Urgent or not, after hours rebate is pretty paltry

The past few weeks have seen an unprecedented controversy around the use of a single word

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The past few weeks have seen an unprecedented controversy on the TMR website and other forums about the use of a single word

Not a word that’s bawdy, offensive, or in bad taste – just the simple benign old term, urgent, in the context of after-hours services.

For those not following the debate, Medicare classifies out-of-hours home visits as non-urgent or urgent, with the rebate obviously greater for the latter.

According to the MBS, urgent after-hours items can be used only where “the patient’s medical condition requires urgent treatment”.

And the source of the current brouhaha is what, in this context, the term urgent actually means.

Some commenters argue (almost to the death) that such a visit must be for a serious medical problem, which if left untreated until the next in-hours period would put the patient at significant risk.

Using this interpretation, practitioners claiming the urgent item number for visits where the diagnosis turns out to be less serious could perhaps be accused of Medicare fraud.

Others, including Sydney GP Ben Howell, whose opinion piece in these pages attracted vociferous criticism, disagree.

“When a medical professional is confronted by a presenting complaint that requires them to drive to a person’s house to determine whether that patient needs urgent hospitalisation, or can safely stay at home, then the condition of a 597 is met.

In my opinion, their presenting complaint required urgent medical treatment,” he wrote.

And to those who claim many of the after-hours calls are for trivial conditions, Ben says such calls are rare.

It’s a tricky one.

To Ben’s credit, he put his money where his mouth is last week, sending off details of his visits to Medicare seeking a ruling, along with an offer to repay his after-hours payments should it find against him.

Whichever way it goes, in my mind one thing is true. Given the inconvenience, responsibility, time and expenses, including a car, petrol and chaperone, $150 is a paltry rebate for a GP home visit in the middle of the night.
STOP PRESS:

Just before going to print, a supposedly clarifying letter to another doctor, from the Department of Human Services, fell off the back of a truck and into TMR’s hands.

The relevant paragraph goes like this:

“The requirement of the item descriptor is met if patient’s concerns about their condition are of such alarm to them, that most medical practitioners would respond to those urgently.”

It looks like now the argument has shifted from what urgent means in this context to what “most practitioners” would do.

Curiouser and curiouser.

kerri@medicalrepublic.com.au