22 March 2021

Named referrals called out for ‘double-dipping’

Medicare podcast Political The Tea Room

Public hospitals issuing named referrals is a contentious issue among some GPs who think states shouldn’t be siphoning Medicare funds.

The requests to GPs that a patient needs to be referred to a specific clinician is possible due to a relatively obscure loophole in the National Health Reform Agreement.

This subclause (G19b) allows for public hospital outpatients – who would normally have their treatment covered by the state-based health service – be treated as a private patient if they are referred to a named medical specialist.

But it’s unclear if this rearrangement of public waiting lists actually leads to better quality of care.

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8 Comments on "Named referrals called out for ‘double-dipping’"

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Adrian Sheen
Guest
8 months 13 days ago

It all started in the 80s when public hospitals developed “private” out-patients. The out-patient departments became “University Clinics” and hence the could bill Medicare. All a fudge.
It grew from there and it is hard to believe that it is now enshrined in Clause G19b.

Leanne Barron
Guest
Leanne Barron
8 months 13 days ago

Why are GPs so hung up abut this practice? Most of the specialists don’t actually receive this money themselves, but the hospitals are able to use it to add federal funding ( which through Medicare funding is designed to fund specialist review) in order to ensure greater numbers of outpatient appointments. The money means that hospitals can employ more staff specialists – and also that patients are actually seen by the specialist themselves ( rather than simply a trainee).
Surely the benefits to patients are worth the 2 minutes of extra paperwork?

Peter Bradley
Member
Peter Bradley
8 months 13 days ago
Leanne, it sounds to me that you are not a GP, otherwise you’d know it takes much longer than 2 minutes to look up websites, scroll through the various specialties, then decide on a certain listed specialist to name the referral to. Either that, or your referral is reduced to being an even more of an insulting action, by them providing the name, and you just meekly going along. In no way does either situation meet the spirit of that subclause (G19b). One might add, why should GPs suffer this insult, and be forced to collude with what is clearly… Read more »
Leanne Barron
Guest
Leanne Barron
8 months 13 days ago
Hi Peter Yes I am a GP – and find that after many years in practice I actually know a number of specialists which obviously saves time. However, I believe that even if I don’t, any named specialist being involved gives a higher level of care than traditional outpatient clinics wherein many patients deemed “not serious enough” were seen and dismissed by the trainee doctors. It is illegal for a patient with a named referral to be seen by a Registrar only The system is clumsy, but the hospital is only funded to provide a limited number of services by… Read more »
Nick Nicola
Guest
Nick Nicola
8 months 11 days ago

Hi Leanne, in my experience, the name on the referral has to be correct, otherwise I recieve a terse fax stating the patient cannot be placed on the waiting list until it is corrected. Sometimes the previous head of unit has changed without notice to me. Furthermore it is rare that the patient is seen by the named consultant, almost always a registrar/resident. If indeed they were seen by the consultant I would not have such an issue with it.

Peter Bradley
Member
Peter Bradley
8 months 12 days ago

Well, Leanne, all I can say is wherever you are in practice, you are working in utopia, and with an outstanding public hospital, and where the OPD staff there all wear halos.

Below is a direct quote by someone who knows, from another forum, on the same subject…referring to OP referrals to named specialists…

…”this happens thousands of times every day in public hospitals in Victoria, where the physician bills Medicare for patients seen by the registrar.”

The above has been my experience also, and I worked in the system for 5 years.

Peter Bradley
Member
Peter Bradley
8 months 13 days ago

It is a rort, and has always been a rort. A rort that the federal govt conveniently turns a blind eye to because it suits them to, as it takes a bit of heat out of the clamour from state govts for more health money. It is actually duplicitous, because the patient has no real choice of specialist, and gets no better or quicker service either, that service often being from some other specialist other than named, or quite often a registrar only.

Brian Sullivan
Guest
8 months 14 days ago

This has been going on for several years. Government knows about it. It seems to be accepted as part of the health funding package. It’s not right, not fair, and should be stopped. Look up hospital referral requests and it’s in your face.

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