The declining rates of accident and emergency type services in general practice are a “wasted opportunity” to save money in the healthcare system, leading GPs argue. Dr Evan Ackermann, Chair of the RACGP Expert Committee for Quality Care said frozen MBS rebates mean GPs doing minor procedures either operate at a loss or charge […]
The declining rates of accident and emergency type services in general practice are a “wasted opportunity” to save money in the healthcare system, leading GPs argue.
Dr Evan Ackermann, Chair of the RACGP Expert Committee for Quality Care said frozen MBS rebates mean GPs doing minor procedures either operate at a loss or charge patients a gap, driving them towards free treatment in hospital emergency departments.
Laceration repair rates performed by GPs have halved in the last two decades according to MBS statistics, largely due to inadequate rebate funding, Dr Ackermann said.
Similar declines are also apparent for other services, including fracture management, removal of foreign bodies from the eye and skin, and abscess/haematoma drainage.
Yet at the same time hospital A&E activity is increasing, and the cost of minor A&E procedures to government is “exorbitant”, Dr Ackermann wrote in an article in MJA InSight.
“What happened is that 20-25 years ago a cost was set for these A&E type services and it wasn’t increased with CPI,” Dr Ackermann told The Medical Republic.
“So the actual pricing of the service has decreased over the years, and when practices couldn’t afford them, or they had to charge a fee to make them appropriate, then patients would just go to hospitals rather than staying at general practices most of the time,” he said.
More funds should be allocated to provide these services in general practice, Dr Ackermann said, and GPs should be allowed to dispense a limited group of emergency drugs.
“It’s a simple way to bring down health costs, it’s more effective, and everyone’s a winner basically,” Dr Ackermann told The Medical Republic.
On top of stagnant rebates, the standards of care have changed too, Dr Ackermann said.
“When you’re treating a fracture you would have had a plaster cast, now you have a fibreglass cast,” he said. “So the fees that they have in the MBS are just totally inappropriate.”
The Independent Hospital Pricing Authority (IHPA) figures show the most basic hospital A&E presentations cost at least $250, which outstrips the Medicare rebates of $44-$99 for GPs performing common laceration repairs.
Basic wound management costs around $37 in the general practice setting, yet is costed at $245 for hospitals.
Yet the issue has been overlooked in the current discussion and reviews of the MBS and primary care, he said.
RACGP president, Dr Frank Jones, said he’s also seen a cultural shift in the last decade “where patients presume that level of expertise is not available in general practice and are tending to go to the emergency department instead”.
“I’ve been a GP for 30 years and people used to turn up all the time with minor lacerations, minor fractures, sprains, cuts, abrasions and bruises, and it was part and parcel of what all general practice did,” he said. “It’s bread and butter stuff for general practitioners.”
While chronic disease management has become a focus of primary care, accounting for about 70% of his patients, we mustn’t forget the 30% of patients who present with acute presentations, Dr Jones said.
“That’s part and parcel of what we do […] and we are perfectly capable of looking after [minor trauma] and there are cost efficiencies there for the health system,” Dr Jones said.
“It’s a matter of communicating to patients that their practices are again ready to do these services. that they do have the capacity and if there is an emergency, like these minor emergencies, then they are prepared to see them.”
