AMA to lose PSR involvement

There are fears that the current PSR setup may have had too much sympathy for doctors.

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The AMA is to lose its say over the appointment of the Professional Services Review director and panellists, as foreshadowed in the budget, after concerns were raised that it may make the regulator biased toward doctors.

A bill has been introduced to the lower house to amend the Health Insurance Act in response to the Philip report into Medicare compliance.

The PSR is an ostensibly independent agency that investigates cases of potentially inappropriate or noncompliant Medicare billings.

The current acting director is Canberra GP Dr Antonio Di Dio, a previous AMA ACT branch president, but his appointment expired at the end of March.

Doctors would dispute that the Medicare billing watchdog is biased in favour of doctors.

The PSR has a notoriously high strike rate. Last year, just one out of the 19 committee reports finalised came to the conclusion that the practitioner had not practised inappropriately. For the previous two years straight, all practitioners who came before the review panel were found guilty of inappropriate practice.

The AMA has long held certain powers with the PSR, including veto power over the appointment of its director.

Even though the AMA has never actually exercised this veto power, it was pinpointed by health economist Dr Pradeep Philip in his government-commissioned report into the integrity of Medicare.

“The positioning of the AMA as a professional body who can veto the appointment of a PSR director no longer reflects the fact that there are a range of professionals who will be referred to PSR,” Dr Philip wrote.

“Either all professions should be engaged and involved in director appointment decisions, or no professional bodies should be involved.”

Given that the power was never actually used, he pointed out, it was unlikely to be missed.

That is not the AMA’s response.

“The AMA is disappointed at the proposed removal of the AMA’s legislated role in appointing a director of the PSR, which was recommended in the Philip Review,” president Professor Steve Robson told The Medical Republic.

“The AMA’s role has been widely seen as essential in the past, particularly in helping to ensure confidence in the PSR among the profession.

“The Philip Review found no evidence that the involvement of the AMA in relation to PSR appointments has in any way interfered with its independence or impacted on its decision making.”

While Dr Philip’s review focused more on the fact that the AMA’s veto power was anachronistic, given that the PSR’s remit has broadened to include oversight of more health professions, the wording of the amendment Bill uses a different argument.

“The current arrangement is inconsistent with public expectations regarding the independence of the PSR and may undermine public confidence in its role as a regulator,” the Bill reads.

“Given the potential conflict between the PSR’s objective to safeguard Medicare and the AMA’s role in representing the interests of medical practitioners who may be subject to PSR review, it is appropriate for the veto power to be removed.”

Other PSR-related recommendations from the Philip report and are now being actioned via an amendment to the Health Insurance Act 1973 include moves to amend consultation requirements for appointing other statutory office holders of the PSR to enable consultation with relevant peak bodies directly and establish a new statutory office of associate director of the PSR.

The fourth and final amendment is to remove the requirement for the chief executive of Medicare to consult with stakeholder groups prior to issuing a notice to produce documents.

According to the explanatory memorandum attached to the Bill, this will mean that the Medicare will not have to take “reasonable steps” to engage with stakeholder groups before issuing a notice to produce documents.

“Consulting with a non-regulated entity about a regulated entity does not demonstrate clear and accountable natural justice to the regulated entity,” it said.

“This amendment will streamline the audit process without limiting the documents or other information that a person may provide.

“There will be no impact on procedural fairness requirements during an audit.”

While it hasn’t issued a formal statement yet, the RACGP indicated via its news service that it was particularly interested in determining the implications of the final amendment.

The AMA is also in the process of working that out.

“We are examining the Bill in more detail to understand its full implications, but it is important to acknowledge that unless strong consultation with the profession about the operation of the PSR continues, it will become just another regulator with little regard for the peer-review process,” Professor Robson said.

“The AMA will always represent and fight for its members and regardless of the passage or outcome of the Bill, the AMA will continue advocating for a transparent, fair, profession-led regulatory system.”