GP home visits could face Budget funding cuts

GP home visit service could be cut in upcoming Budget.

GP home visits could face Budget funding cuts

Concern is growing among doctors that Medicare Benefit Scheme (MBS) payments for after-hours visits to patients will be cut in the upcoming Federal Budget, leading to more pressure on already stretched hospital emergency departments.

The National Association for Medical Deputising Services (NAMDS) has commissioned a poll to gauge the popularity of the service, following signals from Health Minister Greg Hunt that the service was being ‘rorted’.

Mr Hunt said that while the Government was committed to after-hours medical services, these had to be provided and funded in the correct way. “But we also have a commitment to ensuring that every service provided is genuine and that every doctor is up to scratch," he said.

"I am concerned about reports that some doctors are claiming to be providing urgent services when they're not urgent at all."

"The advice from the AMA and the RACGP is that some of these junior doctors and corporate firms are claiming for items which are not genuinely urgent."

However, NAMDS President Dr Doukakis said the service actually saved money and did the job of easing pressure on hospitals.  He explained, that emergency department presentations for genuine emergency issues have grown by an average 26 per cent over the past five years, with growth in non-emergencies stopping at three per cent off a base of 19 per cent per annum prior to 2011. “That shows this is good health policy,” Dr Doukakis said.

"The savings to the health system were calculated by Deloitte Access Economics at $724 million (net savings) over four years,” he said. “Of course, the savings are to the benefit of state health budgets."

The poll found that 74 per cent of Australians would see a cut to the home-visits program as a breach of the Prime Minister’s promise to not cut Medicare funding or services.

Currently, the service is provided by trainee emergency doctors. There is a suggestion that the Government may force visits to be undertaken by GPs. Many such home visits also attract a higher MBS payment than regular visits as these are classed as emergencies. This has led to calls from doctors’ organisations other than the NAMDS to call for a change.

"Doctor home visits are an essential Medicare service and are relied on by 2 million Australian families – especially carers of people with disability, the elderly and young children,” Dr Doukakis also said.

Read more at SMH.com.au

Opinion: Sick and elderly need after hours services

After-hours doctors’ services were flagged for review by the Government’s Medicare watchdog last year, so news that they may be cut in the next Budget comes as no surprise. It just needs to be tackled in a way that doesn't affect those who genuinely need such services.

In its annual report last year, the Professional Services Review advised the Government that the increase in bulk billing to Medicare for doctors attending to home calls was ballooning. The main issue seems to be that, rather than treating the visit as a standard home consultation attracting a fee of $74, doctors are charging emergency rates of $129.

No one would disagree that while a child with a painful ear or throat isn't distressing, it’s not really an emergency. Nor is someone who has a bit of a tickly cough. This is where the problem really lies.

People seem unable to determine if their illness really warrants an emergency visit. In a survey of 50,000 patients who had used the after-hours doctors’ service, only 44 per cent said they would have waited to see the doctor the following day if a home visit wasn’t available.

A whopping 56 per cent would have called an ambulance, visited an emergency department or gone to an after-hours clinic.

Many states now have a service, Nurse on Call in Victoria and Healthdirect in NSW, whereby you can call and speak to a nurse to determine the severity of your symptoms. Would making such a phone consultation compulsory before an emergency home visit is arranged help regulate the service?

The elderly and the disabled, those who are carers and those who are genuinely sick need this after-hours service, but whether doctors can justify charging emergency rates is a very different discussion.

What do you think? Do you regularly rely on home GP visits? Would you suffer if these services were cut? Do you think they need more regulation?

