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Dr Edwin Kruys

10 Feb 2020
Opinion

Departmental ‘GP hunt’ may affect mental health care

Edwin Kruys

10/02/2020 2:57:38 PM

Dr Edwin Kruys warns that the latest DoH compliance push may have unintended consequences.

Opening letter
Dr Edwin Kruys believes a letter warning GPs about the use of mental health treatment items will result in a lower standard of care for people living with a mental illness.

Hundreds of GPs will this week receive a warning letter from the Department of Health (DoH) about Medicare claims related to care provided to patients with a mental health condition.
 
An unintended consequence of this latest departmental campaign – in which some GPs apparently will be asked to pay back Medicare money – will be a lower standard of care for people living with a mental illness.
 
The problem appears to be coming from this Medicare Benefits Schedule (MBS) note:
 
‘If a consultation is for the purpose of a GP Mental Health Treatment Plan, Review or Consultation item, a separate and additional consultation should not be undertaken in conjunction with the mental health consultation, unless it is clinically indicated that a separate problem must be treated immediately.’
 
In other words, if someone goes to the doctor for a mental health issue, GPs are not supposed to claim for general health or wellbeing services provided on the same day (unless it is urgent or an emergency).
 
In my book, it is unethical to deny treatment of comorbid health concerns because someone has a mental health condition. It also goes against the latest thinking around the benefits of optimising general wellbeing to improve mental health.
 
Mental health services across Australia are increasingly focusing on lifestyle and preventive physical health because of strong evidence that this assists their clients’ mental health – but at the same time, GPs are not allowed to charge for doing just this.
 
This Australian Journal of General Practice article states:
 
‘Evidence-based and effective lifestyle therapies are indicated for people with mental illness in addition, or as an alternative, to usual care. Strong evidence shows that lifestyle interventions, such as nutrition, movement, sleep, stress management and substance cessation, are efficacious and cost-effective therapies that improve mental health, physical health and quality of life.’ 
 
Don’t forget the 10–20-year shorter life expectancy of people living with a chronic mental health condition.
 
If the GPs, targeted by the DoH for claiming mental and other health items on the same day, were taking the appropriate time to provide genuine care, they should receive recognition for outstanding services instead of being treated like racketeers.
 
A version of this column was originally published on Doctor’s Bag.
 
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Dr Leslie Clarence Diefenbach   11/02/2020 6:37:08 AM

As long as they save money, they don't care.

Dr Dharminder Jit Singh   11/02/2020 7:31:09 AM

It is sad that some of the employees of Department of health are making a noble profession like General Practice look like rorters and scammers. They should be held responsible for causing suffering to patients by affecting the way GP’s treat their patients. No one is above the law.

Dr Karen Redman   11/02/2020 7:59:29 AM

So you think you’ve finished your consult, you’ve explained test results, written a referral, renewed scripts, checked blood pressure and an ear that was bothering them and you get up to go to the door and the patient bursts into tears. You close the door, grab the tissues, you know this is going to put you behind another 20 minutes at least, and you can’t claim a 23 and a 2713? What do think we are supposed to do, ask them to cone back tomorrow? Or do I claim a 44? That doesn’t really reflect what I do. Nor did Medicare ever tell us prior that the not related 23 had to be urgent. If they change the goal posts then why should it be retrospective? It will be very interesting to see if I get one of these letters, and who do I complain too?

Dr Aline Suan Lin Smith   11/02/2020 8:00:14 AM

It's outrageous that the Department has done this , and what is the Department's interpretation of that statement ... ‘a separate and additional consultation should not be undertaken in conjunction with the mental health consultation, unless it is clinically indicated that a separate problem must be treated immediately.’
If the GP deems that it's clinically indicated that a physical health problem need to be treated immediately, e.g prescribing and checking the diabetes or BP for a patient with Co morbid mental illness , does that meet the criteria or does "problem need to be treated immediately" constitutes emergency or urgent problems only.
It's pretty clear when I refused treating the physical health of my patients when they came in for their MHP.
They were appalled.I told them to write to their local member and Greg Hunt.
We are starting a petition...will the RACGP assist in stopping Medicare targeting the GPs that go the extra mile for patients, and probably outliers of stats!

Dr Kevin Jenn-Lii Ng   11/02/2020 9:35:25 AM

I can imagine there must be a few bad apples in the bag (massive one; of GPs) that forced policy makers into this for both good and bad reasons and perhaps prematurely and reactively given the public purse vs the inevitable profit minded amongst us with self justification perhaps induced by the way MBS is written and outdated.

A MBS claim reform and restructure and simplification would be nice one day, instead of us wasting time with item descriptor semantics.

Dr Anne Louise Gardiner   11/02/2020 9:43:25 AM

No one asked GPs if it was a good idea to pay them for jumping through hoops for things that assist the patient such as a Care Plan for podiatry or Physiotherapy or a Mental Health Care Plan so that the patient has access to counselling. Make them ordinary referrals for a maximum number of visits Ike 5 and 10 respectively, cut the bull, cut the fee and we will all be happier. Get rid of health assessments while you are at it and give the patient an item for an assessment for when they need an Acat referral or nursing care at home etc requiring extra time and input from the doctor.

Dr Eric John Drinkwater   11/02/2020 2:23:52 PM

makes me sad, pressuring me to ignore our great mentor's guidance on the second and third diagnosis

Dr Felix Bisterbosch   13/02/2020 9:30:09 PM

I totally agree with dr Anne: Most plans made by GP's are a waste of time and money and should be replaced by normal referral what should save the government a lot of money which should be used for increasing our tariffs.