Mandy Bryan reports. DESPITE the introduction of tough new laws last year aimed at deterring doctors from developing unhealthy financial relationships with pathology and diagnostic service providers, Medicare Australia thinks doctors may be putting their hip pocket first when deciding where to refer their patients. It’s launched yet another investigation into claiming data – this time trying to identify “possible referral relationships” between doctors and providers which could indicate that the doctor’s desire for a healthy ...
DESPITE losing their battle to protect patient records from the eyes of government officials, doctors have vowed to continue their push for a transparent system of Medicare compliance audits. The promise from new AMA president Dr Andrew Pesce follows the completion of a Senate inquiry into Medicare’s increased compliance auditing activities. The inquiry recommended that the legislation to grant officials the authority to access patient records be passed. Former Human Services Minister Senator Joe Ludwig recently told doctors at the AMA’s national conference the controversial new powers were needed to close a “loophole” that allowed doctors to ...
DOCTORS are contemplating new ways to help their patients meet the financial burden of healthcare, a new MO poll has revealed, however experts are warning there could be unintended consequences of their altruism. A national poll revealed that beyond increasing their bulk-billing rates, 41% of GPs would be seeking more affordable specialists for patient referrals, and 33% said they would cut back on optional pathology tests, such as liquid-based cytology. The poll also showed that 19% of GPs would increase telephone or email consultations for simple matters, while 15% would be rethinking the number of ...
AS the number of patients turning to GPs for mental health care hits record highs, experts have warned mental health services will struggle to cope with increased demand in the wake of the global financial crisis. Recently released Medicare data has revealed claims for GP mental health plans and one-off GP mental health consultations for the first quarter of this year are up nearly 35% when compared to the same period last year – an increase of nearly 90,000. The figures come as a Medical Observer poll reveals 91% of GPs believe the economic crisis ...
MEDICARE has pledged to destroy any sensitive patient data obtained under new measures granting it access to records for the purposes of compliance auditing processes. The clarification from Medicare follows the recent release of draft legislation, which the AMA maintains could compromise patient privacy. Medicare Australia’s program review division general manager Colin Bridge told Medical Observer that extracts from clinical records would be required only “in cases where the veracity of claims cannot be confirmed by reference to other records”. “Upon completion of the compliance activity all copies of documents will be destroyed as ...
RURAL groups have called for the establishment of a rural health research institute to shape a strategic approach to redesigning men’s health policy. In a submission to the Senate Select Committee on Men’s Health, the National Rural Health Alliance listed limited access and reluctance to use Medicare – particularly mental health services – as significant contributors to higher male death rates in rural Australia. The alliance of peak rural health organisations called for a new rural health institute to investigate “barriers to men better managing their own health and to seeking help” as part of a longitudinal ...
GPs are about to face even more scrutiny from the Professional Services Review (PSR), with the body now predicting it will quadruple the annual number of doctors targeted. The revelation comes with the release of the PSR’s annual Report to the Professions . Fifty cases were reviewed in 2007-08 – nearly double the number reviewed the previous financial year – and this is expected to double again on the back of ramped-up Medicare audits. PSR director Dr Tony Webber told MO that during this financial year, the body had already been asked to examine ...
THE controversial Healthy Kids Checks program is once again under fire from GPs and child health experts, despite being on track to meet annual government targets. Medicare data revealed that 23,520 checks had been conducted to date – representing just 9% of the estimated 260,000 four year olds in Australia. Launched in July last year, the checks (MBS items 709 and 711) include GP or nurse-administered health checks for four year olds. The government committed $25.6 million over four years to the program, setting an annual screening target of 10% of all eligible children. However, ...
Will contracting out EPC cost patients? Dr Ginni Mansberg reports. A QUICK glance at Medicare statistics shows that Enhanced Primary Care (EPC) is a good earner for doctors. In the 2007-08 financial year, more than 2.5 million EPC items were billed from Medicare at a total cost of $290 million. No wonder entrepreneurial business people are starting to line up for a slice of the pie. One business poised to get in on the action is the Western Australian-based Revive Clinic group. The clinics are staffed by nurse practitioners, who are registered nurses with ...