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    COMMENTS

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    mogo51
    22nd Mar 2017
    10:14am
    Unfortunately, the medical profession being the greedy body that they are, have found another aspect of the medical field to milk. People with a sore toe calling in house calls from MDs is like cancer it is growing and the MDs are making a bomb.
    About time this got stopped.
    Eddy
    22nd Mar 2017
    1:59pm
    Goodness me mogo51, do you think that everyone in the medical profession is greedy, surely not, Every profession has it's shysters, look at banking. superannuation, real estate, car sales, dental, electricians, tilers, plumbers, accountancy, legal; the list is almost endless. Most medicos are honest, hardworking people who spend a significant part of their lives in getting qualifications to help us when we need it most. They are also in a business which has to turn a profit and provide them with an adequate income relative to their investment (both monetary and personal effort).
    I suggest that anything the 'bad' medicos get is just a drop in the ocean compared to other professions. Sure weed the bad out but don't tar them all with the same brush.
    buby
    24th Mar 2017
    9:05am
    There are many doctors in super clinics, and i think the doctors work hard there. But i do think its the super clinics that have been set up are making the real money.
    The doc's probably just a percentage. how do we really know.
    I'm sure there is so much more going on under the table than we know about.
    Cause i left one of those clinics and i tried to get my file so i wouldn't haven't to repeat anything, and the story was i had to pay to get it. WEll that was a shock to me. I've never had to do it before!
    But let me just say, when i did move on to another clinic, i found i had to redo all tests anyway, as much of the results of what was passed on obviously wasn't very clear. This is where much of the waste is happening. By doing a lot of retesting, tho its necessary sometimes when you need a second opinion. but in my case it got bad i even needed a third opinion, and only for such a simple thing as a torn ligament. HOLY MOLLY.......Our system is shot!! What the hell is going on.????
    buby
    24th Mar 2017
    9:06am
    oops Ps, i wanted to say i think doctor on call, Was a real Great help, I think the doctor was of good quality. This we need to Keep
    nettiser
    22nd Mar 2017
    10:24am
    What? Where is this area that doctors make home visits? I have never attended any clinic that would even give this a moments thought as part of MD service.This service only happens on TV
    Mez
    22nd Mar 2017
    10:28am
    Most medical clinics will have this service in the urban and country areas especially if there is enough staff.
    musicveg
    22nd Mar 2017
    1:42pm
    Not available where I live either, we have to either call an ambulance or drive 20 minutes to a hospital.
    buby
    24th Mar 2017
    9:10am
    OMG nettiser you being hiding under that hood for too long.
    ITs there Ask at your clinic, often they put in notices to your letterbox, and perhaps you got it in your junk mail, but YOU threw it out!!!! lol
    Mez
    22nd Mar 2017
    10:26am
    A Nurse on Call check first before a locum call is made would be a good idea because I know that Emergencies Departments are super busy and stretched to the max without added time wasted on tickly coughs and the like.
    However, there would need to be an accountability arrangement by the Nurse on Call to register each call so that locums can check it before making their visits.
    All time well spent then.
    CindyLou
    22nd Mar 2017
    3:49pm
    In NSW there is government service - think its called Health Direct 1800 022 222 (please check this if your are interested)... Anyhow, you can ring 24/7, speak to a Registered Nurse to get advice as to whether you need to attend ED or whatever. My daughter has called on a couple of occasions re issues relating to her young children. My daughter herself is a RN, but she wanted specific guidance regarding her kids situation. Excellent service.
    Troubadour
    22nd Mar 2017
    4:07pm
    Health Direct in WA too- also Medical Care at Home which does Drs. after hours visits too. Never had to use it, but my daughter has for the children and has been very happy with the service.
    Not Senile Yet!
    22nd Mar 2017
    11:25am
    Administration & Policing of this can be combined in this Instance.
    Doctors are Humans and as such there is one thing they avoid/hate.........Paperwork!
    The simple Solution.....rather than remove or alter the current service or costing......is to make the Visitong Dr provide Evidence/ Proof in writing by filling out an Affidavid stating exactly why it was an Emergency with Specific details to Claim the higher Fee.
    These then can be checked by Govt Drs for Irregularities!
    The LNP have Championed De-Regulating EVERYTHING....which is a Mistake!
    Humans need to be Policed/held Accountable....otherwise Greed & Corruption grow and can be like a Virus!!!!!
    Stop cuts in this Admin Area....and they will stop Fraud & Corruption increasing!
    Supernan
    23rd Mar 2017
    2:08pm
    All GP Practices have to have Quiality Assurance Reviews at regular intervals. All Bulk bill documentation has to be cleared before Dr gets paid. Its not instant !
    Mimi
    22nd Mar 2017
    11:33am
    All accredited GP practices are required to use either their own GPs or a deputising service for after hours visits. It's the deputising services that are claiming the emergency items, sometimes inappropriately. I am a GP and end up seeing some elderly people who live around me on weekends, public holidays etc, as they call me even though I am not their usual GP. I don't mind it although it if often inconvenient to visit them eg when I am about to go out or am sick myself. Once I was doing bowel prep for a colonoscopy and an elderly neighbour couldn't understand why I couldn't come and see her husband. In most cases minor illness can wait till the next day and anything urgent or a true emergency requires either an ambulance or a trip to emergency. The days when a GP visited the home for any illness are long gone. In those days, and when I first started as a GP, many people didn't have cars and there was not much traffic, which made it quite efficient to do daytime calls. The Medicare rebates for home visits are fairly low, patients don't want to pay, and payments for nursing home visits reduce with the number of patients seen, making it not financially worthwhile visiting the elderly in nursing homes for many GPS. General practice needs to be much better funded. Medicare spends an average of about $30 a month in General Practice, for each Australian.
    TREBOR
    22nd Mar 2017
    12:21pm
    I recall discussing, with my GP's husband who runs the practice, this very issue some two years ago - the idea then was to pay a set fee for visit to nursing home etc, rather than individual visits. Knowing full well the costing for running a vehicle per km etc - I opposed that idea. It sounds easy and reasonable to say one travel - but the actual costs are very high.
    dougie
    22nd Mar 2017
    11:39am
    It comes as no surprise to see this happen with the number of entrepreneurial medicos setting up after hours clinics which have become a milking cow rather than a means of emergency assistance to those with a real need.People who could visit their GP during the day stay at home and ring after hours. Lord knows what it costs as those who use the system with gay abandon seem to care little and will sign for anything.
    If a service is provided and then abused it will soon be removed and why not.

