Warning issued on point-of-care testing compliance

Michelle Wisbey

19/04/2024 4:18:22 PM

Despite thousands of MBS claims, the DoHAC understands no clinics are approved for the HbA1c test, sparking calls for practices to get accredited.

Person getting a blood test.
Last year, more than 4000 MBS 73812 items were claimed across Australia.

GPs offering point-of-care testing (PoCT) have been advised to seek accreditation, in the wake of thousands of MBS items being potentially claimed in violation of care standards.
The risk relates to MBS items 73812 and 73826, which require general practices to be accredited under the RACGP’s Standards for PoCT.
Related to glycated haemoglobin (HbA1c) PoCT, the items were first introduced in 2021, with item 73812 relating to the testing being performed by a GP, while item 73826 is testing carried out by a nurse practitioner.
The Department of Health and Aged Care (DoHAC) raised concerns about the rampant claiming in a recent compliance meeting with the college, which is happening widely despite no practices being accredited to offer the service.
Last year alone, 4009 MBS 73812 items were claimed across Australia, and 659 have already been claimed this year.
The item’s use has steadily increased since its creation, with a total of 7610 claims made.
A DoHAC spokesperson confirmed unaccredited practices are not eligible to claim the Medicare benefit items for their patients.
‘Accreditation requirements are important because they provide a quality framework for the provision of Medicare eligible services, ensuring patient safety and the consistent delivery of value for money and quality services nationally,’ they told newsGP.
‘Where the department’s compliance assessment procedures identify potential incorrect payments, it may pursue a range of responses including education, audit, and recovery of incorrectly paid Medicare benefits.’
The accreditation is completed through a site visit, which can occur either concurrently with a general practice accreditation visit, or as a separate process if already accredited.
Dr Tim Senior, a member of the RACGP Expert Committee – Standards for general practices (REC–SGP), told newsGP the accreditation process is designed to ensure GPs are offering high-quality care to their patients.
‘It’s making sure that appropriate testing is happening, that the machine’s working well, and that people know what they’re doing and are operating the machines correctly so they can actually trust the results,’ he said.
‘It’s about making sure the decisions are based on results, in good time, and appropriately, it’s about people being able to make clinical decisions on results that they can trust.
‘What accreditation allows is that you can trust that process so that the patient ends up with quality care because they’ve got the right results at an appropriate time.’
HbA1c testing is most popular in South Australia and New South Wales, where there were around 850 tests in each state last year, while Victoria recorded 677, and Western Australia 589. Tasmania has had the highest per capita use, at 144 services per 100,000 people.
Just one 73826 item was claimed in 2023, and none have been claimed this year so far.
PoCT remains a crucial and popular addition to general practice, with RACGP Rural Council Censor Dr Ken Wanguhu, who works in regional South Australia, telling newsGP it is often the only practical solution for GPs outside Australia’s major cities.
‘Point-of-care testing helps us make literally lifesaving decisions and it’s absolutely vital for my everyday work because it allows me to take the guesswork out of my decisions,’ he said.
‘It means our patients don’t have to wait two days for a result and they don’t have to travel … and without it, patients have to travel long distances at great cost to the system and the patient.
‘Asking a patient to leave their family and go to the city for two or three days is sometimes not an option, and it’s a major undertaking for many of our patients who are not in a city where you can hop onto a bus, go to hospital, get things checked, and come back.’
Moving forward, Dr Senior described the standards as ‘commonsense procedures’, saying most GPs should not have a problem meeting them.
‘The Department of Health and Medicare will want to see that it’s not just about having the right equipment, but that it’s based on quality,’ he said.
‘The Department of Health trusts the college’s accreditation processes, and the college’s standards and they actually allow practices to demonstrate and boast about the quality care that they’re doing.
‘The convenience of point-of-care testing means that there’s just going to be more and more of it done because doctors like it, patients like it, it’s easy to do, and it really helps with decision making, so making sure that quality of care is right is what accreditation aims to achieve.’
REC–SGP Chair Dr Louise Acland told newsGP it is crucial that practices ensure their accreditations are up to date.
‘By getting accreditation, GPs will be ensuring the safety of the patients and the information and clinical decisions that they’re extracting,’ she said.
‘This has been around for about three years, and at the time it was introduced the accreditation was widely publicised.
It’s available on our webpage with all our other standards, and the accreditation agencies have surveyors who have been trained in the assessment processes for the standards.’
To avoid being uncompliant, practices must be accredited against the Standards for general practices (5th edition) and be formally assessed by an accrediting agency approved under the National General Practice Accreditation Scheme.
This accreditation requirement was recommended by the Medical Serviced Advisory Committee to ensure quality in delivering the service, as well as alignment with other laboratory-based pathology tests.
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Dr Chih Chan Yao   20/04/2024 10:16:49 AM

There are a lot of items that allow you to claim, these makes Medicare a lot of opportunity to audit you. I feel that they dig a hole, let GP to jump in and audit you later.
The audit officer said to me, no opportunistic consultation, no co claiming for more than one item number in a consultation, the long consultation item also targeted by medicare audit.
They are abusing statistics, they target on the top 10% of whatever you do, even if you did one item, where there is no other GP claiming, you are the top 10% and will be targeted for audit.

A.Prof Christopher David Hogan   20/04/2024 10:51:59 PM

PoCT has a long & sad history.
Technology increased rapidly from the 1960s & an article in Time magazine in the 1980s said that "A wide range of ailments from diabetes to heart disease should be diagnosable in moments from a single drop of astronaut blood." This claim was repeated several times up to & including statements from the European Space Agency.
Recently a wide range of rapid bench tests can be performed in hospital EDs & ICUs.
Over 20 years ago groups of GPs started doing their own tests bypassing the pathology companies. Sadly they were informed they had to be registered as an accredited laboratory- while the fees were initially affordable, they became severely expensive & the process was uneconomical.
So it became - sure you can do the test but don't charge for it . Oh & you may put yourself in medicolegal difficulty by using an unaccredited device.
How about relying on blood glucometers? Don't ask me, I am not a lawyer & not a member of parliament.