The minister for veterans’ affairs has announced that payments for doctors' reports will ‘better reflect actual costs to practitioners’.
The Department of Veterans Affairs will seek to recognise the work that GPs put into completing medical reports by updating its fee schedule, but GPs on the ground say more reform is needed.
Speaking at the National Press Club last week, minister for veterans’ affairs Matt Keogh pledged to tighten compliance measures for the scheme and ensure veterans were not exploited.
As part of this, he said the agency would be updating its fee schedule for report writing, “ensuring payments for reports are more consistent with other equivalent jurisdictions and better reflect actual costs to practitioners”.
Right now, the DVA values a standard report without consultation is $193.90; a report that involves one standard consultation inclusive of a psychiatric assessment at $805.00; and a report that involves at least three consultations, a psychiatric assessment and interview with one or more family members at $1507.60.
Mr Keogh cautioned against pop-up services which made false promises about getting a veteran’s claim processed faster.
“I also really encourage veterans to work with their usual treating GPs on medical reports for DVA, rather than going to a new provider who might not know them very well,” he said.
“Volunteer veteran advocates have been a core part of Australia’s veteran support system for over a century, with ‘mates supporting mates’ being a founding principle, but, as we’ve heard in a recent Senate Inquiry, some very concerning behaviours have emerged.
“I was enraged to hear evidence that veterans are being charged staggering fees – things like $20,000 for a single day’s work by an advocate and charging commissions as high as 29% of a veteran’s DVA compensation payment.
“We’ve even heard of $20,000 contract break fees and a charge of more than $30,000 for a single report.”
The specific fee increase for doctors’ reports has not been announced yet.
North Queensland GP Associate Professor Michael Clements, who is a veteran himself, told The Medical Republic that extensive paperwork involved in DVA claims had long been an issue for veterans seeking care.
“A simple lower back condition or a knee condition could easily generate 10 to 20 pages worth of paperwork, and the questions are always written by lawyers, and some of them appear quite technical, and so many GPs – particularly if they weren’t experienced at all with injury or impairment assessments – actually told their patients, ‘no, I don’t know enough to fill out those forms’,” he said.
“So, the veterans were forced to seek either doctors that didn’t know them to fill out this paperwork, or special purpose clinics.
“In the last 12 to 24 months, we’ve seen a significant increase in the numbers of clinics and doctors who provide DVA assessments only.”
While this has allowed more veterans to access care, Professor Clements said there were growing concerns about conflicts of interest in a single-issue medical model.
“There is almost an incentive, or there’s an implied bias in that if you maximise the seeming distress or the seeming impairment or suffering of that particular veteran, and they get a higher rebate, then you might generate more business,” he said.
If a patient’s regular GP was incentivised and properly resourced to complete DVA assessments and reports, there would be less of a need for these specialised clinics.
Professor Clements said he would remain sceptical of the promised fee increase until it was announced.
“The wording was something along the lines of, ‘make the compensation claims more equitable to industry standard’, so I am very curious as to what [exact industry] that means,” he said.
The AMA also welcomed news of a fee increase for report writing but called for an increase to DVA gold and white card rebates, which will not be affected by the fee change.
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To this end, Professor Clements also pointed out that DVA rebates would not benefit from recent investments in bulk billing.
Gold card rebates, by law, are 115% of Medicare rebates. But Medicare rebates are not where the government’s investments are going.
“We’ve seen the federal government move towards things like billing incentives and as a way of investing in general practice,” Professor Clements said.
“They haven’t increased that base rebate, which essentially means, in a relative sense, that DVA rebates are falling in comparison to Medicare, because Medicare has been having other incentives increased.
“As long as we have this piece of legislation that says that a DVA rebate must be tied to the Medicare rebate, and we’ve got a government that doesn’t want to increase base rebates, our veterans are going to find it hard to find doctors who want to take on their care.”
This was not the case five or 10 years ago, the Queensland GP said.
“Every veteran comes with a story. Comes with a history,” Professor Clements said.
“Some of them are extremely complex, and there are very few short consults with veterans, given that there’s normally psychological, physical, emotional and other workplace issues in relation to providing ongoing care.”
