The Health Care Homes trials are set up to fail thanks to government penny-pinching, college says
The centrepiece of Medicare reform to deal with complex and chronic illness has been set up to fail by government penny-pinching, the RACGP says.
Health Minister Sussan Ley blindsided doctors with an announcement late on Friday revealing the first details of the landmark Health Care Homes trials to start in 2017, including a surprise cap on funded GP visits for chronically ill patients.
The RACGP said it was disappointed with the framework, the lack of consultation with doctors and funding curbs for what was supposed to be a centrepiece of Medicare reform.
RACGP president Dr Bastian Seidel said a major concern was the decision to put a five-visit cap on benefits for HCH-registered patients seeing their GP for conditions not related to their chronic conditions.
“It is completely nonsensical,” he said, adding he would not recommend patients at his rural Tasmania practice take part under those terms.
“An elderly patient with a heart condition and dementia is also coming in for vaccinations, or they might have had a fall, stomach pain, or skin cancer that needs to be removed.
“It’s completely unclear what benefit there would be for patients compared with what is available now – chronic disease management plans which have been shown to reduce hospital admissions and to improve outcomes … and patients can see their GPs for unlimited reasons if they have acute problems.”
Under the Health Care Home model, practices will receive bundled payments rather than fee-for-service for patients with chronic illnesses, according to three tiers reflecting the seriousness of their condition.
Those with high-risk conditions and complex needs – about 1% of the population – would draw benefits of $1795 a year. Those with multiple conditions and moderate needs would attract $1267 in benefits, and people with multiple conditions largely self-managed are eligible for $591.
The proposed cap on acute visits would only lead vulnerable patients to seek care at hospitals, at far greater cost to the taxpayer, Dr Seidel said.
AMA Vice President Dr Tony Bartone said the government should consider putting off the trials, due to start in some 200 practices in 10 geographical areas around the country, in July 2017.
The government needed to win doctors’ confidence in mapping out a crucial reform that was “too important to fail”, he said.
“Right from the start we have said this needs to be funded appropriately. Doctors want to be part of this new approach but if you don’t adequately fund it, they won’t want to play.
“Doctors needed to be taken on a journey,” the Melbourne GP said.
“At the moment, there’s too much confusion and too much rush. Doctors need time to make their decisions.”
According to Ms Ley’s announcement, doctor have only until December 13 to register their interest in joining the trials.
A webinar to explain details will not be held until November 17.
Like the RACGP, the AMA and other prominent healthcare bodies were not informed in advance of Friday’s announcement.
Dr Seidel said the surprise late-afternoon news was like an episode of the US TV series The West Wing (set in the White House) where communications officials would speak of “taking out the trash”.
The Consumers Health Forum said the five-visit cap threatened to kill the initiative before it got off the ground.
“The patient-centred health care home approach offers a long overdue solution to the contemporary issues our health system is facing: growing complex chronic conditions, poor care and service coordination and the need for better service integration,” CEO Leanne Wells said.
“The overriding concern is that a negative response provoked by the prospect of a cap would doom HCH,” she added.
“The success of HCH will clearly rely heavily on consumer confidence as well as a positive response from GPs and their willingness to discuss the benefits with their patients. From the reaction of the GP community over the weekend, that seems problematic now.”
