If the Health Care Home revolution relies on MyHealthRecord working is that a problem?
MyHealthRecord appears to be key to engaging with the ‘revolutionary’ Health Care Home Medicare reform, despite being plagued with problems and low GP uptake.
“One is tied to the other,” according to Dr Steve Hambleton, chair of the advisory group that helped shape the pilot and current NEHTA chair.
“I would think that a high-performing Health Care Home would want to opt in,” Dr Hambleton said. “And if you don’t want to be a Health Care Home then you won’t have access to the new funding model.”
While Dr Hambleton said creating the records was “dead easy” and took less than 90 seconds per patient, February saw fewer than 400 GPs updating a shared health summary with the program.
The 65,000-person trial of the medical home model for chronic and complex conditions would shed light on doctors and patients opting out of the MHR and guide the national implementation of the reforms.
Between July 2017 and June 2019, up to 200 metro and rural general practices will be asked to sign up to the pilot, designed to inform the Health Care Home infrastructure rollout.
The federal government has promised to revolutionise healthcare for patients with chronic and complex conditions, and called it “one of the biggest health system reforms since the introduction of Medicare 30 years ago”.
Health and consumer groups have come out in support of the move towards a medical home model of funding, with the RACGP calling it a “life-saver”.
However, Dr Bastian Seidel, current chair of RACGP Tasmania, cautioned against overstating the influence of the mere $21.2 million earmarked for the four-year project.
“It’s very easy to do something that underfunded and set it up to fail,” he said. “So you just over-promise and under-deliver, and if we have a look at the funding now we are talking about $100,000 per practice roughly.
“Now you could argue that’s a lot of money, but realistically it’s not that much.”
He pointed out this didn’t come near the $60 million given to hospitals to fix the elective surgery lists, or the $600 million extra money given as part of the Community Pharmacy Agreement to expand into “GP-lite” services.
Nevertheless, Dr Seidel was enthusiastic about the trial, and said that it was reasonable to hope the reform could reduce unnecessary hospital admissions and emergency hospital presentations.
Opposition leader Bill Shorten criticised the announcement for being scarce on details, but a spokesperson from the Federal Department of Health promised the details around practice enrolment, payments, patient identification and participation requirements would be finalised over the next few months.
The reform takes cues from the Coordinated Care Trials and Diabetes Care projects, and will move toward a blended payment model.
According to a spokeswoman from the Department of Health, “payments for Health Care Homes will consist of an upfront payment and quarterly payments. The upfront payment will cover assessment, enrolment, initiation of a care plan and appropriate referrals”.
The quarterly payments are for ongoing care for a patient’s chronic conditions, she said, and to ensure that the patient’s healthcare needs are regularly monitored and reviewed, and will be dependent upon a number of requirements which will be finalised over the coming months.
As well as the above payments, GPs will be able to charge for episodic care not covered by a care plan. The Department would not provide further clarification on how they would be distributed or how much they would amount to. Patients will be stratified into one of three risk levels, with payments proportional to the complexity of care needed.
The government is also looking at the role private health insurers may play in contributing to the funding pool.
Others in the medical community have expressed concerns about how the money will be distributed to individual GPs, potentially disadvantaging female GPs who are more likely to be part-time and not practice owners.
