GP Network News, Issue 13 Number 6

AMA Calls for an end to the Public Hospital Funding Blame Game

Today AMA President, Dr Steve Hambleton, released the AMA Public Hospital Report Card 2013. The report highlights that the Australian public hospital system does not have the capacity to meet the clinical demands being placed upon it.

In launching the report card, Dr Hambleton said the clear message is that no Government should be reducing its public hospital funding at this time, for any reason. The AMA calls on all Governments to stop the blame game and work together to maximise the effectiveness of every health dollar in providing quality care for patients.

Key findings from the report that will be of interest to GPs include:

• the number of hospital beds per capita is static;
• there has been no change in capacity of public hospitals to admit patients to wards from emergency departments more quickly, or to perform more elective surgeries;
• the number of public hospital elective surgeries performed in 2011-12 across Australia was 661, 707. This was an increase of around 5.5 per cent over the number of elective surgery admissions in 2010-11 (627,184);
• 2.7 per cent (17,866) of the patients admitted for elective surgery in 2011-12 waited for more than a year for their elective surgery;
• while an estimated 81 per cent of category 2 elective surgery patients (those who should be admitted within 90 days) were admitted on time, this is well below the new performance benchmark of 100 per cent set by COAG; and
• median waiting times for elective surgery have substantially deteriorated over time. In 2011-12, the median waiting time was 36 days, no change from the previous year. Ten years ago, the median waiting time was only 27 days.

Click here to view the full media release and to download the AMA Public Hospital Report Card 2013.

AMA Calls For Better Funding Model For Medical Teaching and Training

The AMA is calling on the Independent Hospital Pricing Authority (IHPA) to heed the expert advice of the AMA and other stakeholders as it develops, over the next five years, a new model of activity based funding (ABF) for medical research and training in Australia.

AMA Vice President, Professor Geoffrey Dobb, said that current funding arrangements do not adequately reflect the costs of teaching and training and that more needs to be done to encourage and support this critical activity in our public hospital system.

The AMA has provided IHPA with comprehensive funding recommendations that came out of a high level meeting of seventeen representatives from thirteen organisations involved in medical education and training, convened by the AMA in October 2012.

GPs will be particularly interested to note that participants at the meeting agreed it is essential that any funding model does not create disincentives to train in settings beyond public hospitals, and should not undermine other funding or training models.

The meeting produced an agreed set of Objectives and Principles which is at http://goo.gl/6xlmR, and a summary of outcomes at http://goo.gl/El2nl. IHPA has been provided with both these documents.

Click here for the full media release.

Byte from BEACH: Measuring the impact of pay-for-performance in general practice

The latest Byte from the Bettering the Evaluation and Care of Health (BEACH) program comments on a recent article by Jessica Greene of George Washington University, titled ‘An examination of Pay-for-Performance in general practice in Australia’, which reports on the effectiveness of the PIP program in improving care provided by GPs for asthma, diabetes and cervical screening. The article found no significant link between the 2001 initiative and health outcomes ten years later.

BEACH explains how one of the diabetes testing outcome measures used renders the study invalid. BEACH highlights how the ‘coning’ of tests, with only the three most expensive tests in a referral able to be claimed, means that not all the tests a GP orders can be counted via Medicare claims.

Data presented by BEACH demonstrates that testing for HBA1c and microalbumin has increased since 2001 when the PIP incentives to support GP management of diabetes were introduced. BEACH states that ‘this article provides an example of the need to have a solid understanding of the limitations of administrative data collection systems such as Medicare claims before using the data as a measure of effectiveness of a Government intervention’.

Click here to view the BEACH report.

Voluntary Patient Registration – What Do You Think?

There has been growing interest in the concept of voluntary patient registration in recent months, with a number of articles appearing in the medical press that have generated comments indicating that GPs are yet to be convinced of the benefits of such an arrangement. The AMA Council of General Practice Executive will consider this issue at its upcoming Policy Day meeting, including a number of alternative ways to link GPs and patients. The AMA Council of General Practice would welcome the views of members on this topical issue. Send your comments to gpnn@ama.com.au

Protecting your Provider Number

GPs are reminded to be aware of the potential for fraud arising from the misuse of their Medicare provider numbers. Third party Medicare provider number fraud is very serious, particularly because of its potential to affect a medical practitioner's Medicare profile.

Providers need to ensure that their provider numbers are protected within their own practices. The risk of fraud can be reduced by:

• applying good record-keeping practices, including provision for security and storage of records;
• using features of practice management software. This can include using individual passwords to track changes to records and talking to software providers about the features of the software that can help to manage records more efficiently;
• keeping software current by uploading the most current version of the product used and becoming familiar with new features - especially security updates;
• reviewing the operational guidelines of the practice, keeping them up to date and making sure that staff are aware of their compliance obligations;
• reporting any suspected cases of fraudulent activity; and
• informing Medicare Australia when they leave the practice so that their provider number can be closed for that location.

If GPs allow a third party to use their provider number for billing purposes the GP must understand that they are legally responsible for the services requested or provided under Medicare against that number. If Medicare services are billed incorrectly the GP will be liable to repay any benefits paid in excess of what should have been paid.

To guard against this GPs should:

• understand the billing practices of the entity billing on their behalf, i.e. using their provider number; and
• get a full record regularly of all Medicare claims raised in their name and check that items billed are appropriate for the service provided.
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