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DOCTORS working for medical deputising companies will be banned from claiming urgent after-hours items— at least if the Federal Government adopts new MBS Review Taskforce recommendations.
The restrictions are designed to curtail the boom in after-hours services— specifically the provision of low-grade care in return for high-level rebates.
But is it good for general practice? Good for patients? Who are the winners?
Given that the proposal is forecast to save the government more than $ 75 million a year, it won’ t be doctors who benefit.
Clearly, the government will welcome the savings and if you want to take the Yes, Minister approach, it will be welcomed by the taskforce itself, which has been trundling on for some two years now.
Taskforce under pressure Given it employs around 450 people, has 17 expert clinical committees and has cost $ 34 million, the taskforce has surely felt the sticky breath of government bean counters. By going for the GP items in the MBS, it shows the taskforce can, at least, pay for itself.
What about the losers? There are obviously the after-hours start-ups, whose financial viability is built on‘ urgent’ after hours claims.
But then there are the IMGs
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and junior doctors contracted by these companies, and let’ s not forget VR GPs. All will be banned from using the lucrative urgent after-hours items if the recommendations are adopted.
Is the RACGP getting what it wants? The college’ s media machine went into action in a big way on this issue.
President Dr Bastian Seidel issued plenty of dark warnings via tabloid newspapers about the risks to patient safety of IMGs and junior doctors doing‘ urgent’ after-hours work.
They are not properly trained, he said. The work could and should only be done by VR GPs and those on the pathway to becoming GPs.
You could argue that the taskforce ignored all this. Its suggested ban hits VR GPs working for deputising services in the same way as IMGs and junior doctors. And the number of VR GPs— including those with college fellowships— is not insignificant.
The taskforce itself says that 27 % of urgent after-hours claims are made by VR GPs and 7 % by GP registrars.
These doctors, still tasked with providing urgent afterhours care, will not have much to celebrate at the news of a drastically reduced rebate. What about patients needing after-hours care? What happens to them?
There is little doubt that, amid the boom time for after
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hours, thousands of patients with relatively trivial problems have been ringing up for a free call out, along with prescription drugs delivered to the door.
There’ s no blame attached to them, as that’ s what the system was offering.
Multiple after-hours visits In May, the health department revealed more than 10,000 patients received multiple urgent after-hours visits between 2014 and 2016 while claiming no normal in-hours GP consults.
Yet the big question is; what will the landscape will look like if urgent item cuts come in?
Yes, it removes incentives for after-hours cowboy operators, but what is the collateral damage for patients?
Will it dent the financial viability of traditional medical deputising services that have been doing the work for GP practices?
It would be comforting to know the taskforce had undertaken a comprehensive examination of the possible future to ensure patients can still access after-hours care when they need it. Alas, it seems it hasn’ t.
It is important to stress that this taskforce recommendation
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is primarily about going after those providers abusing the system, rather than ensuring those who need high-quality after-hours care can access it.
For instance, there is no suggestion of increasing the rebate for urgent after-hours care to encourage more‘ daytime’ GPs to attend to patients at unsociable hours.
So then comes the question, if regular deputising services are badly hit by the inevitable reduction in their revenue, what will fill the void?
It is worth noting that groups like the RACGP and the AMA are describing the taskforce’ s recommendations as the beginning. They believe the government still needs to bolster after-hours care.
But given the recent history of federal health policy development, which has been little short of appalling, you sense that these recommendations could also be the beginning of a big political mess.
Are the taskforce’ s recommendations a done deal? No, but the Minister for Health, Greg Hunt, has already declared he is“ very, very drawn” to what the taskforce is pushing. He is expected to make a decision by Christmas.
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