Sunday, May 29, 2011

SSWAHS = SWSLHD + SLHD and the Medicare Locals - 48

Work with us on Medicare Locals, Roxon tells AMA

27th May 2011 - Medical Observer
Mark O’Brien   all articles by this author
HEALTH Minister Nicola Roxon has urged incoming AMA president Dr Steve Hambleton to work with the Government on Medicare Locals and defended the “sensible recalibration” of rebates for GP mental health plans, in a speech to the association’s national conference in Brisbane today.

Ms Roxon urged Dr Hambleton to “stay inside the tent” when it came to discussing Medicare Locals, following ongoing criticisms from the AMA of the rollout of the organisations.

The AMA has called for the rollout to be put on hold until the exact functions Medicare Locals will have are made clearer and GP leadership within their governance structures is assured.
“My message to the AMA, and in particular to Steve as your new president, is to work with us on these changes,” Ms Roxon said.
“Ultimately, as a new president, the choice of how we engage is yours. But my suggestion to you is this: if you’re not sure you like what you see, come and talk to us about it.”

In response, outgoing AMA president Dr Andrew Pesce said the remaining “lack of detail” about the Medicare Locals was “disturbing”, and pledged that the association would maintain its pressure on the Government.
“The Government’s proposal to roll out Medicare Locals is the next big challenge of the AMA,” he told the conference, adding that he was “confident the Government will have to revaluate its position”.
Ms Roxon, meanwhile, defended the recently announced rebate cuts for GP mental health plans outlined in the Federal Budget, saying they were “based on good data and sound reasoning”. ('Calls for mental health rebate cuts to be reversed,'MO, 24 May)
“They are a sensible recalibration of the rebates which GPs receive, designed to better reflect time spent by GPs and bring them in line with other time-based Medicare items – while, importantly, maintaining a premium if GPs have undertaken mental health skills training,” she said.

Ms Roxon said the AMA’s pre-Budget request for $20 billion in health spending without proposing any savings was not sustainable.
“There is an endless range of areas where you can invest to do good in health – but not a bottomless bucket of money with which to do that,” she said.

Later, while answering questions from conference delegates, Shadow Health Minister Peter Dutton said a Coalition government would ensure Medicare Locals did not become fund-holding organisations, pledging that their funding would be returned to GPs.

