Doctors forced out of care for veterans

Dr Phelps said many doctors will have no choice but to leave the RPPS if the Government does not increase fees for all specialist disciplines and for all services provided to veterans in private hospitals and doctors' rooms.

Dr Phelps has written to all Federal MPs and Senators alerting them to the problem in advance of Federal Cabinet examining the issue on 19 August.

"Fees for treating veterans under the RPPS are capped under the Medicare Benefits Scheme (MBS) but have not been properly assessed for around a decade, since the time when all veterans were treated in Repatriation General Hospitals," Dr Phelps said.

"Meanwhile, the Government has progressively increased the number of veterans with Gold Cards and shifted them into the private health care sector.

"The costs of medical practice, however, have increased much more than the MBS, making continued treatment of veterans under the RPPS increasingly non-viable.

"While the Government continues to promote the RPPS to veterans as being equivalent to treatment as a 'private' patient, it is the doctors who are being forced to absorb the high cost of providing this level of specialised care and treatment.

"The reality is that fees for specialists under the RPPS are well below the private medical services market.

"Unless the Government increases the fees to properly reflect the level of service provided, the RPPS will have trouble attracting suitably qualified doctors to look after our veterans," Dr Phelps said.

The AMA has been working closely with the RSL in lobbying the Government over this issue.

CONTACT: John Flannery (02) 6270 5477 / (0419) 494 761

Sarah Crichton (02) 6270 5472 / (0419) 440 076

9 August 2002

Letter to all Federal MPs and Senators

I am writing to seek your urgent assistance to maintain access by veterans to private medical services under the Repatriation Private Patient Scheme (RPPS). The RPPS is administered by the Department of Veterans' Affairs and is promoted to the veteran community by the Government as entitling veterans with Gold Cards access to Specialist medical services as private patients in doctors' rooms and in private hospitals.

Since 1918 the medical profession has worked in partnership with the Repatriation Commission and its predecessors to provide high quality medical services to veterans. The profession has recognised the contribution that veterans have made to the Australian community and has responded accordingly.

Under the RPPS Specialists are expected to provide quality private medical care in their rooms and in private hospitals at rates of remuneration set out in the Commonwealth Medicare Benefits Schedule (CMBS). These fees are significantly less than that paid by privately insured patients in private hospitals for the same care and are often less than that paid to visiting medical staff treating public patients in the public hospital system.

The use of CMBS fees in the RPPS was determined a decade ago when all veterans were treated in Repatriation hospitals. These were large teaching hospitals and visiting medical staff had the support of resident medical officers and registrars. Today the majority of veterans are treated in contracted private hospitals in which the treating Specialist personally provides all the medical care and treatment. In addition, veterans often have multiple co-morbidities which require considerably more effort and attention than other patients in the same private hospitals.

The commercial realities of contemporary medical practice have made continued support for the RPPS by the profession extremely difficult. The Government has allowed the CMBS to lag well behind the escalation in the cost of medical practice, while progressively increasing the number of veterans with the Gold Card and shifting veterans into the private health care sector.

This is impacting on the continued viability of the RPPS, with Specialists expected to treat more veterans as "private" patients at remuneration well below private rates. At the same time the number of privately insured patients seeking Specialist services in private hospitals has increased, creating a further disincentive to treat veterans under the RPPS.

The AMA has been making representations to the Government on this issue for over 12 months, during which a growing number of Specialists have withdrawn from the RPPS. This number is expected to increase in the absence of additional funding for the scheme.

The AMA understands that Federal Cabinet will be considering a submission on the remuneration for Specialists treating veterans under the RPPS on 19 August 2002. The AMA believes it is important you are aware of the medical practice issues associated with the RPPS and that you advocate for the decisions necessary to ensure the Government's promise to veterans of private medical care can continue to be met.

In order to retain the medical profession's support for and participation in the RPPS the Government must ensure that:

• Remuneration under the RPPS is increased for all Specialists, including physicians, psychiatrists and surgeons, to a level that reflects the commercial realities of contemporary medical practice, the actual fees paid by privately insured patients for Specialist medical services and the high quality of private medical care provided to veterans;

• Remuneration for medical services provided outside of hospitals in doctors' private rooms and other facilities is also increased for all medical disciplines;

• An adjustment mechanism for specialist remuneration under the RPPS is introduced, based on a mutually acceptable and contemporary index that reflects the movements in the cost of medical practice; and

• Further discussions between the AMA and the Government are held on the remuneration proposed under the RPPS, with the aim of reaching a mutually acceptable outcome that will ensure the continued participation of all Specialist groups in the RPPS.

The AMA is keen to continue its support for veterans' access to private medical care in recognition of their service to the Australian community. However, the medical profession is unable to continue to subsidise the RPPS to the extent it has to date. The Government must accept its responsibility to adequately fund veterans' medical services if the RPPS is to continue.dical practice, the actual fees paid by privately insured patients for Specialist medical services and the high quality of private medical care provided to veterans;

I trust that above clarifies the AMA's views at this critically important time for veterans' health services and would appreciate any assistance you may be able to provide on this issue.

Yours sincerely

Dr Kerryn Phelps

President