The college has tasked the government with removing the restriction on GPs billing the MBS for patients admitted to Hospital in the Home and better utilising GP obstetricians in the private sector.
The RACGP says members “regularly” raise concerns about policy and guidance inconsistencies when patients are admitted into Hospital in the Home (HITH) programs – but the incoming private health reforms present an opportunity for change.
Last month, the Department of Health, Disability and Ageing released the first in a set of three consultation papers looking at options to reform the private health sector.
The first paper covered mental health care, maternity care, HITH programs, regional private hospitals, private health insurance product simplification, and risk equalisation.
The RACGP submission, published last week, mostly focussed on opportunities to expand GP involvement in private maternity care, with particular attention to GP obstetricians.
“While [GP obstetricians] play a significant role in the provision of maternity care in the public system, opportunities to provide private maternity care are limited, particularly in metropolitan settings where hospital credentialling and service models often do not support [GP obstetrician]-led intrapartum care,” the college wrote.
“This can result in an underutilisation of procedural GP skills, particularly when [GP obstetricians] relocate from rural or regional areas to larger centres.”
It also called for more consideration of GP shared care arrangements in the private sector, given that it was a relatively common arrangement in public hospitals.
Related
Much of the remainder of the submission pertained to HITH models, with the college writing that improving care transitions between primary and secondary care was a “strategic priority”.
Technically, GPs were not allowed to bill the MBS when conducting a home visit with a patient who was officially admitted in a HITH program.
This meant that HITH patients had to either pay their GP in full, or the GP had to wait to be reimbursed through the hospital system.
“… In practice, our members have advised this system creates confusion for patients and GPs, and the reimbursement approach is not practical,” the RACGP wrote.
“GPs must be allowed to bill Medicare and co-manage their patients care, for example requests for regular scripts or referrals unrelated to the reason for admission such as a routine cardiology appointment.
“The RACGP recommends the government remove the restriction on admitted HITH patients accessing MBS services from their GP.”
Doing this would also allow GPs to claim for telehealth consults with HITH patients.
Still on the broad topic of HITH, the RACGP said its GP members had been concerned that action was needed to achieve “more consistency in policy and guidance on the role of GPs when their patients are admitted into the HITH program”.
In support of this, the college recommended that DoHDA issue “clear and nationally consistent guidance” to public health departments regarding GP liaison on patient admission, GP referrals and subsequent billing practices.
It did not give further detail on what this might look like.
“The success of any care transition arrangements depend on timely information sharing. In the absence of interoperable electronic medical records, there is a significant risk that GPs may not receive critical clinical information in a timely manner, potentially compromising continuity, patient safety and quality of care,” the college wrote.
“Improving digital interoperability should therefore underpin any expansion of HITH services.
“This is imperative for improving clarity and consistency on the requirements, expectations and principles for funding across the general practice and hospital interface and ensuring safe and continuous care for all patients.”
