AMA, Labor slam move to prepare for disputed GP co-pay

The Australian Medical Association (AMA) and the federal opposition have both criticised moves by the government to begin work on changing Medicare electronic claiming and practice management software to accommodate the proposed GP co-pay before the legislation has even been introduced to parliament.

As reported yesterday, the Department of Human Services (DHS) has notified medical software vendors that it is beginning work on developing a client adaptor that they will need to implement to accommodate the $7 co-payment, as well as a verification service to allow general practices and out-of-hospital pathology and diagnostic imaging providers to check if a patient has reached the proposed service cap of 10 visits or episodes.

While DHS says the implementation of the changes is subject to the passing of the necessary legislation, it has outlined a series of steps that will need to be taken by July next year, when the government proposes that the co-pay commences.

However, Pulse+IT has learned from several software vendors that they have no intention of beginning any integration work until the legislation is passed, which is looking unlikely.

There is also a great deal of confusion over how pathology practices will collect the fee given they often do not see the patient in person, and how GPs might collected the fee from patients in residential aged care. There are also concerns about how providers will handle cash transactions when many bulk-billing general practices no longer keep a till.

Chair of the AMA's Council of General Practice Brian Morton said the AMA remains opposed to the government's co-pay model due to its effect on the most vulnerable patients and described the proposed DHS work program as “a bit premature, given the way things are shaping up”.

Responding to rumours that the government could introduce the co-pay by regulating for it rather than legislating, Dr Morton said the co-pay would need legislation but it was possible the government could still move to reduce the Medicare rebate by $5 by regulation.

“This reflects the zealotry of a government to enact its ideology despite the deleterious effect on general practice and the harm to the health care of the vulnerable,” he said.

Shadow health minister Catherine King said the move “highlights the deceit and dishonesty at the heart of this arrogant and out of touch government”.

“They lied about the GP tax before the election, and now faced with the overwhelming rejection of the Australian people and the parliament, are trying to introduce the GP tax by stealth, just as they did this week with the fuel tax.

“This is a government that refuses to listen to all the evidence from health experts and professionals, and instead ploughs ahead with its bid to wreck Medicare in defiance of the parliament and the people.”

DHS did not respond to a number of questions about the plans, including how the proposed verification service for the service gap and the low gap incentive would work in practice.

It also did not respond to questions on whether software vendors would be remunerated for any integration work.

“A new version of the client adaptor will be made available in 2015 that will resolve a technical issue and is not specific to the introduction of the patient contribution measure,” a DHS spokesperson said.

“The implementation of all government measures, especially those involving ICT, require considerable forward planning. Even where legislation has not been passed, forward development work of this nature is standard procedure for the department.”

The spokesperson confirmed that funding to develop the new capability was allocated in the May budget as part of the measure that funded it to investigate a “commercially integrated payment system” for Medicare's claiming and payment processes for the MBS and PBS.

An expression of interest (EOI) was published in August, with a two-week timeframe for submissions. DHS did not respond to questions on the status of this EOI.

The AMA's Dr Morton said he was also concerned about an increase in red tape if general practices had to check on whether each patient had reached the service cap.

“The practical implications are worrying as the system will have to be live, real-time and the interactions at the reception desk (and during the consultation) will add time and complexity to every patient visit,” he said.

The AMA released modelling last week showing that the $2 “windfall” that Health Minister Peter Dutton said would go to GPs would be almost completely swallowed by extra administrative time and costs. It has proposed its own co-payment that would not include a reduction in the Medicare rebate.

“The AMA alternative model spares the vulnerable (concessions and under 16s) with virtually no change to the billing requirements for these groups who will continue to be bulkbilled,” Dr Morton said.

“Practices will be enabled to charge those able to pay but these on costs can be balanced by a fee that recognises the quality of GP care – put simply the ability to recoup these extra overheads.”

A spokesperson for Mr Dutton did not respond to questions and instead referred Pulse+IT to DHS.

Posted in Australian eHealth

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