Reform Medicare to strengthen General Practice
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General Practice is the cornerstone of primary health care and is key to ensuring we have high quality, equitable and sustainable health system into the future.
I petition the Government to prioritise General Practice in Medicare Reform, to engage with representative professional bodies such as the RACGP and begin meaningful discussion regarding changes that could strengthen General practice, improve patient access to care and do this in a financially sustainable way.
I have recently written to my local MP George Christensen to propose the following changes for earnest discussion.
1. Increase the consultation items numbers by at least 20% as recommended universally by the professional bodies and the AMA. Most likely some clinics would still charge a co-payment of some $30 for non bulk billed patients to take the total fee close to the AMA recommended fee of $79. It quite simply costs this amount to provide the high quality and cost-effective care that GP’s are best placed to provide.
2. Increase the bulk bill incentive for patients in genuine need e.g. pensioners, from around $8 to $20 or $30. In this way patients who genuinely require bulk billing can be assured a high value medical consultation in a viable way with minimal or no out of pocket expense.
3. I would suggest a mandatory co-payment of at least $5 for patients that can afford it. The RACGP acknowledges that those who are able to make a contribution to their fees should do so. I believe this would also curtail wasteful consultations such as consults for sick certificates, which a pharmacist or JP are quite qualified to provide. This would also curtail fraudulent consults such as with patients who are drug seeking. For example, I am not sure if you are aware of the prescription shopping program? This is a program that identifies patients who might be doctor shopping to obtain drugs of dependence. The scheme only identifies by prescriptions that are actually filled, so does not include the vast number of other consultations with GP’s who decline a request for a drug of dependence. Nor does it identify patients who regularly see the same 3 or 4 GP’s every week, unknown to the others, for medications that they may be misusing or on selling to supplement their income. The scheme will only identify if a patient uses 6 or more prescribers, or has dispensed 25 or more drugs of dependence, or 50 or more prescriptions in total in a 3 month period. I have been told that the current number of patients on this three month data base is 55 000. So for example, if half of these are genuine patients with say palliative care needs or chronic medical conditions we might conservatively estimate some 25 000 who are drug seeking patients. I would conservatively estimate that for every prescription obtained, each patient would try at least 3 GP’s who would decline the request. So that is at least 18 Medicare consults for each of these patients in 3 months as a conservative estimate. For level B consults of $37 for each of these patients, x 18 consults every 3 months we are looking at a yearly estimate of some $65 million dollars. $65 million per year for patients to have the privilege of walking into bulk billed clinics over and over again attempting to obtain these prescription medications. Why in the world are tax payers funding this? Every pharmacist and GP could tell numerous stories of the lengths of deception that these patients will go to obtain these prescriptions. I have no doubt these patients need medical care, but this needs to be offered through drug and alcohol specific programs.
4. Limit the number of patients a doctor sees in a day. This might vary from city to rural areas, and would need to take into some account the complexity of patients, but for example I would rarely see more than 35 patients on even a very busy day, and average would be 25-30 on a full day. This is because it takes at least 15mins for most consultations to provide quality care.
5. Potentially look at limiting the number of times a patient can see a GP in a month also, with the exclusion of exceptional circumstances, to prevent wasteful use of consults as above.
With the additional remuneration for consults GP’s will be able to structure their business such that, for example, patients could be sent SMS messages for normal investigation results, rather than the current practice of some clinics to have patients return for these in order to generate more Medicare billings.
6. As is done with PIP and SIP payments, limit Medicare benefits to general practices with accreditation. Obviously, some practices such as skin clinics will need to institute an accreditation process, but the process for GP’s is well established and ensures the Government some quality standard and assurances of processes such as follow up and triage for appointments.
7. Remove the nonsensical restriction against charging co-payments for dressings and procedures such as skin cancer removal. This restriction forces practices to either bulk bill the procedure- which is not sustainable due to the cost of consumables and instruments- or to charge the patient the entire amount upfront.
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