stevekth
27th May 2011
5:05pm
Ms Roxon- your slash-and-burn policy towards the better access / mental health care planning process is both short-sighted and inflammatory to a profession already struggling to meet demand, especially in poorly doctored and often realtively poor, bulk bill-dependent communities. Your slashing of the rebate is not sensible. Maybe for your departmental purse strings, but neither for policy in this area nor for bringing GPs on side with your policies. Recalibration? No. Decimation, maybe. Better reflect time spent? How convenient, when the rebates for the other attendance items are frankly insulting and belong at a standard of living comparative rate in the last millenium. This is also in effect dumbing this vital area of our work down. You require us to undergo training to do this work, and then barely either reward or reasonably renumerate us for having done that work. All that this will do for many GPs is encourage them to charge a significant gap fee, or eschew this work altogether. Most of us are already so overbooked we would do better to see our much briefer level B type consult patients who wouldn't otherwise get an appointment. It is no secret that many GPs could see three level B consults in the time it takes for a Level C consult- and for much better net renumeration. What message are you and the pre-existing pegging of rebates for level B and C consults sending? Patients have a need for your help. You are not helping us to provide that help. Premium being maintained? Or derisory incentive to develop and maintain our skills and provide extra time for relatively less renumeration; derisory uplift when considering the extra paperwork, secretarial time, ink, paper, and often telephone calls and correspondence that goes with doing these plans? I and my colleagues are passionate about our patients. I believe strongly in continuity of care and in holistic services for my patients. But YOU are helping to make that not sustainable for me. YOU are decreasing the reasonable renumeration for my time, skills and experience- and all in a world of endless need, when I must decide how I use my time best for patients, maintain an income, support my family, employ staff and run a business, on a background of ever decreasing relative worth of the Medicare rebate system... how am I supposed to be able either to prioritise this work (which was the whole point of the scheme that you recently lauded as successful) or offer to do it at bulk-billing rates? And how is the local community mental health structure meant to manage the undoubted increase in referrals through to them from GPs unable to do this work now for as many patients as they did before? A depressing move indeed, and one which patients themselves need to be advised of- the Government has slashed funding to support GPs in doing this work for them, and is not willing to support our provision of bulk-billing for these services. This is not our fault, although Ms Roxon would paint it as so- and I say to her, my suggestion to you is this: you can't put lipstick on this particular pig, Ms Roxon. You have revealed what our Profession is worth to you, and how you intend to 'reward' us for our work and incentivise us to go that extra mile and to help the community health system.
skindoc4
27th May 2011
5:41pm
Don't bulk bill!!!!!! Duh!
stevekth
27th May 2011
6:00pm
then not only do we have the pressure of patients not being able to afford appointments (the vast majority locally are HCC holders or pensioners, so we would have to bill them) but then we have the expectation of 'I'm paying, so I need longer than the booked time for my problems which I've saved up' or 'I don't have to pay- it's a follow up'... and my point is that the Govt wants us to bulk bill. I am trying to maintain that. Nixon needs to understand that. Isn't that obvious? Duh! right back atchya
tvkdas
27th May 2011
6:42pm
Fair points by both skindoc4 and stevekth - I do agree with these sentiments, might I suggest a new notice for the patient notice board "As a result of the Federal Government Budget of Julia Gillard and as endorsed by Nicola Roxon, Mental Health Treatment Plans will now incur a fee of $160. Your entitlement to the full rebate has been slashed by the government. We encourage you to voice your concerns to the local member."
stevekth
27th May 2011
6:58pm
I don't think that I have much option. But you understand my motives- it will inevitably come back to accusations of greed, and the fundamental patient misunderstanding about rebate versus recommended fee for a consult. Especially uncomfortable around HCC and Pension holders. I think that I am going to have to go mixed billing for these things, care plans, etc. I already have stopped joint injections and use a bulk-bill local radiology outfit. Ears syringing also has no rebate, and I am advised by Medicare now that (a) removal of sutures placed at hospital but sent to us for removal has already been paid for by Medicare to the hospital, hence we are NOT entitled to claim a 10996 (or where done by another GP, irrespective of the time elapsed), and (b) 16500 can not be used when pregnancy is diagnosed, and where a patient attends for their antenatal related issue, eg. for a scan or bloods or results or BP monitoring, or pregnancy-related issues, the 16500 covers everything, even totally unrelated script requests, a cough or cold, etc- totally unrelated to the pregnancy- and 16500 can't be co-claimed with other attendance items (which I am aware is contrary to what had been thought by many GPs previously)- and, more outrageously, a 36 can't be used if the patient comes in for a pregnancy test or follow-up and other issues and it goes beyond 20mins and is complex- just a 16500! This came direct from e-mailing the Medicare resolution centre, given that the Provider hotline is useless, just reading out what is already on the internet for item descriptors. Also dealt with by them- 16591 apparently can't be claimed by me for pregnancy planning and management beyond 20 weeks as this has already been funded by the State to the local hospital, who doesn't even have formal shared care with me, yet expects me to do the usual care of low risk pregnancies and other care elements of those at higher risk... What is the point in this system (medicare) when it is so obviously broken? The lack of transparency, the complete absence of useful item descriptors and a 'knowledge bank' online to help Q&A in ambiguous areas, and often a feeling of anti-Provider sentiment (beware the audit etc.) is appalling.
stevekth
27th May 2011
7:01pm
(when I said about not being able to claim for a 36 if coming in for a pregnancy test, I meant a planned antenatal follow up for getting a test when already proven pregnant, or the results of that test, plus other matters, 20mins+, with complexity- for the initial consult when pregnancy is proven by a urine or blood test, apparently that falls only under the 23/36 category for VRs, depending on time and complexity)
KarynPsych
27th May 2011
7:18pm
Stevekth is correct yet I guess it all comes back to your rationale in medicine and whether all professionals would be happy for health provision in Australia to be a means based system. Obviously this is not an ethical issue for our erstwhile colleague above.
Polly
27th May 2011
7:59pm
Perhaps we should just bill on a time basis, as do lawyers, electricians, plumbers etc etc.?
Then the patient is free to ramble on - or take as much time as they wish - as long as they are forewarned?
Solidarity
27th May 2011
10:44pm
As Lionel Murphy was to law, so is Nicola Roxon to medicine. She needs to resign now and hand over to a medically qualified politician or at least one who understands what the doctors and patients of Australia need - before we all lose the good points of our current system and are consumed by the cataclysm of what she is proposing.
Stratmatonman
27th May 2011
11:12pm
......Come and talk to us! She's got a hide! When has she ever talked to the profession? Eh Roxon! What about Joint injections, Mental Health rebates, naming Medicare Locals, Costs of practice, Appropriate CPI rises etc etc etc. When have you and your Labor Government consulted US. The nerve of you!
DrBX
28th May 2011
3:19am
If MO is reporting accurately Ms Roxon has yet again revealed her inner self. Has she effectively commanded Dr Hambleton that he should stay within the 'party' lines. That as I work in secrecy so should you. That everything is on a 'need to know' basis and 'you do not need to know'.
Since Ms Roxon became health minister, federal health policy development has felt like a personal attack on GPs. As many other comments have pointed out, there is this gradual trimming of reimbursement of the 'usual' GP services that we are still expected to deliver. I certainly have not seen any politicians take a pay cut for the good of the country.
It seems that all new health policy abuses the altruistic nature of the GP - that we will keep caring for our patients no matter what. She confidently if not arrogantly knows that we will keep providing expensive services at reduced on no reimbursement because our patients come first. Same can't be said for our health minister. She states that she comes from a family with medical backgrounds so is eminently qualified as health minister yet displays no evidence of knowledge of the delivery of health services. She personally preached on the importance of preventative health, the importance of GPs and input to delivering complex services yet is slowly disabling primary health, the frontline of preventative health in Australia.