    22nd Mar 2017
    11:48am
    As with a lot of things in life, those who abuse the system cause problems for the 95% who are prepared to follow the guidelines. As it is most difficult to sort the good from the bad, the end result may well be that everybody wil miss out because of the greed of a few.

    Not all doctors are squeaky clean and I had an experience with one of them. I was hospitalised for about 10 days and then had to spend some time recuperating at home. During the recuperation, I had time to read the paperwork from the hospital prior to taking it to my health insurer. I noted that the doctor had billed for a daily visit although I had never actually seen him and I pointed this out to the person dealing with the paperwork at the health insurer. She told me that they were aware that doctors do this and told me of a doctor who they questioned about a claim. They had three separate claims that showed that the doctor was at his surgery as well as two separate hospitals at 11.00am on the same day. When challenged, the doctor told them that if they didn't pay that he would take the matter to a tribunal. They paid.

    I hasten to add that the greater majority of doctors are good, honest people and the illustration is only to reinforce that a very few will destroy a good idea because of greed.
    CindyLou
    22nd Mar 2017
    3:53pm
    Agree re the 95% of rat bags that abuse services, I'd guess that the police spend the majority of their time with perhaps 5-10% of the population - just a fact of life.
    Anonymous
    22nd Mar 2017
    4:39pm
    CindyLou, either you misread my post or you have misspelt your response. I maintain that 95% are the good guys who follow the guidelines.
    Cynic
    22nd Mar 2017
    11:54am
    We used the National Home Doctor service late last year. My husband had recently had knee replacement surgery and couldn't drive. I'd had a skin graft on my ankle and also couldn't drive. We would normally have gone to the local hospital emergency centre, but didn't feel we should call an ambulance, as we felt there were other more serious cases needing their service. My graft was getting hot to touch and very red around the edges, so we called the National Home Doctor service, as I felt I my graft was infected and I needed some antibiotics. I was worried about waiting until morning to call my own doctor. The doctor came, gave me a script for an antibiotic and 2 antibiotics to take immediately. I was impressed with the service and feel it is important for people who can't get to a hospital, for the elderly or for parents with a sick child. We had to explain the reason for the visit when we rang.
    Old Geezer
    22nd Mar 2017
    12:00pm
    We now have a system called Doctor on Duty" where you call a 1300 number and a doctor comes and see you after hours at home. It has nothing to do with your own doctor or their practice.
    Anonymous
    22nd Mar 2017
    12:16pm
    Reading the article suggests that it is the after hours medical practitioners who are providing trainee emergency staff who overcharge by claiming an emergency call-out rather than a home consultation.
    Nan Norma
    22nd Mar 2017
    12:12pm
    Greed is ruining this country. And it seems to me its the people that have the most that are the greediest.
    Rosret
    22nd Mar 2017
    12:33pm
    Very interesting.
    The after hours phone call, " I am really worried about X, I can't move him to get him in the car - he has XYZ."
    Response, "I think you should take him to casualty. Bye."

    Who has had a home doctor visit in the last 10 years? If the medical profession are ever in doubt as to the severity the phone call almost always ends in 'call an ambulance' or 'go to the hospital'. There never seems any point in making the phone call in the first place.
    Pass the Ductape
    22nd Mar 2017
    12:51pm
    I'll second that!
    KSS
    22nd Mar 2017
    2:38pm
    That's the point Rosret. The local GP can (and in fact must) either do after hours visits or deputise someone else. There are now companies that ONLY do after hours visits 13sick National Home Doctor Service is one such enterprise, 'doctortoyou.com.au' is another and you don't even have to go through your regular GP service to get to them. In fact GPs are complaining that they do not get proper reports from these after hours doctors about why they were called out, what the issue was, how it was treated and what advice was given.

