Dr Pesce discusses diabetes policy at a doorstop press conference

Subjects:    Voluntary enrolment policy for patients with diabetes

ANDREW PESCE:    Okay, thanks ladies and gentlemen.  I've come here today to talk about the Government's announcements of reform in the area of chronic disease management for diabetes.  First off all, the AMA welcomes the acknowledgement of the Government that the current funding for general practice to look after these chronic and complex patients leaves a lot to be desired.

But, unfortunately, this announcement today reflects a process where there has been a decision made without any significant consultation, and no consultation with the AMA or other general practice groups.

The AMA has indicated a willingness to constructively engage with the Government in the health reform agenda.  We've made it clear that we don't want to block health reform, but this is policy on the run.

It's a top-down announcement without consultation with the doctors that provide the health services.  And as a result, we see a lot of problems with it.

REPORTER:    Will it help patients, though?

ANDREW PESCE:    It's difficult to see how it's going to help patients.  I mean, what are the key messages?  The key messages are that patients are going to be encouraged to forego their Medicare benefits and entitlements to Medicare services in return for signing up for care supplied out of a practice.

They don't have the option of signing up with a nominated GP, and the vast majority of patients really value their relationship with their family doctor.  And we have difficulty knowing how foregoing Medicare entitlements for health care is going to interact with this block funding approach.  When the money runs out - how are you going to get health care for services that you need?

QUESTION:    Is this an attempt to soften up the Premiers for the funding arrangements…

ANDREW PESCE:    Well, perhaps it is.  And in that case, you know, I'm a bit worried that, you know, primary health care reform should be focusing on improving primary health care.  It shouldn't be seen as part of a strategy to get the

Premiers on side by saying - well, we'll have less admissions to your public hospitals.

QUESTION:    The $1200, how does that compare with what a GP would be billing Medicare at the moment for an average diabetes patient?

ANDREW PESCE:    Look, it's very difficult to know the answer to that question. Diabetes patients range from those with mild diabetes to those with very very severe diabetes, and obviously the Government is working on the principle that there are going to be swings and roundabouts.

But when you are relying on swings and roundabouts, you want to make sure that they end up in the right spot.  And there has been no consultation with the groups to ensure that this plan has merit - and is going to achieve the outcomes which are desired.

QUESTION:    So Dr Pesce, do you doubt the Government's claim that this was recommended, this policy was recommended by both the National Health and Hospitals Reform Commission and the draft national primary care strategy.

ANDREW PESCE:    There are elements of this plan which are mentioned in those documents. The National Health and Hospitals Reform Commission did say there was an argument for a mix of payments between the capped payment system in this model and Medicare Benefits Schedule payments as well.

As I said, without consultation we don't know exactly what the Government's planning, but it seems to move well beyond those recommendations.

QUESTION:    Why wouldn't they consult you? After all, they've been fairly close to you in the - in this whole general area.

ANDREW PESCE:    Yeah, I think people have picked up that the AMA has really wanted to support the reform agenda.  We haven't set ourselves up to block it, to be naysayers.

So I can't answer that question.  I'm personally disappointed that there hasn't been consultation about this.  And we hope that the Government doesn't repeat this as more of its health care reform strategy is rolled out.

QUESTION:    Broadly speaking, is $1200 going to be marked to service the average diabetes patient.  Once they have exhausted their $1200, what would happen to the services that they require?

ANDREW PESCE:    Well I really don't know the answer to that. Perhaps they're going to have to go to another practice and get funding outside their agreed package.  Look, we don't know enough of the detail of this.  And I guess this is one of the problems - that the Prime Minister has just told us he spent 12 months going around the country to hospitals, hearing how bad things have got - because hospital management stopped listening to doctors.  And now we're seeing the first example of where the Government's policy in general practice is being determined in the same way - without consultation with the doctors that have to provide the services.

QUESTION:    Is this also an Americanisation of the system?  I mean, if you're - if you've got a system where you're buying services outside of the Medicare system, it's a bit like the GMO systems in America, which is one of the reasons why Barack Obama is trying to bring it down.

