Backflip over Health Care Homes visit limit

4 minute read

Canberra drops proposal to cap GP visits for chronically ill patients under its Health Care Homes scheme


The federal government has dropped its proposal to cap GP visits for chronically ill patients under its Health Care Homes scheme after a blistering reception from doctors.

The RACGP said the Health Care Home trials had been “set up to fail” because of a decision to put a five-visit cap on benefits for HCH-registered patients seeing their GP for reasons not related to their chronic conditions.

Health Minister Sussan Ley blindsided doctors with an announcement late on Friday revealing the first details of the landmark Health Care Homes trials to start in 2017, including a shift from fee-for-service to monthly bundled payments and the surprise five-visit limit on acute care.

“All general practice health care associated with the patient’s chronic conditions, previously funded through the MBS, will be funded through the bundled payment,” a payment information factsheet said.

“Enrolled patients can still access fee-for-service billing for a small number (up to five) of episodes of care not related to a patient’s chronic conditions.  This will also enable patients to visit different practices, for example when travelling.”

But after an outcry by doctors groups, Ms Ley’s department today backflipped and changed the wording of the fact sheet to say:  “Enrolled patients can still access fee-for service episodes of care not related to a patient’s chronic conditions.”

For the majority of patients, the number of such presentations was expected to be small, and the number of fee-for-service visits would not be capped but would be monitored during the stage-one trial, the amended version said.

RACGP president Dr Bastian Seidel told The Medical Republic the proposed limit was “completely nonsensical,” adding he would not recommend patients at his rural Tasmania practice take part under those terms and it was unclear what benefit it could offer.

“An elderly patient with a heart condition and dementia is also coming in for vaccinations, or they might have had a fall, stomach pain, or skin cancer that needs to be removed,” he said.

The college has also criticised the proposed funding levels and the government’s failure to consult with the profession before coming out with the plan.

AMA Vice President Dr Tony Bartone said the government should consider putting off the trials, due to start in some 200 practices in 10 geographical areas around the country, in July 2017.

The government needed to win doctors’ confidence in mapping out a crucial reform that was “too important to fail”, he said.

“Right from the start we have said this needs to be funded appropriately.  Doctors want to be part of this new approach but if you don’t adequately fund it, they won’t want to play.

“Doctors needed to be taken on a journey,” the Melbourne GP said.

“At the moment, there’s too much confusion and too much rush.  Doctors need time to make their decisions.”

The Health Care Home model for dealing with complex and chronic illnesses was announced earlier this year in a joint press conference by Ms Ley and Prime Minister Malcolm Turnbull, who described it as a revolutionary step that would become the centrepiece of Medicare reform.

Dr Bartone said the implementation needed just as much visibility and attention.

According to Ms Ley’s announcement, doctor have only until December 15 to register their interest in joining the trials.

A webinar to explain details will not be held until November 17.

The three-tiered scheme will require sweeping changes in how participating GPs practice medicine.

HRC-registered patients with high-risk conditions and complex needs – about 1% of the population – would draw bundled payments of $1795 a year.  Those with multiple conditions and moderate needs would attract $1267 in benefits, and people with multiple conditions largely self-managed are eligible for $591. 

The RACGP and the AMA have criticised the lack of consultation with doctors and the adequacy of the proposed $100 million funding.

The Consumers Health Forum said the proposed a five-visit cap threatened to kill the initiative before it got off the ground. 

“The patient-centred health care home approach offers a long overdue solution to the contemporary issues our health system is facing: growing complex chronic conditions, poor care and service coordination and the need for better service integration,” CEO Leanne Wells said. 

“The overriding concern is that a negative response provoked by the prospect of a cap would doom HCH,” she added. 

“The success of HCH will clearly rely heavily on consumer confidence as well as  a positive response from GPs and their willingness to discuss the benefits with their patients. From the reaction of the GP community over the weekend, that seems problematic now.

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