    I suspect that many many of these call-outs are for non-urgent reasons and more convenience based than a health related imperative. If that's the case the visits should be appropriately charged and not bulk billed.
    Mimi
    23rd Mar 2017
    10:47am
    In this circumstance you would need to call an ambulance anyway.
    Mimi
    23rd Mar 2017
    10:47am
    In this circumstance you would need to call an ambulance anyway.
    Mimi
    23rd Mar 2017
    10:47am
    In this circumstance you would need to call an ambulance anyway.
    floss
    22nd Mar 2017
    12:33pm
    The most effected will be you guessed it. Well done Tumbull you are a mean person and the sooner you are gone the better.
    Pass the Ductape
    22nd Mar 2017
    12:54pm
    Well if think that, wait until the other mob gets in. Your troubles will only just be beginning!
    lwcarden
    22nd Mar 2017
    1:15pm
    The only time I have rung the after hours service is if my husband or I have had a migraine and have been vomiting. There have been senior doctors who call and have been great. For other issues such as a dislocated hip, I ring the ambulance. Otherwise we go to the doctors when we need to - anything emergency wise immediately and we are seen or with an appointment.
    Old Geezer
    22nd Mar 2017
    1:32pm
    You can't get into to see a doctor around here in under a fortnight so you just wait until it gets worse and call an ambulance. Awesome service then.
    jackie
    22nd Mar 2017
    1:17pm
    I agree there are too many lazy slobs that are exploiting the service with their doctors. If you are that sick call Nurse on Call who can advise your next move of just call an ambulance.
    Paddles
    22nd Mar 2017
    1:48pm
    Just one year (before I die) could you avoid a topic such as this until the budget is ACTUALLY DELIVERED??????????

    That way, you can prevent many of our vociferous "victims" getting bent all out of shape without just cause.
    Eddy
    22nd Mar 2017
    2:22pm
    Sorry Paddles, but this story was released for a reason. Maybe the profession is worried about funding cuts, or the government is seeing what the reaction will be before they make it official. Either way it cannot be avoided, it is the way the politics of economics is played these days.
    KSS
    22nd Mar 2017
    2:30pm
    As usual people are very quick here to blame the doctors and accuse them of greed. What about the people who are calling the after hours service? Seems to me that we have another example of people abusing the service for their own convenience - mainly I suspect because they are 'too busy' to make an appointment with a GP. Wouldn't we all like to have a GP at our beck and call and have it all bulk billed to boot!

    One alternative is to have a phone triage system where the person answering the call is appropriately qualified, can get the details and decide whether a visit is really necessary. If it is it would be classed as a genuine emergency (not bad enough for the hospital but can't wait for the morning) the visit goes ahead and a claim made accordingly.

    Or perhaps if the after hours visit was primarily user pays rather than bulk billed the number of call outs would be reduced. If the call out was a genuine emergency, the visiting GP would waive the bill. Likewise, the emergency department. Turn up with a sniffle and get charged - not bulk billed. Turn up with a genuine emergency and the bill is covered by medicare.

    Why wouldn't people use the after hours service? It is on call, at your convenience and you don't have to pay!
    Mimi
    23rd Mar 2017
    10:55am
    KSS, it's good to hear from someone who does not accuse us GPs of greed. Regarding patient who are 'too busy' to attend the GP during opening hours, which in some medical centres are from 8am to 10pm, I once worked in a medical centre that was open 24 hours per day.At 10pm the night doctor took over till 8am next day.
    A patient rang the receptionist and demanded a referral. It was our rightful policy that we had to see the patient before giving a referral. I was asked about the request and spoke to the patient, who said they were too busy to come in. Their appointment with a specialist was the next day, they were not our usual patient, and they probably had weeks to organise a referral from their usual GP. I wouldn't give them the referral, in fact it would be illegal for me to do so. I was amazed that a person could not attend even though we were open 24 hours! It was so unreasonable.
    Tom Tank
    22nd Mar 2017
    3:20pm
    This is a serious issue and I have no doubt that some people are needlessly using it, just as some do with A & E.
    Some sort of triage, i.e. Nurse on Call for example might be appropriate but the overall cost effectiveness might be an issue.
    We do need the ability to access after hours if needed and care should be given in establishing a system that provides that care at a reasonable cost. That is however a big ask as what would be considered to be a reasonable cost?
    Play Fairly
    22nd Mar 2017
    3:40pm
    I'm a bit 'over' what is happening with the present government. There is very little they haven't changed regarding people's living standards and entitlements. Health and Aged Care are both areas that funding shouldn't be cut.
    I am starting to believe that the Budget shortfall must be pretty huge, and much larger than the government has stated. Either that is the case, or these people are just plain unconcerned about everyday people's living standards and quality of life. However, they certainly are hell bent on giving $50 billion in tax cuts to the big end of town.
    Maggie
    22nd Mar 2017
    3:58pm
    I really don't understand why you want to worry old folks about something that might not happen!
    Anonymous
    22nd Mar 2017
    5:19pm
    Agree Maggie

