15 August 2018

Health Care Homes data paints a sorry picture

Chronic Disease General Practice Government

Doctors’ warnings that the Health Care Homes trial was being set up to fail seem to have been borne out, with fewer than 100 of the 175 HCH practices having any patients on their books.

As of June 6, a total of 76 Health Care Homes did not have a single patient enrolled in the government’s scheme to introduce a new patient-centred model of complex and chronic-disease management, health department figures show.

Doctors’ concerns about the scheme – which Prime Minister Malcolm Turnbull famously promised would revolutionise Medicare – centred initially on its inadequate capitation payments, doled out according to three levels of complexity based on assessment of patients’ needs.

The RACGP withdrew its support early last year.

But doctors who are supportive of the concept say that many potential patients have been put off by the requirement that they maintain a My Health Record.

Health Department figures show a total of only 2075 HCH patients were enrolled as of June 6 with just 99 of the 175 registered practices active – a far cry from the 65,000 patients and 200 practices envisaged originally.

The figures also show a dramatic fall in involvement by Aboriginal Medical Services and big corporate practices – two groups that dominated the original shortlist of applicants.

Only one of the 18 Aboriginal Medical Services registered as HCH providers had enrolled any patients. The lone active AMS had recruited just 22 patients.

The big four corporate players – Primary Health Care, IPN, Healthscope and Tristar Medical – also appear to have largely fled the scene.

Of the 39 large corporate practices registered as HCH providers, only 22 had any patients.  Their  total enrolment came to 285 patients, include a cluster of seven corporate practices in Adelaide that had 119 patients.

Not surprisingly, the trial launched in December across 10 primary health network areas, appears to be propped up by mainstream general practices and GPs who have had a long interest in the “patient-centred medical home” model.

The figures, released in answer to a question on notice in Senate estimates in May, show mainstream practices had enrolled 1768 of the total 2075 HCH patients.

Of the 118 mainstream practices registered, 76 were taking active part, with the biggest caseloads in the Western Sydney, Brisbane North, Southeast Melbourne and Adelaide PHN areas.

Dr Kean Seng Lim, President of AMA NSW, said the HCH trial was floundering for multiple reasons.

“Many of them were quite foreseeable when we look at the experience of implementing large-scale change (in primary care) around the world,” he told The Medical Republic.

“The learning is, we have to put practice improvement and transformation first – then apply the funding model which is appropriate to support this new model of care,” the western Sydney GP said.

“The Health Care Homes implementation pretty much did the opposite.”

Dr Lim said some patients were reluctant about taking part in trials, when they didn’t know how they would pan out.

About half of the patients invited to join the HCH at his practice had declined because of the rule demanding they participate in the My Health Record, he added.

Dr Richard Kidd, chair of the AMA’s Council of General Practice, said the lack of time and preparation, as well as funding shortfalls, had made GPs back away from the trial.

“No new money has been put into this and yet practices and GPs have been asked to fundamentally change how they do their work,” Dr Kidd said.

“That change management in any business is an expensive and time-consuming process to do properly.”

Dr Kidd, a GP in Brisbane, said there was “a lack of clarity” as to how doctors and nurses in HCH practices were going to be paid for their efforts.

Some GPs also had concerns about clinical governance.

“The big concern for these doctors was the impression that they were being asked to step back from looking after their patients, because of the way the team management was being promoted,” Dr Kidd added.

“They got the feeling that their work was going to be replaced by others who would do it cheaper, like nurses, yet they  would still be the ones responsible for any adverse out comes or perceived adverse outcomes.”

Of the government’s $110 million in funding for the Health Care Homes trial, most has been redirected from existing chronic-care MBS items.

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