The AMA says a proposed crackdown on urgent MBS claims by home-doctor services could backfire on “genuine” GP deputising services and imperil critical after-hours patient care.
The MBS Review Taskforce in June said the soaring growth in urgent claims for after-hours home visits did not reflect clinical need and could be solved by changing workforce rules.
In a preliminary report, the taskforce said use of the four urgent item numbers (597, 598, 599, 600) should be restricted to GPs in regular daytime practice who are called out for an urgent patient assessment.
Specifically, it recommends a business established to routinely provide care in the after-hours period (including a medical deputising service) should be permitted to claim only on non-urgent items for after-hours calls.
The AMA says those curbs are a step too far.
It says there should be a place for a “collaborative” model, including services that operate exclusively after hours, to complement the care provided by a patient’s regular GP or through their regular general practice.
In their current form, the recommendations “will potentially undermine the viability of genuine medical deputising services and significantly impact on access to care for patients”, the submission says. “While we agree that there is scope for some MBS savings through the better targeting of funding for urgent after-hours GP services, the extent of the likely financial impact of the taskforce’s approach is significant and this is not recognised or well addressed in its report.”
The AMA submission urges more work to explore different funding arrangements for “genuine” medical deputising services linked to general practice.
These could include a revised MBS item number structure for deputising doctors or, as suggested by the 2014 Jackson Review of After-Hours Services, the adoption of a blended funding model.
The taskforce’s interim report fails to strike the necessary balance between infrastructure and activity-based funding for a sector with unpredictable and uneven service demand, as recommended by the Jackson Review, the AMA submission says.
The AMA also appears to leave the door open to wider participation by doctors in after-hours calls, a field that has attracted many emergency and hospital clinicians.
As reflected in the taskforce report, the RACGP has been adamant that after-hours deputisers should be restricted to using vocationally registered GPs and GP registrars under supervision.
RACGP President Bastian Seidel said earlier this year that patient care could be compromised by junior doctors performing after-hours work.
But the AMA says only that the deputising services should have access to, and utilise, an “appropriately skilled workforce”.
While the taskforce has been limited by its terms of reference to a review of existing MBS item numbers, the AMA urges that a broader package of reforms is required to ensure high quality and appropriately targeted services.
The reforms should include:
• MDS workforce skills, training and supervision;
• MDS accreditation arrangements;
• Patient triage processes;
• Direct-to-consumer advertising; and
• The necessary link between an MDS and a patient’s usual GP or regular general practice.
The taskforce investigated use of urgent after-hours item numbers in response to doctors’ concerns and Medicare data showing the number and cost of home visits was far in excess of population growth.
In the five years to 2015-16, the number of “urgent” after-hours MBS services, grew by 150% to more than 1.87 million a year, while standard GP services grew 15%.
The AMA response also emphasises that any savings from after-hours reforms should be re-invested in general practice, calling attention to significant funding pressures on GPs.