ANDREW PESCE:    Yeah.  There's no doubt this is a significant recasting of the way that general practice services will be delivered.  There may be room for change, but it has to be done very carefully, in consultation with the doctors themselves who are delivering the services.

QUESTION:    Dr Pesce, can you assure us that your concerns are more to do with patient care, than doctor's incomes?

ANDREW PESCE:    Oh, absolutely.  I mean the feedback we're getting from our surveys - and I'm sure the Government's getting the same feedback from their surveys with patients - is over 80 per cent of patients really value the relationship with their family doctor. This proposal potentially undermines that relationship.

We do want quality outcomes for our patients.  Doctors will make a living - doctors in hospitals make a living.  I'm a hospital doctor, but I can feel for my general practitioner colleagues, who I think are getting changes imposed on them, without consultation, which reminds me very much of what happened to me in the last few years in the public hospital system.

QUESTION:    If the Government persists with this plan, does that alter your support for the overall reform agenda?

ANDREW PESCE:    Look we're always more interested in engaging positively with the Government.  The Government has indicated that it wants to consult on the detail of the implementation, and so we will engage with that.  Now we still understand that our health system needs reform.  We will continue to work with the Government to make sure that reform occurs in the right directions.

QUESTION:    This announcement seems to be about relieving pressure on the hospital system. Won't it do that?

ANDREW PESCE:    There's no guarantees it will do that.  We haven't got any detail of how it's going to achieve that.  It's a stated intention.  It's a sweetener to the Premiers and, as someone pointed out, I'm worried that this announcement has got more to do with getting an agreement from the Premiers on public hospital funding, rather than improving care for our diabetic patients.

QUESTION:    Why would it undermine the relationship between the doctor and the patient? Isn't it about enhancing that relationship by making - linking them to one clinic and potentially one doctor?

ANDREW PESCE:    Well the problem with that is that general practices are being organised in very many different ways.  So sure, if it's a small practice with two or three principal GPs it won't.  But increasingly general practice is being delivered in larger practices with corporate owners.  They have an eye on the bottom line.  If they see a potential to increase their profitability by fragmenting care in the lowest cost denominator provider, that has a great potential to undermine that ongoing continuous relationship between a patient and their preferred family doctor.

QUESTION:    Do you think it could also have the impact of doctors picking and choosing who they have as patients if they know that someone with a chronic health condition would be a drain on their budget?

ANDREW PESCE:    Well there's no doubt and people ask what happens if the money runs out when you're treating a patient.

Well, you'll have to refer that patient off to a specialist, an endocrinologist, to look after their diabetes.  You'll have to break that commitment to the care of the patient because there's no funding left for it.

QUESTION:    So your understanding is that diabetes patients who sign up to this plan won't get access to any Medicare Benefits for that treatment.

ANDREW PESCE:    Our understanding is that for their condition management, the practice can no longer charge Medicare Benefits for other treatment that's required for the treatment of that condition.  The only payment that they can adopt is one or the other.

QUESTION:    Jeff Kennett has said that he doesn't think the Opposition should accept the Government's hospital reform plan, saying that the diversion of GST funds would cripple the States.

ANDREW PESCE:    Look, I'm not an expert on tax, GST, and I don't think the AMA can get involved in the percentages of GST which are a fair swap for the reform process.

The AMA is very, very interested to see the public hospital reform takes place.  We believe that a single funder enhances the prospects for meaningful reform and improvement of our public hospital services.  The agreement between the States and the Commonwealth on how the GST is divided up in return for that is something that I can't comment on.

QUESTION:    Aren't you guys just cherrypicking what parts of the health reform debate you like.  I mean, you're saying we need hospital reform, but as soon as someone talks about GP reform you go, oh, it's all too much.

ANDREW PESCE:    We haven't said it's all too much.  What we've said is we want to be consulted.  We haven't had that consultation.  I hope the Government learns from this, that if it wants to reform the system it should consult with us before it announces what changes are going to be made.

So no, we're not cherry picking.  We want to be involved in all the decisions.

QUESTION:    When were you told about this?

ANDREW PESCE:    I got a phone call at about 11 o'clock last night from my CEO.

31 March 2010

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