THE AMA has launched a scathing attack on the government, accusing it of using red tape to limit health expenditure. In a recent submission to the Productivity Commission review of social and economic infrastructure service regulations, the AMA claimed that, while cutting red tape would free up doctors to see more patients, it would ultimately cost more, and go against the Government’s cost neutrality principles. “[The] Commonwealth Government uses red tape as a blunt rationing mechanism to discourage medical practitioners from providing more services and in some cases actively limiting the number of services [they] can provide ...
NEW fines linked to Medicare’s ramped-up auditing program could provide “perverse incentives” for GPs to pay back MBS rebates without question, the AMA has warned. The association has criticised new compliance measures set to be introduced on 1 July, accusing Medicare of failing to clearly describe the evidence needed to justify billing practices. The new system imposes a 20% fine on top of any amount over $2500 to be repaid to Medicare, however it offers discounted fines for providers who admit fault before and during an audit. AMA council of general practice chair Dr Rod Pearce ...
MEDICARE has unveiled harsh new financial penalties for incorrect bulk-billing practices, including additional fines for doctors ordered to repay claims. The planned changes would add a 20% fine on debts owed to Medicare of more than $2500 and will come into effect from 1 July. However, the new penalties will not be imposed retrospectively. Fines will be halved for providers who admit fault and repay incorrect claims before a Medicare audit. If a provider admits fault during an audit, they will see the penalty reduced by 25 per cent. Under the new system, providers failing ...
A COMBINATION of global financial turmoil and poor government policy could be contributing to the recent drop in the GP bulk-billing rates, experts have suggested. The latest Medicare figures have revealed a 0.5 percentage point decrease in the level of GP bulk-billed services – overall 78.6% of all non-referred GP attendances in the September quarter were bulk-billed, down from 79.1% in the June quarter. The drop further distances the government from the National Health and Hospitals Reform Commission’s proposed benchmark to have 80% of all GP consultations bulk-billed. According to Menzies Foundation fellow and health economist ...
GPs have angrily rejected media accusations they are using after-hours consultations to cheat the Medicare system out of almost $200 million in taxpayer dollars. The allegations came just weeks after Medicare warned that, as of next year, there will be greater scrutiny of “unexplained growth in after-hours items”. A recent article in Sydney’s Daily Telegraph reported a 34% jump in the number of rebates claimed for consults after 8 pm, and went on to suggest doctors had been cashing in on higher after-hours rebates – to the tune of $197 million – by “changing patient ...
A RENEWED bid for higher Medicare rebates for GP spirometry is to be launched as concern mounts that asthma may be overdiagnosed. A Canadian longitudinal study of 496 adults found that about one-third of patients diagnosed with asthma were shown not to have the disease after spirometry testing. Professor Christine Jenkins (pictured), president of the Thoracic Society of Australia and New Zealand (TSANZ), said spirometry was crucial for asthma diagnosis but it was unlikely to be more widely used while reimbursement was inadequate for a test which took at least 20 minutes. Professor Jenkins said the ...
IT is time for GPs to decide who’s the boss. Lately I’ve been sensing a lot of unrest in our specialty, as the health minister starts to hint about the plans afoot in her department. I suspect that this unrest is emerging from a collective feeling of loss of control over our professional destiny. I would have thought that the parlous state of the medical workforce would have had the health minister treating GPs with at least the same gentle consideration as other endangered species like the spot-tailed quoll. Unfortunately, some of her statements are coming across ...
MEDICARE has moved to demystify its claiming processes and services for GPs and other health professionals with a new online learning module. Titled Medicare and You , the module aims to provide information across a range of Medicare claiming platforms, improve the confidence of health professionals in using the MBS, and increase the awareness of associated rules and regulations. The module follows recent controversy over the eligibility of GPs to claim Levels C and D and comes just weeks before Medicare is due to release its latest report on healthcare provider compliance. Still in its ...
