MEDICARE has accused nine doctors of over-servicing patients at corporate medical clinics, in an unprecedented get-tough attitude towards medicos who allegedly put profits before patients.
An investigation by the federal Department of Human Services involving sophisticated data-matching and interviews with more than 200 doctors will see the nine doctors having to justify their charging to a professional review panel.
It is believed to be the first time Medicare has targeted a group of doctors who have not officially breached the so-called 80/20 rule, where doctors cannot conduct 80 or more services on 20 or more days over a 12 month period.
Changes in the primary healthcare market — including Labor’s GP Superclinics — has seen more medical services co-located, prompting Medicare to warn that if referrals were kept in-house, doctors might “not act as an agent of their patient, but of a corporation whose main concern is profits”.
The ongoing investigation identified 60 mostly urban clinics where four or more GPs had gone close to breaching the threshold.
While the former government altered Medicare rebates in an effort to prevent double-dipping, the changes in the market — not to mention the department’s ageing and complex internal systems — demanded a new approach to compliance.
The investigation is looking for possible over-servicing, and any systemic issues with the corporate models.
The Professional Services Review panel will decide whether the nine accused doctors have to repay money to Medicare or face other sanctions.
Former PSR director Tony Webber has raised concerns clinics might encourage doctors to service as close to the 80/20 rule as possible, and questioned whether Medicare could detect if doctors were churning through patients in a shorter work day than their peers.
The move comes as the Abbott government moves to introduce a $7 co-payment for medical services, which critics fear will lead to a costs blowout and make essential healthcare unattainable for some people.
The government has yet to detail how co-payments would work, although Health Minister Peter Dutton has suggested clinics might continue to treat some patients at no charge while requiring payment from those who can afford it. There are also questions as to whether insurers might have a greater role to play.
The Australian yesterday revealed the Health Department, in its submission to the commission of audit, highlighted how as much as a third of individual spending on health was for non-essential items, and that higher co-payments “would not, therefore, necessarily increase overall costs to consumers by the same amount, as consumers might substitute out some of their current discretionary spending on health”.
The department told the commission that “compared with other countries, Australia has an efficient health system that delivers strong health outcomes at a reasonable level of expenditure”.
It also pointed out how countries that relied more heavily on insurers for basic care tended to have greater inequality and lower quality of services, and that introducing similar measures in Australia might not reduce overall health costs.
“It should be noted that overall health costs per capita tend to be higher in countries with the greatest reliance on private insurance for basic care and market mechanisms, although the share of costs borne by government in these countries tends to (be) lower,’’ the submission says.
Mr Dutton is monitoring a Medibank Private trial in Queensland where members are bulk-billed, the health fund picking up additional costs.
Ahead of its privatisation, the government-owned health fund is planning innovations to demonstrate the value of insurance.
The government, however, has not adopted the commission’s proposed model for high-income earners to be compelled to take out insurance and use it and not draw on Medicare.
Source: The Australian