GP co-pay software changes going ahead despite deadlock

The Department of Human Services (DHS) is proceeding with changes to electronic Medicare claiming to accommodate the proposed $7 GP co-payment despite the legislation not having been introduced to parliament.

In an email sent to software vendors from DHS's eHealth and government to business systems branch last Friday and seen by Pulse+IT, DHS says vendors will need to make changes to their practice management software to accommodate the co-pay and allow practices to check if a concessional patient has reached the annual service cap of 10 visits to a GP or community pathology or diagnostic imaging provider.

The federal government announced in the May budget that it would introduce a $7 co-payment for GP consults and out-of-hospital diagnostic services. The Medicare rebate would be cut by $5, with healthcare providers encouraged to charge an up-front $7 fee per consultation.

Health Minister Peter Dutton said providers could then directly bill the patient $5 to make up for the rebate cut as well as a $2 “windfall” for the provider. The $5 cut would then be directed into the government's proposed medical research fund.

The proposal has received strong opposition from consumer and healthcare groups, with the Australian Medical Association putting forward its own co-payment plan that does not include a cut to the Medicare rebate.

The AMA revealed independent modelling last week that showed that the extra red tape involved in collecting the co-payment would cost between $1.41 and $1.61 per transaction, effectively wiping out the “windfall”.

In addition to opposition from Labor and the Greens, PUP leader Clive Palmer has stated his party will not pass the co-pay legislation in the Senate, although Mr Dutton says negotiations are ongoing and he hoped the legislation would be passed. He has yet to introduce the legislation to the lower house.

In the meantime, DHS has been told to begin developing a client adaptor for electronic claiming systems to accommodate the new co-pay, as well as a verification service to allow practices to check if a concessional patient or child under 16 has reached the proposed 10-visit service cap.

This will theoretically allow the practice to revert to the previous bulk-billed arrangement for those patients once they have reached the cap.

The government also proposes to rename the bulk-billing incentives paid to general practices as the low gap incentive, which will be paid to practices that bulk bill concessional patients and children under 16 as long as they also charge the co-pay.

Changes to the electronic claiming system will be required to allow practices to continue to receive the low gap incentive after concessional patients reach the service cap.

While it is understood the changes to software will not be onerous, it is not clear if practice management software vendors will be paid for the integration work required. DHS and Mr Dutton's office have been approached for comment.

In the email to vendors, DHS proposes to develop a new client adaptor that will interact with the Medicare Online and Eclipse electronic claiming systems.

DHS says it will develop new logic packs that are compatible with existing client adaptors – of which there are several versions going back to 2009 – as well as a new client adaptor to be released next year that will accommodate the co-pay provisions.

Software vendors need to undergo an integration process and receive a notice of integration (NOI) with Medicare to use the client adaptors. DHS says that those vendors that don't have an NOI will need to upgrade to a newer client adaptor and receive an NOI.

Those vendors that have an existing NOI will still need to implement the logic pack changes and receive a new NOI. DHS says vendors can choose to wait until the latest client adaptor is released in June 2015, the month before the co-pay is proposed to start, or to implement the logic pack changes earlier.

It proposes to release a beta client adaptor in January next year to allow for NOI testing and a final version in May. The full “patient contribution” release is scheduled for June.

Pulse+IT has approached both the department and the minister's office for more information on the costs associated with developing the new system, and whether software vendors will be remunerated for their integration work.

Posted in Australian eHealth

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