Health not buying MSIA’s eScript complaints

A rather peculiar tender was issued by the Australian Department of Health back in September 2021 for a review of the electronic prescribing ecosystem, with particular emphasis on the funding model. The tender was full of the usual government verbiage, talking about the need to look at “opportunities to improve the customer experience for prescribers, patients and dispensers; optimise the environment to support further scale; and to ensure the effectiveness and sustainability of the operating and funding model”. In other words, it wanted to look at cutting costs.

We hear that one of the usual suspects in the big four consulting groups won the contract to take at look at this ecosystem, saw that the department was not only funding every eScript token that a GP sent out by SMS but that it had in fact been paying for every printed script issued with a barcode for close on a decade, and decided to recommend cutting back on these subsidies.

Each script issued using one of the electronic prescription exchanges, eRX or MediSecure, comes with a charge of 8c to the pharmacy to scan it in. The government then reimburses each transaction by the same price. General practices of course don’t have to pay anything to use eRx or MediSecure as GPs are subsidised fully through the eHealth Practice Incentive Payment (ePIP).

While these systems have been running along nicely for many years, the health department has since taken great pride in ushering in the new eScript ecosystem, precipitated by the coronavirus pandemic, boasting regularly that it was able to roll out eScripts to enable telehealth consults and contactless prescriptions in a matter of weeks, if not months, when COVID-19 hit. (The fact that the department could have ushered in this brave new world simply by preparing legislation for it many years ago is now a moot point, one suspects.)

eScripts, like “universal permanent telehealth”, will no doubt go down as one of the grand legacies of Health Minister Greg Hunt’s tenure, despite that fact that enabling these new systems should have been sorted years ago.

Nonetheless, in late March, the department issued a tender for prescription delivery service (PDS) providers and for a single active script list registry (ASLR) provider as part of its review of the electronic prescription ecosystem. It was pretty obvious at the time what the department wanted – it had been told by the consulting firm that 8c a script was a scandal in these digital days, and it would be much better off dealing with one supplier, on its own terms of 2c a script, than dealing with the current situation.

We hear that the Medical Software Industry Association (MSIA) blew its top over this tender, and corralled a bunch of upset vendors into a meeting with the powers that be, threatening hell and damnation much as it had done with complaints about primary health networks developing their own software to overcome the failures of existing products.

We also hear that the MSIA put in a question to the department about whether it had got an exemption from the Australian Competition and Consumer Commission (ACCC) under existing competition laws.

Nope, the department said. “The Commonwealth has not, and does not intend to, seek an opinion from the ACCC in relation to this Request for Tender at this time,” it said. “Approaching the open market encourages competition between market participants and will assist the Commonwealth to achieve best value for money.”

The situation reminds us of the MSIA’s failed attempts to bully the PHNs into withdrawing their plans to develop software best suited to their requirements for gathering population-wide data. The ACCC was approached but they were swiftly rebuffed then as now. The ACCC reactions to both say that the Commonwealth is perfectly entitled to go to market for better value for money, or to develop its own systems if there is a market failure, and you can’t get much more competitive than that.

Meanwhile, the long-running, way over budget JP2060 project for the Department of Defence’s Joint Health Command has finally been awarded to awarded to IT services firm Leidos’ consortium to develop the Health Knowledge Management (HKM) solution. This rather grandly titled solution is pretty much an electronic health record for deployed and garrison staff, using a PMS system from MediRecords, a videoconferencing solution from Coviu and a longitudinal view integrating different data streams using Alcidion’s Miya Precision platform.

An equally large contract for mobile medical and surgical modules was awarded to Saab and Philips last year. It was always obvious that Leidos was odds on to win the contract – it issued press releases announcing its partners for the bid two years ago and also exhibited at the Australasian Digital Health Institute Summit in Melbourne in February, along with MediRecords – and but what is interesting is the cloak and dagger announcement of the contract. We saw it on the Australian government’s tender site last week, and according to ITNews, which first broke the story last week, the contract was signed back in December. Why the secrecy now? Any ideas? Let us know here.

Finally, the week has been big for aged care and for virtual care, with the AIDH calling on political parties to commit to a national virtual care strategy, Sydney’s rpavirtual rolling out new services, and Victoria’s ambulance ramping crisis receiving much needed funds and new models of care.

Of all of the stories this week, however, we think the Aged Care Data Compare project could be the most important. Getting data into aged care, out of aged care and actually used in aged care could be a big solution to the crisis in this country, which despite various gaffes and dissembling, is still a major election issue.

That brings us to our poll question for the week:

Should the Commonwealth be allowed to set the price for IT solutions it commissions?

Vote here or leave your comments below.

Last week we asked: Have our political parties dropped the ball on healthcare policy in this election campaign? YUP! 97 per cent said yes, while just three per cent said no. Here’s what you said.

Tags: Department of Health, MSIA, eScripts, ACCC

Comments  

0 # Kate McDonald 2022-05-13 13:09
Readers were evenly split on this one: 51 per cent said no, 49 per cent said yes.

We also asked, if not, why not? Should the market set the price instead? Here’s what you said:

- They have no idea as to the cost of development.

- If it goes to an open tender it should allow vendors to submit a price with their proposal - that is a true competitive process.

- If competition is the intention, then yes, the market should set the price.
The Commonwealth should set the ceiling price. It’s up to the market to find competitive advantage within that ceiling price.

- It inherently cramps the final solution models. It also needs an ‘experienced’ governing model with those who understand the domain. Remember, “medicine is not a business. Our business is clinical care.”

- Governments funds about 70% of all spending in Health, and are entitled in the interest of the taxpayer to test the market and find the lowest prices that will deliver a sustainable national services. I get the impression that historical prices have not really been market tested, and were set too high to get e-prescriptions accelerated during the early days of the pandemic. The Cwth can not set any price, since if it is too low then no provider will want to deliver the service or the Cwth will end up having to provide the services themselves.

- The government does not have the capability to specify solutions in enough detail to understand how much a solution will cost. A vendor is most likely to cut costs and produce a less than optimal solution just to meet arbitrary price caps.

- It should be by Public Competitive Tender, otherwise it has the potential to be a RORT.

- Yes. Free Market Competition means competing on price as well as service, functionality, etc. Forcing the market to meet a specific price point typically ends up with a 'low cost' solution that may have cut corners and eventually does not meet the real needs. We should be focusing on solving real problems, meeting real needs and delivering real outcomes at a fair price. That is real value for money.

- Market to set price.

- Market prices

- there is a commercial aspect to healthy competition price setting in the private companies of the healthcare industry that must be respected unless the government is wanting to eliminate this normal enterprise aspect of our democratic economic principles

- Defys market principles. This is Bullying by a monopoly.

- Because - in IT more-so than any other industry - you get what you pay for.

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