Are the after-hours reforms really a win for GPs?

Paul Smith looks at the good, the bad and the ugly
after hours

ANALYSIS


It is always best to handle with care the fragile semantics used in the political battle over Medicare funding for after hours.

Hold the meanings too tight and they become dust.

For instance, when you read through the ministerial media release announcing the changes — issued shortly before Christmas — you can see very clearly the way the Federal Government wants to sell its reforms.

It states the following:

  • The Medicare rebate will be adjusted to better reflect the qualifications of the doctor providing the urgent after-hours care to patients;
  • GPs will receive a greater level of financial support for after-hours visits compared with non-GPs in metropolitan areas; and
  • The plan will ensure that patients needing an after-hours doctor receive the best quality care under Medicare.

The RACGP is very happy with this. The organisation is quoted at some length in this media release, "commending" the Minister for Health, Greg Hunt, for his “evidence-based adjustments” to the Medicare schedule.

The source of that endorsement is that from 1 March, only GPs and GP registrars will be able to claim the $129.80 for an urgent after-hours attendance in a metro area.

All other medical practitioners will generate a $100 patient rebate for the attendance, with this figure being reduced to $90 in January 2019.

College president Dr Bastian Seidel said:

“The gold standard for after-hours care is a consultation with a specialist GP. The proposed changes to the Medicare rebates make that very clear. This can only be in the best interest of patients.”

But, in fact, the lustre of this gold standard changes a little depending on time and place, and what else the doctor is doing.

First, the reduced rebates for non-GPs in metropolitan areas won’t apply if they are working “predominantly” in in-hours general practice.

Second, the government will also maintain the current rebates for urgent after-hours items for all doctors working in the unsociable period — between 11pm and 7am.

And third, any doctor — with an RACGP fellowship or not — is still deemed suitable for the highest rebate if they are undertaking after-hours work in rural and remote areas where the urgent items.

According to the ministerial media release, this is because the rural communities have “special needs”.

It is worth pointing out the obvious: none of this is about new investment in after hours, such as greater financial support to encourage more gold standard GPs into offering after-hours care.

In the first and last analysis when you read the word “reform” and "quality care", you should be thinking “funding cuts”.

You could argue that the “good news” for GPs in these long-awaited changes is just that the bad news is happening to someone else.

 

The other changes to after hours

Seeing more than one patient

Introduce a new urgent after-hours item with a flat fee for subsequent attendances at the same location for each additional patient.

Current rebate: derived fee — $74.95 for the first subsequent, down to $51 for seventh subsequent for VR GPs and non-VR GPs on a workforce program* derived fee — $43.50 for the first subsequent, down to $26.70 for seventh subsequent for non-VR GPs not on a workforce program*.

But from March this year, the rebate will be $41.95 for all GPs for every subsequent attendance.

Rules on "urgent"

Revising the rules for urgent after-hours items to define that a patient’s medical condition requires urgent medical assessment if:

  • medical opinion is to the effect that the patient’s medical condition requires assessment within the unbroken after-hours period in which the urgent after-hours attendance was requested; and
  • assessment could not be delayed until the start of the next in-hours period. 

Deciding if it's an urgent attendance 

Changes will be made to ensure that the attending practitioner determines that the urgent assessment of the patient’s condition is required.

Booking after-hours appointments

Ceasing the ability to pre-book urgent after-hours services (up to two hours) before the after-hours period.

Triage

Introducing minimum triaging standards for medical deputising service providers, to better identify patients in need of urgent after-hours services.

Source: Federal Department of Health and Ageing


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