Medicare changes must protect access to urgent care

Moves to tighten Medicare payments for “urgent” after hours services should ensure that any new measures do not reduce services for people with valid need for care, the Consumers Health Forum says.

“The report by the Medicare Benefits Schedule Review acknowledges that after-hours GP services are essential services and highly valued by consumers. Some medical organisations appear to have exploited the availability of higher Medicare fees for those calls deemed “urgent”. This is generating a much higher number of such calls but it is unlikely to mean that all such calls are unjustified,” the spokesman for the Consumers Health Forum, Mark Metherell, said.

“In recent decades the number of home calls made by GPs either in hours or after hours had been in decline until the advent of better organised after hours services.

“Without these services many people, including parents and young families and the elderly and chronically ill have faced greater difficulties in getting the care they need.

“What might constitute an “urgent” call is a matter for wide difference of opinion. Parents worried by the illness of an infant but unable to get to a hospital and elderly people in need will seek urgent attention for a condition that ultimately may not meet the clinical definition of urgent. But their plight is genuine and arguably a timely visit by a doctor can mean a better longer term outcome for many patients.

“The review proposes that Medicare payments for urgent after-hours services should only be payable if a GP who normally works during the day is recalled to manage a patient who needs, in the opinion of the GP, urgent assessment.

“While that provision might theoretically provide a better outcome, it does raise the question of why that is not happening now and whether many GPs, whose working hours have tended to decline in recent years, would be willing to take up the challenge of a late night call-out.

“The Consumers Health Forum suggests that there are other solutions to reducing any unwarranted exploitation of the payment for urgent services, including setting a time later than the current 4.00pm at which prospective patients can call for urgent after-hours services. As well enhanced routine monitoring by the Medicare watchdog, the Professional Services Review, should discourage abuse.

“We also think there is a role for Primary Health Networks to work with GPs to ensure consumers have local access to after-hours primary care.

“While we support Government initiatives to ensure Medicare is cost-effective, we also would want to avoid a position where a decline in after-hours GP visits leads to sicker people needing to rush to hospital emergency departments.

“The latest results of the Medicare benefits review underline the importance to consumers of ongoing assessment of expensive medical care and its value to the community. Beside the after-hours issue, the MBS Review has also examined other procedures ranging from spinal surgery to dermatology. It has recommended consideration of changes to improve the medical care Australians receive and pay for.

“In several instances the number of items for which specialists charge Medicare, and patients, could be reduced without diminishing quality of care. There are concerns that items were potentially being misused, providing low value care but enabling doctors to claim larger rebates from Medicare.

“The MBS Review is yielding important insights into Medicare costs which are important for the sustainability of the health system and we are glad to see that the 2017 Federal Budget has provided more funding for the Review to complete its work,” Mr Metherell said.

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Media contact

Mark Metherell

Em.metherell@chf.org.au
T:  02 6273 5444 
M: 0429 111 986