An Australian health company will be investigated for a second time over evidence it potentially put profits ahead of patients through over-servicing.
The Federal Government has launched a second investigation after the ABC obtained evidence that Primary Health Care offered its doctors bonuses to see extra patients each day.
The bonus scheme was offered to doctors working in Primary Health Care clinics across Australia between September and February next year.
GPs were offered a bonus for seeing three extra patients each day and incentives to write extra diabetes and asthma management plans.
When doctors write up a plan they can bill an extra charge to Medicare on top of the scheduled appointment.
Health groups have been outraged by the offer and said patients were being treated like numbers to help the health company’s bottom line.
Primary Health Care is the country’s number one provider of large medical centres and made a profit of $162 million last year.
Legal experts said the bonus scheme was not a direct breach of health laws unless the result of the offer was for doctors to charge for extra unnecessary visits, called over-servicing.
The majority of Primary Health Care clinics bulk-bill, and extra billings mean extra costs to the taxpayer.
Primary Health Care said there was a problem with under-servicing in the health care system and the Government was trying to encourage more management plans for asthma and diabetes.
The ABC reported in October that the Government had launched an investigation after documents revealed Primary offered two of its radiologists share options in the company in 2010 based on revenue.
It is illegal to offer pathologists and radiologists incentives to over-service and the company said the offer was withdrawn the next day.
Health laws state doctors must not over-service: expert
The Consumers Health Forum said they were concerned by any offer that put financial incentives ahead of health outcomes.
The forum’s chief executive, Adam Stankevicius, said in the end it was patients and the public who would pay.
“On the basis of the information we have seen, it’s certainly a scheme that warrants investigation by Medicare, warrants investigation by the Professional Services Review,” he said.
“And depending on the outcome of those, maybe it may warrant investigation by the corporate regulator.
“I think it will exacerbate what we see as four-minute medicine, which is doctors who are rushing through appointments in order to bill higher numbers every day.”
Under the offer, GPs who work for Primary Health Care were offered $1,000 if they wrote 100 diabetes plans, $2,000 if they wrote 100 asthma plans, and $3,000 if they saw three extra patients a day, all completed inside six months.
University of Sydney health law expert Professor Cameron Stewart said national health laws stated clearly that doctors must not over-service.
There were also specific laws against offering incentives to over-service to radiologists and pathologists, but not GPs.
Professor Stewart said while the offer in itself might not break the law, the net result of it could potentially break the law.
“The concern [with this offer] is what you’re creating is an environment of over-servicing,” he said.
“If you have over-servicing it will mean patients will be subjected to further testing that they don’t need.
“More information means there’s less chance that the proper information will be picked up and they won’t get the diagnosis or the treatment that they need.”
A spokeswoman for the Department of Human Services said it took all allegations of prohibited practice seriously and sought to investigate where sufficient information was provided.
“All reports about potential prohibited practice, by either a member of the public or a medical practitioner, are reviewed in accordance with our compliance assessment procedures,” she said.
Extra visit to tell patient their foot wasn’t broken
West Australian mum Nicole Myers said she was concerned when her daughter Pfieffer injured her foot at calisthenics.
Pfieffer is a successful athlete and the pair went to their local bulk-billing GP clinic for an X-ray and speedy diagnosis.
When Ms Myers rang the Primary Health Care clinic to get the results, she was told she could not get the results over the phone nor at the desk because of privacy reasons.
“I was irritated and frustrated because I needed to take a morning off work and to take my daughter out of school,” she said.
“We were obviously taking medical appointments from people who really need them.”
Ms Myers waited for an appointment with her daughter, only to be told Pfieffer’s foot was not broken.
When asked for a copy of their privacy policy, Primary Health Care would not provide it.
Ms Myers said she suspected the clinic wanted the follow-up appointment to create more revenue.
“It’s just their way of getting people to come back for another consultation which they can bulk-bill to Medicare,” she said.
“More appointments means more money.”
Doctors’ decisions are their own: Primary
Primary Health Care chief clinical officer Dr John Houston rejected suggestions the company was promoting over-servicing.
Dr Houston said there was chronic under-servicing in the health system and over-servicing was an “alien” concept to him.
“It is almost impossible to keep up with the local demand for healthcare services which, on an almost daily basis, exceed what we can provide,” he said.
“Primary’s doctors are independent persons and so their decisions on how to conduct their practices are their own.”
Dr Houston said the Government had been trying to encourage doctors to better manage asthma and diabetes which was why the Government created special management plans for the conditions.
“The uptake from overwhelmed GPs has been poor,” Dr Houston said.
“Without doctor awareness, health policy is just that – policy and paper pushing.”