1 March 2021

What’s in a named referral? Money

Clinical Communication General Practice

A named referral may be a bunch of roses to a public hospital, but it does not smell as sweet to those who think states shouldn’t be siphoning Medicare funds.

Named referral requests normally come in the form of a letter from a public hospital to a GP, informing them their patient has elected to attend a bulk-billed clinic within the public system, and needs to be re-referred to a specific clinician.

These requests come in due to a relatively obscure loophole in the National Health Reform Agreement, subclause G19b.

This subclause 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 who is exercising right of private practice.

Once the hospital has a named referral, it can bulk-bill the patient’s appointment, accessing federal rather than state funds.

The patient will still have an appointment at no out-of-pocket cost; but GPs argue this practice indirectly results in poorer outcomes in primary care.

University of Queensland Associate Professor Gino Pecoraro, former AMA Queensland state president and an obstetrician and gynaecologist, told TMR he sees named referral requests as “double-dipping”.

“The only people who suffer are the taxpayers of Australia, who are paying twice for the public hospitals to do their job, because you pay money to the state government and you pay the Medicare levy to the federal government,” Professor Pecoraro said.

“Because [the state governments are] taking money away from Medicare, rebates aren’t being kept up to date with inflation.

“When someone sees a GP or specialist in the community, the rebates that the patient is given are next to meaningless because they haven’t been indexed to the true cost of providing health care.”

For Professor Pecoraro, a step in the right direction would be for public hospitals to publish their waiting list times.

“If I could tell a patient up front [how long it will be until they are treated] then a percentage of people who can either afford health insurance or self-fund will do that,” he said.

“That will have two effects: one, those people will get appropriate treatment in a timely manner; two, their names will be taken off the waiting list so that people who truly have no option other than relying on our public system will receive treatment faster.”

This is one of the few points on which Professor Pecoraro and public health economist Professor Stephen Duckett agree.

“In most states, there is no transparency about what the waiting times are for outpatient services, and so we end up with a hidden, or secondary, waiting list which could be very, very long,” Professor Duckett told TMR.

This, however, is where their opinions diverge; Professor Duckett, who is Director of the Health Program at Grattan Institute, sees named referrals as a viable way of addressing these long wait times.

“Any increase in [public hospital] activity is capped, and this in turn caps, growth in hospitals – but the hospitals still have to respond to increasing demand,” he said.

“The private clinics are essentially 100% funded by the commonwealth because they’re private activity, making them a way of increasing services to the local communities at no extra cost to patients.”

Despite seeing named referrals as an innovative solution, Professor Duckett admits the core issue is a lack of healthcare funding in general – a point which can get lost during these federal-vs-state discussions.

“We shouldn’t just be seeing this as a cost shifting issue – we should be asking what the best system for the patient is,” he said.

Professor Pecoraro, for his part, also acknowledged a lack of healthcare funding as a major roadblock.

“If the solution is to give more money, that’s fine,” Professor Pecoraro told TMR.

“But let’s make the politicians whose job it is to come up with ingenious ways to funding things put their energies towards that, rather than finding ingenious ways of hiding things.”

COVID-19 live update
Something to say?

Leave a Reply

8 Comments on "What’s in a named referral? Money"

Please log in in to leave a comment


Sort by:   newest | oldest | most voted
Karen Wayne
Guest
Karen Wayne
1 month 5 days ago

I always found it curious and a bit greedy that the public hospital out patient department requested a specific referral for long-standing patients to be seen
I would like to know whether that the particular specialist named,continued to personally consult on the particular patient, and that the specialist provided timely letters back to the referring GP! I doubt it very much.
It really ‘holds a gun to a GP’s head’ as if no referral is given, then the long-standing patient cannot be seen ! Or thinks the GP is the problem.

Michael Rice
Guest
Michael Rice
29 days 16 hours ago

@KarenWayne in Qld the patient will be seen regardless of the referral being private (named) or public. It’s been confirmed by several Qld Health Ministers at RDAQ forums.

If individual facilities in Qld are running “off-script” they need to be reported

Jayne Ingham
Guest
Jayne Ingham
1 month 9 days ago
Patients get the impression they won’t be seen without a named referral. The GP also gets a reminder to re refer after 12 months of the initial referral. Sometimes the patient hasn’t been seen yet ! The patient is being asked to return to the GP for a new referral. If we don’t see the patient often then I suppose this is a safety measure to check on their condition but more likely it is a patient we see regularly and they feel pressure to come in a referral before their next GP review adding another cost to Medicare. It… Read more »
Peter Bradley
Member
Peter Bradley
1 month 9 days ago
I am somewhat flabbergasted, that …”Professor Duckett, who is Director of the Health Program at Grattan Institute, sees named referrals as a viable way of addressing these long wait times.” Because there is no question it is dubious double dipping, and with little to justify it other than the woeful underfunding that all agree is the root cause. It does not increase the amount of service the public hospital can provide, because it does not increase their resources, just funds what they are already doing a bit better. However, in doing so, it actually allows those who can be seen… Read more »
Tim Leeuwenburg
Guest
1 month 9 days ago
I think the author (and indeed Prof Duckett) need to read the precise terms of the arrangement by which such ‘named referrals’ (or better still – private appts) are made First up, it HAS to be the patients decision to choose this – not the hospitals Given that the decision has already ben made (at the time of referral), to refer to a free public hospital OPD rather than a private clinician, it seems ridiculous to ask GPs to ‘re-refer to a named practitioner’ It also eats into our precious time, for little or no reward Moreover the benefits of… Read more »
Peter Bradley
Member
Peter Bradley
1 month 9 days ago
Tim, you are so right, as I hope will be supported by the comment I recently put up and still in moderation. I have always detested the very dubious mix of allowing private patients to be treated in public hospitals. It was absolutely verboten back in NZ, and even after living here 32 years now, I still detest it. It just reeks of conflict of interest. However, as in the OPC situation, it actually does not, in effect, result in any queue-jumping, or favoured status for that private patient. No, it just goes into the hospital’s funds. They made no… Read more »
daman langguth
Guest
daman langguth
1 month 9 days ago

It is total rubbish to think a BB 110 or 116 covers the costs of a public hospital outpatient clinic appointment. The real cost would be multiples of that. Named referrals are 100% without a double dipping. It is the very definition of double dipping. Two sources of funding for the same task!! [Edited under TMR comments policy] You cant see a pt, have a letter and appointment system, for the medicare amount.

Michael Rice
Guest
Michael Rice
29 days 16 hours ago

I’m sure you’re correct – there is undoubtedly a State contribution to any MBS-billed “private” patient in public OPD.

And THAT State contribution also makes it of dubious legality, doesn’t it?

MBS GN.13.33 and National Health Reform Agreement G17a

wpDiscuz