Australian Doctor Australian Doctor 17th November 2017 | Page 28

Gut Feelings
Finally the ‘big guys’ are facing
rotten tomatoes in the stocks
W
vidual doctor.
Medicare oversees a tenuous finan-
cial arrangement, predicated on trust-
ing tens of thousands of doctors to
select whatever rebate they feel applies
to a private interaction inside a closed
room, and the taxpayer pretty much
pays whatever bill is produced.
This unusual honour system, which
actually works remarkably well, relies
on three layers of scrutiny.
The first of these is scrutiny by the
patient. This is the least robust safe-
guard, particularly where patients are
bulk-billed and tend to have no idea
or interest in what rebates are chosen
for them.
The second layer is the threat of
an audit. Like tax returns, no one is
watching most of the time, but you are
aware that they just might be.
Of course the regulatory punish-
ments have modernised since we used
stocks in the public square, though the
larger audit cases are correspondingly
public and equally uncomfortable.
For the poor sods who merely
stretched the boundaries, we’re all
thinking, ‘there but for the grace of
God go I’. However, the more egre-
gious cheaters threaten the entire
system. Lock the stocks and pass the
rotting tomatoes.
The third, and most important,
layer is self-scrutiny, which relies on
doctors doing the right thing.
Guest
Editorial
Dr Justin
Coleman
28
|
Australian Doctor
HEN it comes to cor-
rectly billing Medicare
items, the buck still
stops with the indi-
|
17 November 2017
Rebate increases may be disappear-
ing faster than MPs with dual citizen-
ship, but most doctors follow the rules
and get on with the job regardless —
it’s in our nature.
Until recently, these three protago-
nists — patient, doctor and regula-
tor — provided all the scrutiny we
needed. Any over-reaching thrust by
one was parried by the other two.
However, a fourth sword has joined
the ‘three scrutineers’ — the corpo-
rates. In its latest review of Medicare
bad thing, but the catch was that the
business model relied on most visits
being billed at the higher ‘urgent’ rate
because not even night-shift doctors
want to drive around town bulk-bill-
ing standard home visits.
Many locums, sold the dream of
lucrative billings by their after-hours
overlords, found themselves stretching
the definition of urgent.
And when the alarm was eventually
sounded, the regulator was unable to
admonish the after-hours service pro-
LIKE TAX RETURNS, NO ONE IS WATCHING
MOST OF THE TIME, BUT YOU ARE AWARE
THAT THEY JUST MIGHT BE.
compliance, the Department of Health
notes it must ‘better address the real-
ity of practices, corporations and hos-
pitals billing on behalf of individual
providers’.
Yes, every doctor is still responsible
for billing, but increasingly some find
themselves delegating this administra-
tive task to their workplace.
After-hours billing is a classic exam-
ple. The system was designed for GPs
who wholeheartedly deserved every
penny for getting out of bed to attend
urgent calls.
However, companies soon realised
they could make money using over-
night locums. This in itself wasn’t a
www.australiandoctor.com.au
viders and instead put only the doctors
in the pillory.
Less in the news than their noctur-
nal counterparts, but also the focus of
this compliance review, are corporate-
owned GP practices.
GPs are still theoretically responsi-
ble for their own billings, but in reality
there has been administrative creep.
As the department of health
explains, “[some] corporations are
either claiming directly on behalf of
the individual provider or significantly
influencing their claiming behaviour.
In a number of compliance cases
[the practice] has claimed benefits on
behalf of health providers without
provider knowledge.” The term ‘aid-
ing and abetting’ springs to mind, and
if tomatoes are to be lobbed, it doesn’t
seem fair to only line up the little guys.
Not that I’m baying for any red
juice here, but the corporates can’t just
keep cheering on the three scrutineers
from the sidelines and expect doctors
to take all the nicks for them.
The final party of interest to the
department of health is state-run
hospitals. Hospital outpatient staff
are kept busy shunting millions from
Medicare’s federal coffers to their
state-funded systems.
I’m not overly bothered by this
redistribution of my taxes. However,
it is irksome that so much GP time
is wasted signing outpatient letters
insisting on a named referral just so a
registrar (who is never named) can see
our patient and the hospital can bend
the rules to breaking point.
This federal-state gaming should
either be allowed under purpose-built
rules or be disallowed.
It’s that simple, and should not
require the collusion of either GPs or
hospital specialists.
At least we’re at no risk of copping
a stab wound for this one in court, but
it’s none too pleasant haemorrhaging
by a thousand paper cuts.
Equitable scrutiny and a fairer
apportion of responsibility?
Yep, this is one Medicare review I’m
almost looking forward to.
Dr Coleman is a GP at Inala
Indigenous Health Service in
Brisbane, Queensland.