Medicare’s secret trial undermines after-hours services

secret trial

 

Medicare’s recent secret trial could be viewed as undermining their own policy objectives around after-hours services. The Weekend Australian recently uncovered a secret behavioural economics trial being undertaken by the Department of Health[i]. Medicare has been focused on the increased cost of after-hours services, which have risen by 140% over the last 10 years, due to a variety of reasons such as the rise of Medical Deputising Services (MDS).

The department believes that the issue comes directly from the incorrect billing of urgent care items by medical practitioners for financial gain. The department has commenced a secret trial by sending out letters to the top GP billers (that use the urgent after-hours codes) advising them to ‘acknowledge incorrect billing and shift their behaviour’.

Whilst the trial has seen improved results (the GPs have reduced use of those codes), is this the right way to go about it or is this just a scare tactic?

 

Undermining their own objectives

The government, primary healthcare networks, and Medicare have had a strong focus over the past few years on improving after-hours primary health care to reduce the amount of hospital admissions within the after-hours period. There has been a range of supports and pilot projects in recent years to increase the number of GPs providing after-hours care for patients who would otherwise present to the emergency department. Not to mention the MBS items that handsomely remunerate GPs who treat patients after hours.

However, now we have trials being done such as this one that completely undermines their other policy directives. If Medicare wants to relieve the burden on our hospitals and encourage cheaper primary care options within the after-hours period, then it is hard to make sense of this secret trial.

Whilst there has been increasing resentment from Medicare around cost blow-outs, and the subsequent crackdown on MDS item codes, this trial appears to take a different approach. A review (source not known) of the after-hours cost issue has recommended that the government implement new rules that will only allow or encourage, billing of urgent after-hours items by a daytime GP who gets called back into work for an urgent case.

This recommendation alone shows just how out of touch Medicare is with current GP workforce issues.

 

This causes a lot of uncertainty for GPs providing After hours care and the clinics that operate them. For GPs who work through the evening, doing home visits – they deserve significant financial incentives to make up for working unsociable hours and putting their personal safety at risk.

Whilst we acknowledge that there are some GPs out there who may bill incorrectly, this does not relate to the majority.  In our view, Medicare is undermining their own policy objectives and adding uncertainty to funding and remuneration for those working in these areas.  Which is likely to lead to a reduction in after-hours services.

[i] Sources: http://www.theaustralian.com.au/national-affairs/health/letters-lead-to-gps-reining-in-urgent-afterhours-billing/news-story/90663de32c98da4c98c8c29496b4581d