15 January 2020

PSR 2019 s92 annual award winners (and other stats)

Medicolegal

An s92 agreement is when a medical practitioner of some description is flagged for inappropriate use of MBS items, goes through review, and then agrees with the Professional Services Review ( PSR) to make amends via repayment, and usually some disqualification of using certain numbers for a period of time.

Notably, the PSR agreement acknowledges that though “inappropriate”, the fact of making an agreement comes down to the PSR determining that in the end the doctor made a mistake. That is, the misuse was not deliberate, and therefore should not be subject to more serious action further up the line.

Following are the most interesting stats we collated from a year of s92s from 2019.

If these numbers seem a bit scary or unfair remember there are only 79 doctors in trouble here, repaying a total of $24.4million, against 88,000 practising doctors in the country and an MBS total spend per year of $20.2 billion. Which means not many doctors are actually getting things wrong.

1. Overall Winner – Single biggest repayment agreement made

Goes to a haematologist (sigh of relief from the RACGP) who managed to clock up $1.4 million in inappropriate billing and reached a deal last August. The PSR director reprimanded said specialist and banned them from using MBS items 132, 133, 13942 for 12 months.

2. Worst in Class, GP: Single biggest repayment from a GP

The highest agreement made with a GP was for $785,000 in December. Innappropriate MBS item use included 36, 585, 721, 723 and 732.

3. Best in Class, GP: Single lowest repayment from a GP

$10,000 in March for misuse of items 721, 723 and 3162K

4. Most abused GP items: 721, 723 and 732

The highest abused by a factor of about 10 overall and notably an item only GPs can use. They are GP Management Plan and the Team Care Arrangement items which generally pay a lot more than other items and can be mechanised by software, which will often get a GP into trouble as they tend to trust software more than they should. These items also seem to explain why GPs top the list of abusers overall by speciality (see below).

5. Speciality most in trouble on s92

There were a total of 79 doctors reprimanded and with which agreements were made of which 55 were GPs (sigh of regret from the RACGP). Given there are more other specialists out there than GPs, this doesn’t immediately make much sense, especially given the average GP repayment is much higher than “other”.

The Medical Republic asked the PSR to comment but it didn’t get back to us. It seems likely though that GPs just have more scope to get things wrong because day to day they deal with so many extra potential items, and are the only ones who can do GP Care and Team plans, which is the most badly used item by a big factor. It would be interesting to look at this trend over the period the government decided to not pay GPs any CPI rises in MBS items and GPs had to work a lot harder to find enough money to maintain themselves.

We probably should have an award for speciality which is most misusing the MBS, if you take away items 721,723 and 732. If you do that the winner would be sleep and respiratory physicians, with haematologists coming in a close second (although to be fair the winner of the top award who did a whopping $1.4 million all by him or herself really skews haematology).

6. Highest average monthly agreements made

GPs average $1.3 million in repayments per month,  against ‘the rest’, who averaged $723,000 per month. In total, 55 GPs agreed to repay a total of $15.735 million, and 24 non GPs agreed to pay a total of $8.675 million. Again, the disparity seems to come from more GPs making mistakes on more items, especially care plan and team items.

7. Other random but interesting stats

• Two optometrists got caught out for a grand total of $110,000
• Second place getter on most to repay was a sleep and respiratory physician with $900,000.
• If you take away the potential handicap of having to do items 721,723 and 732 (especially when you decide to not give GPs payrises for about five years), then by a long margin sleep and respiratory physicians are the winners of worst, although its only a few bad eggs that cause it.
• Although overall GPs are having to make the most agreements for repayments, if you look at the patterns month by month, in nearly every month the highest repayment by a GP is almost always less (and usually significantly so) than the highest made by a non GP. What is to be made of this? Non GPs when they make mistakes just make them much bigger? Feels a bit uncomfortable for non GPs.

 

A key trend is GPs tend to have much lower repayment agreements than non GPs but there are lot more GPs having to do repayments, mainly because of Care Management and Team plan mistakes