No one thinks capitation is a good idea: DoHAC

5 minute read

The once-sceptical RACGP president has come to see MyMedicare as the way forward, and DoHAC is emphatic: it’s not capitation-lite.

The introduction of a voluntary patient enrolment system, MyMedicare, will be the biggest shake-up to general practice in decades.

But despite the fact that patients can start registering in just a month, there’s still uncertainty as to what it actually is.

First off, the Department of Health and Aged Care would like to stress that MyMedicare is not capitation, capitation lite or a stalking horse for capitation.

“We have been consulting on this system for more than four years,” DoHAC primary care first assistant secretary Simon Cotterell told an RACGP-run webinar on Thursday night.

“No one thinks capitation is a good idea.

“We’re not going there.”

Convincing GPs of that notion has been an uphill battle, as RACGP president Dr Nicole Higgins can attest to.

“I’m going to admit I have been a sceptic in the past,” she told webinar audiences.

“And I have to say that, now, I think this is going to be one of the most important drivers for general practice moving forward.”

Her reasoning is that, first and foremost, Australia is one out of the two OECD countries that don’t have some form of patient registration system.

The second biggest reason is that MyMedicare marks patients as belonging to general practice, something that Dr Higgins said will be vital in a time where allied health professions seem determined to increase their scope of practice.

“I’m going to be a little bit crude … if we don’t [register our patients], somebody else will,” she said.

“I think it’s really important that we make sure that we bring our patients with us in general practice and provide that continuity of care.

“Because if we don’t, the system will fragment and there are going to be other options about how that care gets delivered, potentially through the [unleashing allied health care] reforms that are coming.”

With that somewhat ominous overtone, the department and college released morsels of new information regarding how MyMedicare will work.

Practices will be able to register patients from 1 October.

There are three ways that the registration process can happen:

  1. The patient initiates registration digitally
  2. The practice initiates registration digitally
  3. The patient or their carer fills out a paper form provided by the practice

DoHAC has a public information campaign planned for the next month to get the word out to patients about the potential benefits of MyMedicare and how to register.

Individual patients will be able to use the Medicare website to initiate the registration process with their preferred practice and nominate a provider.

That will show up on the practice’s end as a kind of application or expression of interest from the patient.

It’s then up to the practice to accept that application.

If the practice initiates the registration, the reverse will happen.

A paper-based form for less digitally literate patients will come in due course.

GP and Strengthening Medicare Taskforce member Dr Walid Jammal emphasised that practices do not have to rush to enrol patients.

“Please don’t give yourselves, your staff and your patients a nervous breakdown trying to register everybody on 1 October,” he said.

“Take it easy and have a think about what it means for us [as a practice] and what patients it’s important for.”

The patient requirements for registration are that they have had at least two face-to-face visits with the nominated practitioner in the previous 24 months.

This is slightly different from the RACGP’s definition of an active patient, which is a patient who has had three or more visits of any kind in the previous two years.

Patients in rural and remote areas will have reduced requirements.

Patients can register, deregister or move their registration to a different provider at any time.

The practice requirements for registration are a little more complex.

To be eligible for MyMedicare, practices have to provide Medicare funded services (duh!), be registered with HPos and PRODA, have at least one eligible provider linked to the practice in the organisation register and be either RACGP-accredited or working toward accreditation.

Under the current practice incentive program, practices have 12 months from the date they register to gain accreditation.

For MyMedicare, DoHAC will apply a two-year exemption for unaccredited practices and solo practitioners that deliver services to rural communities and residential care settings via a mobile or outreach model.

Individual GP registration requirements are that they have a valid prescriber number, work in an eligible practice to which they are linked via the organisational register and be eligible to deliver MBS or DVA services.

It doesn’t matter whether the GP is vocationally registered, non-vocationally registered or a registrar, according to Mr Cotterell.

If a GP moves practice, patients do not have to see them for two more appointments in order to move their registration; the registration is tied to the provider, not the practice.

Alternatively, patients can move their registration to another provider in the original practice without having to meet the minimum visit requirements.

Likewise, the SIP and PIP payments relating to MyMedicare will flow directly to the provider and the practice respectively.

“It’s the person who does the work who gets paid,” Dr Higgins said.

It’s hoped that these separate payment flows will help illustrate that the GP-practice relationship is not that of employee-employer, and therefore not liable for payroll tax.

“The process of enrolment is not a funding model in and of itself, and that’s been a purposeful consideration for a number of years in coming up with this model,” Dr Jammal said.

“Payroll tax just happens to be one of [those considerations].”

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