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.
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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?