The same laws that will allow Medicare to withhold rebates if pathology companies don’t play ball are expected to eventually encompass general practice too.
Proposed sharing-by-default laws will enable the government to make Medicare payments conditional upon upload of information to My Health Record – a move that primarily targets pathology companies but may extend to general practice.
Health Minister Mark Butler flagged the changes, which are laid out in the Health Legislation Amendment (Modernising My Health Record—Sharing by Default) Bill 2024, in October last year.
When he made the announcement, it was in the context of a discussion about private pathology provider Healius having suspended the upload of pathology reports to My Health Record for 12 weeks in 2023.
“The ‘sharing by default’ framework will ensure that pathology and diagnostic imaging companies that do not upload the results of a test or scan will not get a Medicare benefit for that test or scan,” Mr Butler said at the Victorian Healthcare Week conference in 2024.
“Withhold a patient’s results and we will withhold the Medicare payment.
“It’s as simple as that.”
Mr Butler explicitly namechecked Healius in the announcement.
The pathology provider has never given a formal reason for its temporary boycott of My Health Record.
While the context of the legislation’s introduction was almost exclusively related to pathology companies, the bill itself is not specific about the types of services it applies to or what health information needs to be uploaded.
These particulars are governed by a separate set of rules which can be added to and changed over time and will only be developed once the legislation has passed parliament.
Related
Providers will still be able to take Medicare payments prior to uploading the necessary documents – there will be a mandatory timeframe in which the upload can be made. If the upload is not made in time, Medicare can ask for the benefit to be paid back.
To be clear, it was already known that sharing by default laws would apply to general practice; the somewhat new part is that Medicare rebates won’t just be held hostage for pathology companies.
An explanatory memorandum attached to the Bill suggests that the government does not feel that the current financial incentives for GPs to use My Health Record have been value for money.
“Outcomes to date suggest that while [the Practice Incentive Program eHealth incentive] has resulted in some increase in My Health Record document volumes, it has had unintended consequences of setting minimum expectations and has not resulted in behavioural change,” the memorandum said.
“There is some evidence that ePIP has led to counter behaviours such as delaying upload of summary documents for individual consumers until sufficient volumes of documents are available to maximise incentive payments.”
An FAQ document put out by the Department of Health and Aged Care clarifies that the rules will “initially” only apply to pathology and diagnostic imaging services but does not mention what other areas may be added.
In its submission to a consultation on the bill, the RACGP acknowledged that general practice would likely be among these additional areas.
“The legislative changes mean that where a patient Medicare rebate is payable for a healthcare service, there will be a requirement to share information about that service to My Health Record,” the college wrote.
“This requirement will initially be applied to diagnostic imaging and pathology services with the intention to progressively extend this requirement to other health information, including information from general practice.
“The RACGP is well placed to advise government on what is workable for general practice and recommends any future requirements for GPs to upload information to My Health Record are determined in consultation with the RACGP.”
While the college said it supported consumers having access to their health data and supported sharing pathology and imaging by default, it did not support real-time access to all results.
The bill was referred to the Senate Community Affairs Legislation Committee in late November 2024, with a report due back before the end of this month.