    A lot of such articles appearing on this site lately
    srs21
    22nd Mar 2017
    5:07pm
    Can you believe that mob? They want us to stay in our homes instead of nursing homes and they're thinking of cutting funding to that service?! Unbelievable, but I'm shouldn't be surprised or disappointed in them, but by gum I am!
    srs21
    22nd Mar 2017
    5:19pm
    Was thinking ......you know about 30 years ago I'd phone up the surgery to make an appointment for one of my kids and several times the dr would say that he's driving passed shortly and he'd call in. How good was that?! On top of that he'd only charge for the needle or whatever..... not a small country town either by the way. The "old days "
    Snowflake
    22nd Mar 2017
    5:33pm
    My daughter works in a hospital and is privy to what junior doctors get up to. One manipulated the system to gain an extra $200000 additional to his yearly salary. Stupidly, the system allowed him to do this legally, he just happened to take advantage of it.

    Another senior specialist billed the hospital for two consultations. Problem was they were in different hospitals at exactly the same time. Not very bright in my opinion.

    Might I suggest more regulation and when these rotten apples are caught they are prosecuted for fraud, jailed if need be and struck off for a period of time. Maybe this would deter them from ripping us all off.

    Unfortuanately, the hoops that you have to jump through to punish these grubs is long and drawn out.
    I think we need a huge overhaul of the bureaucracy so that things can be rectified sooner rather than later.
    Snowflake
    22nd Mar 2017
    5:42pm
    Just to be clear I believe a good percentage of doctors act in good faith and I have personally dealt with some really good ones. Also dealt with some unsmiling, misreable idiots.
    Snowflake
    22nd Mar 2017
    5:42pm
    Just to be clear I believe a good percentage of doctors act in good faith and I have personally dealt with some really good ones. Also dealt with some unsmiling, misreable idiots.
    Snowflake
    22nd Mar 2017
    5:43pm
    Just to be clear I believe a good percentage of doctors act in good faith and I have personally dealt with some really good ones. Also dealt with some unsmiling, misreable idiots.

    22nd Mar 2017
    6:47pm
    looney's typical answer to any question posed on this site, just eat lots of onions and blames turnbul or the liberals for his farts

    22nd Mar 2017
    6:47pm
    looney's typical answer to any question posed on this site, just eat lots of onions and blames turnbul or the liberals for his farts
    Supernan
    23rd Mar 2017
    2:12pm
    The Home Doctor service is not run by loacal GPs. Its a separate service. You ring the special number. Or you can ring 132Health & talk to a nurse.
    Maggie
    24th Mar 2017
    9:19am
    HELP! How do I unsubscribe from getting notifications about this thing? I do what I am told and can't get out. I am getting up to 4 notifications for every single post!!!!
    Nursie
    25th Mar 2017
    11:58am
    A trustworthy After Hours Home Visiting Service is essential for our Health Care system and they are out there eg National Home Doctor Service.
    Most Medical Practitioners are conscientious reliable Practitioners who CARE responsibly for their Patients.
    As a retired nurse who has worked in health care for 60 years latterly in General Practice (the lynch pin of our health care service) I am amazed at the poor decisions that continue to penalize the general public and Medical practitioners. I am old enough to recall when Hospitals and Governments decided that Health Care should become a business model with the bottom line being Money ahead of Care.
    Instead of funding stand alone phone services swing the funding to supporting the After Hours Services to enable them to employ experienced medical personnel to triage effectively. In effect establish a system that means one phone call that enables the problem to be handled efficiently, the request documented and relevant information passed to the Patient's GP within 12 hours and to the recommended Hospital ER / Ambulance if this is required.
    Most people request Home Visits for the right reasons but there are the minority who abuse the system hence it is reasonable to monitor the service. Perhaps tie this to Accreditation?