MEDICARE could join Google and Microsoft in providing patient-managed online electronic health records, with senior management now looking closely at potential formats. Speaking at the 7th Annual Health Insurance Summit in Sydney last week, Medicare CEO Catherine Argall suggested that patients’ online Medicare accounts – which are already accessible online – could be expanded to include a “quasi-electronic health record”. The account would be events-based, and – like the government’s proposed Healthbook website – would depend on patients granting their GP permission to access the record via a “health professional portal”. While Ms Argall said the ...
THE federal government has softened its hard stance on Medicare claims for Level C and D consultation billing, issuing a new clarification to allay widespread GP anxiety. But questions have been raised as to whether the new advice – drafted in consultation with the AMA – will actually reassure practitioners. A furore erupted earlier this year when Medicare watchdog the Professional Services Review (PSR), in its annual Report to the Professions , warned GPs against billing for longer consultations for patients presenting with multiple unrelated ailments, even if they took longer than 20 minutes ...
Government plans to dramatically increase the number of Medicare audits have GPs worried. Pamela Wilson reports. IF you’ve ever felt the ominous presence of Big Brother scrutinising your every move – that feeling is about to get stronger. Among the flurry of health savings announced in its first Budget, the Rudd government signalled its intention to claw back nearly $150 million through a massive 400% increase in Medicare compliance audits. The audits involve investigating billing patterns to make sure claims match Medicare guidelines. Currently, only 1% of doctors a year are ...
PSR director Dr Tony Webber’s suggestions to practitioners confronted with a patient with a “string of unrelated ailments” call for discussion. He says, “Raise your private fee” (i.e., don’t bulk-bill). Or he suggests telling patients that if they want more than one problem dealt with today, Medicare won’t pay, but come back another day and Medicare will pay. I’m sure Dr Webber is aware that if the patients choose to come back another day, it will ultimately cost Medicare more money for three Level B consults than one Level D, also wasting time. I suspect it will also ...
POLICY changes are urgently required to address the complex healthcare needs of asylum seekers who cannot access subsidised treatment, an Australian study claims. An audit of 1000 consultations in three Melbourne clinics providing medical services to asylum seekers found demand for free services imposed a considerable burden on small community-based organisations and volunteer healthcare professionals, the authors said. They called for the current eligibility criteria for the Asylum Seeker Assistance Scheme to be broadened and the scheme given a significant funding boost, and universal access to Medicare for this population ( MJA 2008;188:344-48 ). Currently, ...
RURAL practices will receive letters from Medicare this month outlining a new $4000 PIP incentive for the provision of domestic violence support services in the bush. The incentive, which will roll out in May, aims to boost general practice as a key referral point for patients needing domestic violence support in rural and remote Australia. Practices in RRMA 3-7 with a practice nurse or Aboriginal health worker who has completed recognised domestic violence training will be eligible. To qualify, free training to help nurses and other health workers recognise the symptoms of domestic violence is available from Lifeline Australia, either as a face-to-face or ...
OUTER-METROPOLITAN and rural areas are missing out on millions of dollars in after-hours grants because urban practices are better resourced to submit stronger applications. A report by the Auditor-General revealed that the bulk of grants handed out under the $62.5 million Round The Clock Medicare scheme were awarded to metropolitan practices based on the quality of applications. However, the scheme was set up by the Howard government in 2004 to offer practices grants of up to $200,000 a year to establish local after-hours services, on a needs basis. The Administering Round the Clock Medicare ...
DOCTORS have snubbed Medicare’s EFTPOS Easyclaim system, according to government data on the scheme’s first eight months of operation. So far just 1123 medical practices (specialist and general practices), have made a total of 355,000 claims through the system since it was introduced in June last year. The number reveals low uptake among the 7356 general practices recorded in a government services report earlier this year. AMA president Dr Rosanna Capolingua, who has campaigned against the system since becoming president last year, said the figures were a case of ‘I told you so’. In its ...