The RACGP weighs into the after hours misuse debate and they aren't happy
After-hours GP services are again in the spotlight, with claims their doctors continue to charge $129.80 per callout, billing for ‘urgent’ instead of general after-hours visits at the lower $74.95 rate.
Renewed scrutiny of the billing practice coincides with the release of the A Healthier Medicare report, which hints at changes to after-hours services, saying a patient’s Health Care Home should handle after-hours support “including advice or care for enrolled patients to avoid unnecessary emergency department and hospital admissions out of hours”.
The proliferation of after-hours startups in recent years has fragmented care and led to sub-par follow-up, said AMA chair of general practice Dr Brian Morton.
Meanwhile, the RACGP has just wrapped up its own consultation on after-hours services, which bulk-bill patients but are expensive for the taxpayer.
The college has echoed GPs’ concerns about the increased use of urgent after-hours items and suggested that “entrepreneurial” services might not provide quality care.
The Medical Republic understands the college is weighing up whether to publicly release the feedback from the consultation, submissions to which closed on March 18.
The college and AMA were caught between a government pushing for health efficiencies and doctors who bill the more expensive Medicare item 579 for non-urgent callouts, sources said.
“The current dialogue in the whole Health Care Home and primary care reforms revolves around so-called efficiencies and better use of Medicare resources,” said Dr Morton.
Every accredited practice needs to have some arrangement for after-hours care, and many GPs have been careful not to criticise the current system, which provides them freedom from being on call 24 hours.
Writing in this issue of The Medical Republic (page 8), Sydney GP Dr Ben Howell, who has worked in one of the services, says after-hours services are “most definitely” being “abused”.
Most of the patients he sees after-hours could wait until business hours, but don’t, despite their use of the after-hours service implying their condition requires urgent medical attention.
But he blames policy makers, not doctors.
“Politicians and medical administrators seem fixated on how to best cater to people who want to misuse the healthcare system,” Dr Howell says.
A sympathetic story about after-hours GP services on Channel Ten’s The Project was criticised as a “puff piece” on the program’s Facebook page, where high-profile ACRRM fellow Dr Tim Leeuwenburg said most callouts seemed to be based on patients’ “wants” rather than their “needs”.
Distinguishing between a sick note at 11pm and a 3am heart attack, Dr Leeuwenburg said: “Medicare rebates to patients have been frozen due to the blowout in health spending in recent years. And yet here we have a service providing often unnecessary visits for top dollar, funded by Medicare and our taxes.
“Use of the higher fee item numbers 597/599 have risen exponentially since the introduction of these services… suggesting that the system is being rorted by unscrupulous ‘dial-a-doc’ owners. We are all paying for this.”
The Medicare Locals’ after-hours program launched in 2011, giving those organisations the responsibility for commissioning after-hours services. Prior to that, GPs who performed after hours services were eligible for the PIP scheme. Most Medicare Locals paid GPs in much the same way as the After Hours PIP, but with new contracts set by the Department of Health, in a system that a 2014 landmark review criticised as “needlessly complex”.
The government reintroduced the after-hours PIP in the 2015 federal budget.
A 2014 review of after-hours services showed the MBS had paid out more than $600 million for nearly 20 million after-hours items from 2013-14.
According to the ABS’s 2014-15 patient experience survey 83% of people saw a GP in the previous 12 months, while one in 12 saw an after-hours GP.