RACGP: support for PCEHR review, little for co-pay

The Royal Australian College of General Practitioners has given certain aspects of the Royle review into the PCEHR its support, particularly its focus on improved usability, but remains resolute in its opposition to the proposed $7 co-pay for standard GP consultations.

RACGP president Liz Marles said the college's key concerns about the operation of the PCEHR in terms of usability seemed to have been taken on board, but that the recommendation of moving to an opt-out system need more consultation.

Dr Marles said the college had not been consulted at all on the introduction of a co-pay and she did not believe the government had any understanding of the practical implications and costs for general practice in administering the fee.

“They have talked about an additional $2 to GPs, where there is a $5 cut in the rebate but a $7 co-pay and they say you'll be $2 ahead,” she said.

“In fact, the bulk billing practices will have to install a billing system or to collect cash and also to train their staff, and there is more staff time involved [in collecting it]. There's an estimate that's about $2.54, so you are behind from the outset, and that's not even taking into consideration any patients for whom you may wish to waive the fee.

“It wasn't obviously discussed with us in any detail. We knew like everyone else a co-pay was on the table so we put forward our view, but there was no discussion whatsoever, until we saw the details, that they'd be cutting the rebate.”

On the PCEHR, Dr Marles said a focus on clinical usability of the system had been lost since its introduction and the college was very pleased to see an improved focus on how doctors actually use it. “We are particularly pleased at the focus on secure messaging systems, which had been lost before,” she said.

In terms of the recommendation that the system move to an opt-out model, she said the college recognised “the importance of that in terms of an increase in patient and clinician uptake, and we'll certainly be working with the government to try and make that as operational as possible.”

What needs to be taken into consideration, however, is the extra time it will mean for GPs and the issue of a continuing lack of remuneration, she said.

“If they're going to be reviewing item numbers to take into account increasing work on the PCEHR, we would certainly be supportive of that. There is a little bit of concern around the privacy for minors in terms of the opt-out system, particularly when it's around sensitive information like mental health and reproductive health, and I think those issues still need to be addressed.”

However, GPs will only use the system if they see the clinical benefit, she said, and there were also concerns that doctors who did not want to use it would be forced to do so.

“They talked about including it in the [practice incentives program] and that is about trying to force GPs to use it, but I think we really need to be careful about requiring GPs to do more work when they can't see the clinical benefit.

“If there is a clinical benefit that comes through, because GPs discover just how valuable being able to access all of that information is, then we won't have a problem.

“It's a bit like moving to computerisation in the first place. There's been a really high uptake although there is still a small percentage of people out there who use paper records, but I think when you see the advantages you get the uptake. If the patients are driving it as well then GPs will always try and meet the needs of their patients.”

One of the review panel's other key recommendations was the creation of a 'minimum composite of records' that would include basic details on demographics, medications and adverse events, and discharge summaries. The review panel said that with this information available at a glance, it would bring an immediate value proposition to clinicians.

However, Dr Marles said it would be more likely to bring value to other clinicians rather than the GP, as the GP is the one who is writing it in the first place.

“The other issue of course is that every time you change a medication or add something to the history, you've got to remember to update it on the PCEHR otherwise you will lose the value,” she said. “That has to be taken into account and the Medicare schedule has to reflect that.”

Posted in Australian eHealth

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