Let me leave you with two of her election statements:
“GPs are incredibly well trusted within the community so I think, as a policymaker, it is foolish not to look at ways you can engage GPs in a broader health promotion and prevention strategy when they are clearly the best conduit to the community at large,”

“GPs are so busy and so pressed for time and there is such high demand for their services that trying to get more involvement in prevention and long-term health goals of the population is quite difficult. It is obvious we need to address consultations that require more time.”
stevekth
28th May 2011
9:02am
Great points guys, and my feelings pretty much too. The point about 'come and talk to us' was a particularly bitter pill to be offered by the Government 'quack', lol- can I recommend that she 1st gets the wax removed which is totally occluding her ear canals! (Giving the benefit of the doubt that she would actually give a damn about anything that we have to say). The biggest insult for me- the way she talks of renumerating at a premium and in line with the time-based items, as if that is some great act of grace, wisdom and mercy. BUT the premise that there are appropriate rebates against which to benchmark 2710/2712 renumeration is a lie, and she knows it!!!!
stephmed
28th May 2011
1:36pm
Stevekth says it all so well, that I feel redundant making a posting

Funnily enough after completing mental health training bar some final paperwork, I decided not to bother when I discovered (at that time) that there would be no difference in payment. Subsequently when this changed the "Medicare local" thru whom I had done my training, could not assist me in completing it for some reason. So I have bitten the poorer bullet for some years, & churned out many of these plans, done thoroughly over 45 minutes.
Now I really cannot do it any more, which is a shame unless I give up a weekend for one of these rushed training courses that will teach me nothing that I have not garnered the hard way already!
& Yes like Stevekth, I recognize that the most needy have little means to pay, & getting older (I am 62), many of my patients are over 65 with multiple needs & bulk billing expectations
I have worked out that it costs me $100 per hour to run my room based on overheads & am lucky to get $160 before costs. meanwhile at the "take-away" down the road where it is "1" problem & all bulk billed, they see 6-8/hr, & only scratch the surface of patient care
This is not really about mental health rebates, it is all about the demise of General Practitioners & the rise of Nurse Practitioners, who will soon be performing all these complex services & being paid the same rate
I like Stevekth's freudian slip when he spoke of renumerating instead of remunerating, because that is exactly what Nicola has done!
To misquote Shakespeare "A Pox on Roxon!
stevekth
28th May 2011
4:17pm
lol!! I am disgraced- and thoroughly English still, though I try my best to assimilate, in true Borg fashion! Props for seeing my spelling- it wasn't a slip or typo, alas, just ignorance on my part. And I'm the guy who freaks his husband out when he talks of his aegis, elucidating, being cognizant of something, etc, etc. (ie I generally have good English & vocab) LOL
stevekth
28th May 2011
4:19pm
ps For other Trekkies, the phrase "We are Borg. You will be assimilated. Resistance is futile..." seems oddly apposite when considering the Roxon Master Plan...