The MBS Review says the deputising services are not providing taxpayers with value for money
A plan to bar medical deputisers from using “urgent” item numbers has been welcomed by doctors’ groups, but sparked concerns about the impact on housebound and disabled patients if services disappeared.
The long-awaited MBS Review Taskforce recommendations, released last week, also proposed that the deputising services be barred from employing non-GP doctors.
The taskforce’s decisions are tough news for the commercial deputisers, which report 30% of their call-outs being billed as “urgent”, and whose doctors are not, in the majority, qualified GPs.
The report focuses on the four urgent item numbers (597, 598, 599, 600), which attract substantially higher rebates than non-urgent services.
The most commonly used item 597 is worth $129.80, compared with $74.95 for a non-urgent call-out (5023) or $49 for an after-hours Level B consult at a doctor’s rooms (5050).
The MBS taskforce report concluded urgent items should be restricted to GPs in regular daytime practice who are called out for an urgent patient assessment after hours.
Taskforce Chair Professor Bruce Robinson said it was the strong view of the Urgent After-hours Working Group and the taskforce that the steep growth seen in urgent after-hours services did not reflect clinical need.
“After-hours services are important, but we must ensure that patients get the right test or treatment first time, every time, and not be subjected to unnecessary and inappropriate care,” Professor Robinson said.
National Home Doctor Service (NHDS), a private-equity backed company which commands about half the after-hours market, was apparently stunned by the working group’s call.
NHDS has been working on a new code of conduct, including rules around advertising, hoping to appease concerns over alleged abuses of the system and the financial drain on Medicare.
In the five years to last June, the number of urgent after-hours services billed to Medicare grew by 150% to more than 1.87 million a year. The cost of those services surged 170%
to $245.9 million in the same period. Meanwhile, standard GP services grew by just 15% in number and rose 27% in terms of benefits paid.
The current situation supported “low-value medical care and did not represent value for money for the taxpayer”, the report concluded.
“The rebates for urgent after-hours services should only be payable in circumstances where a GP who normally works during the day is recalled to work for management of a patient who needs, in the opinion of the GP, urgent assessment,” it said.
“The higher rebate recognises the additional clinical value provided by, and lifestyle and financial imposts on, GPs who deliver these services to their own patients, the practice’s patients, or patients of other local practices where on-call work is shared.”
This was likely to result in better patient triage, based on the GP’s (or a closely supervised GP trainee’s) knowledge of the patient, better access to patient records, and better follow-up, it said.
The taskforce is now inviting consultations on the proposals.
Dr Spiro Doukakis, clinical director of NHDS and president of the National Association of Medical Deputising Services (NAMDS), said the proposals would force regional closures and hospital emergency departments would be “flooded”.
“The proposed changes will result in rolling closures of the service in communities such as regional Victoria and NSW; Cairns, Gladstone, Mackay, Townsville; parts of western Sydney, the Hunter and Central Coast, Western Australia, Canberra, Tasmania and Darwin,” Dr Doukakis told the ABC.
The Rural Doctors Association of Australia, however, said it would push to have the recommendations implemented. “Medical deputising services are largely an urban-based phenomenon and ensure that urban general practices do not have to take on an after-hours load,” association President Dr Ewen McPhee said.
Rural GPs were the same doctors who saw their patients at night, either at a hospital or at home, and they did not rely on “urgent” after-hours visits to earn an income,” Dr McPhee said.
The AMA and the RACGP also commended the taskforce proposals.
“This report is a positive step towards better supporting continuity of care between patients and their regular GPs,” RACGP President Bastian Seidel said.
Dr Seidel said he hoped it signalled a further shift by the government towards preventative care and building a world-class health system.
But the Consumers Health Forum noted that while after-hours house calls by GPs might theoretically provide better outcomes, there was no guarantee GPs would rise to the challenge of filling the breach.
“It does raise the question of why (GP after-hours calls) is not happening now and whether many GPs, whose working hours have tended to decline in recent years, would be willing to take up the challenge of a late-night call-out,” forum spokesman Mark Metherell said.
Ara Cresswell, CEO of Carers Australia, said home-doctor services had been a “godsend” to seriously ill and disabled patients and their carers.
“Carers Australia is very concerned about the impact on family and friend carers of some of the recommendations on urgent after-hours GP services,” she said.
