The PSR was under fire on day two of Senate estimates for DoHAC, as was the 8CPA. Of course, payroll tax also got a mention.
Today, bucking the normal state of affairs, the Professional Standards Review – the body responsible for investigating cases of possible inappropriate practice relating to Medicare – was itself under review at the Senate estimates hearing.
Contesting that investigations conducted by the PSR were undertaken in a “completely fair manner”, Senator for Queensland Malcolm Roberts queried how a 100% prosecution rate for doctors seen by the PSR committee was indicative of a fair process.
Since 2008, 173 doctors have faced the PSR committee.
“My understanding is that the number of prosecutions that were successful for the PSR scheme out of 173 was 171, not including two doctors who passed away,” said Senator Roberts.
“So that’s a strike rate of 100% against the doctors.”
Testifying on behalf of the PSR, executive officer and general counsel for the agency Bruce Topperwien confirmed that the 173 doctors were only those that were referred for committee review.
To defend the – in Senator Robert’s words “extraordinary” – strike rate compared to any other court system, Mr Topperwien said that the 173 that were referred to the committee were a small subset of over 1800 that the PSR reviewed.
“The small number of practitioners who ended up going to the committee have gone through an exhaustive process prior to even getting there,” he said.
Further breaking down the prosecutory “pyramid”, PSR acting director Dr Sarah Mahoney outlined the many outcomes preceding PSR committee review in most cases.
These included educational activity, targeted letters and follow up billing practice review, DoHAC-undertaken audit and the practitioner review program, which is undertaken by senior medical practitioners.
According to Dr Mahoney, only cases of “really serious concern to the medical advisors in the department” are referred to the PSR.
“The only ones above us that we don’t deal with are outright fraud, that’s non-compliance.
“So, the only cases that we are looking at in the PSR are those that have already been through [the pyramid], and they’re near top.”
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According to Senator Roberts, his consultation with doctors and legal advisors revealed a “system loaded against doctors”, in which “doctors cannot appeal the merits of the evidence, they can only appeal the process”.
While Mr Toppenwien conceded that appeals focused on process, he maintained that doctors had “multiple opportunities” during the processes to bring their own evidence, witnesses and have legal representation.
“The substantive evidence on which the committee makes findings is the doctors own practice notes, it’s the doctor’s own evidence that shows that they have engaged in inappropriate practice,” he said.
“They have an opportunity to take an action to the federal court at any stage of the process about whether [the PSR] have acted fairly.”
The recently signed Eighth Community Pharmacy Agreement proved to be another contentious topic.
Opposition health spokesperson Senator Anne Ruston accused the federal government of breaking its earlier agreement with the pharmacy sector through 60-day dispensing and that the new agreement was an attempt to make amends.
“The pharmacy sector has paid the full price for your cheaper medicines,” she said.
Senator Ruston said the $2.1 billion promised in the 8CPA to support ongoing dispensing “recognises the fact that double dispensing has had an impact on the pharmacy sector”.
“[It’s a] $2.1 billion price tag that consumers are going to have to pay for because they’re taxpayers.
“So to try and suggest that [the 8CPA and 60-day dispensing] are not connected is being a little bit disingenuous.”
Federal Minister for Finance Katy Gallagher refuted the claim.
“The pharmacy guild sought an early agreement,” she said.
“[The federal government] put a focus on cheaper medicines through 60-Day dispensing, which has generated enormous savings to people and along with our other measure lowering the price of scripts, and with this pharmacy agreement, we will provide more cost relief.”
Speaking to our sister publication Health Services Daily, Wisam Zoghbi, a pharmacist and spokesperson for NSW-based pharmacist advocacy group CAPS, flagged the organisation’s ongoing concerns over 60-day dispensing.
“The issue of trusting the government remains a concern due to the challenges the pharmacy sector faced for the past 14 months, and the attitude adapted earlier on by key members of parliament.
“Pharmacists felt a sense of worthlessness and despair and the cut in funding and sudden changes in remuneration reduced the confidence in the industry.
“While the policy aimed to reduce costs for patients, it compromised the financial stability of pharmacies by reducing dispensing fees necessary for covering operational expenses and wages.
“It also led to price adjustments in services like Webster packing, OTC prices, home deliveries, and EFTPOS fees. The promise that no patient or pharmacy would be worse off has proven to be inaccurate and misleading.”
The groups said the recent difficulties would “not be forgotten” and outlined ongoing demands not met in the 8CPA, including removal of the DAA cap, an immediate end to the $1 discount, broader entitlement to free Webster packing and more Opioid Treatment Program funding.
Payroll tax also got a mention during today’s Estimates.
Greens Senator Jordon Steele-John queried why states couldn’t work towards changing their legislation to clearly exempt GPs.
“I imagined [states] could change their payroll tax legislation to exempt certain classifications of workers but that would be difficult to maintain. I mean, where do you stop then?” replied Ms Gallagher.
“A lot of private businesses would argue because of international and national factors that they should be exempt from payroll tax, which is why there’s a threshold [on business income].
“The states have responded in almost every case to put in an amnesty and work with general practice to outline how the court ruling applies.
“That was a sensible response to an issue that really hadn’t emerged [before] and had to be dealt with.”
