Opinion

RACGP President calls for immediate end to co-claiming crackdown


Harry Nespolon


19/02/2020 2:00:43 PM

GPs treat each patient as a person, not a statistic. Dr Harry Nespolon has called on the Department of Health to treat GPs with the same respect.

Harry Nespolon
Dr Nespolon has called for an end to the campaign. ‘That will end the fear and anxiety that so many GPs have articulated to us,’ he writes.

Over the past two weeks, many of you have contacted the RACGP with deep concerns over the latest compliance letter sent by the Department of Health (DoH).
 
It is fair to say that GPs everywhere have been deeply upset by the fact this letter targets something we hold dear – the ability to treat the whole person, mind and body.
 
The RACGP agrees with the sanctity of genuinely holistic care.
 
It is for that reason I have sent a letter to Federal Health Minister Greg Hunt, expressing my serious concerns about this myopic campaign.
 
I have called for two things.
 
First, the immediate end to this inappropriate and poorly targeted campaign.
 
Second, amendments to the Medicare Benefits Schedule (MBS) to remove the ambiguities that have caused this mess.
 
Specifically, we want clarity regarding claiming GP Mental Health Treatment items (2700–2717) and permission for the co-claiming of professional attendances where clinically indicated.
 
It must be noted that many of the GPs who have written to the RACGP have not received the letter. Regardless, they are angry about the intent of the letter and its condemnation of Australia’s frontline primary care professionals.
 
What they see in the letter is an attack on comprehensive and holistic patient-centred care. They feel that what drew them to general practice in the first place is now under threat.
 
We know that patients are increasingly coming to their GP with mental health issues. In fact, it is now the most common reason people visit their GP. We also know many patients do not come to us for a single issue.
 
That is the point of general practice – we can treat the person as a whole, not as a specific illness or issue in isolation.
 
While the RACGP supports measures to prevent wrongful and fraudulent claiming, this campaign makes no sense. It must be abandoned.
 
As we have pointed out in our recent submission to an ANAO audit on the way the DoH undertakes compliance, the reliance on algorithms to detect statistical outliers can get things drastically wrong.
 
GPs who do a lot of palliative care will prescribe more opioids than average. Should they be punished for that, as some were with a poorly targeted earlier campaign?
 
GPs who spend significant time with patients seeking help with mental and physical health will co-claim MBS items. Should they be punished for that?
 
The answer is simple: no, they should not.
 
Data can give the illusion of truth. But without context – without seeing the GP and the patient cohort – it is just data.
 
You don’t need to go far to see how this campaign has hurt general practice. Ask any GP and, chances are, they will tell you they have already begun to rethink how they provide care.
 
If GPs retreat from providing holistic care, it will hurt the community. Perversely, it may even cost Medicare more, if GPs are forced to ask people to come back another day for fear of the crackdown.
 
That’s to say nothing of the difficulties of scheduling separate consultations in rural and remote areas, or the potential for conditions to go untreated.
 
What’s really important here? That patients get the care that they need, when they need it? Or GPs ticking each and every box to ensure compliance?
 
I will be seeking to meet with Minister Hunt urgently.
 
We must stop the campaign immediately. That will end the fear and anxiety that so many GPs have articulated to us.
 
We then must take steps to prevent such short-sighted and cynical crusades in the future. We must amend the MBS so that it values and supports what we do, every day, as specialist GPs.
 
And we must support holistic, high-quality care – now and forever.


Letter to Minister Hunt

Dear Minister,
 
Re: Concerns with targeted compliance letters on co-claiming mental health and attendance items
 
I am writing to express the Royal Australian College of General Practitioners’ (RACGP) serious concerns regarding the targeted compliance letters recently sent by the Department of Health (the Department) to GPs who are co-claiming GP Mental Health Treatment Plans and professional attendance items more frequently than their peers.
 
As we’ve previously stated, measures aimed at preserving the integrity of Medicare and use of health resources by preventing wrongful and fraudulent claiming are supported by the RACGP. However, we are firmly opposed to this latest compliance activity due to the myopic nature of the campaign and the counter-productive message it sends to all GPs.
 
In the interest of patients and patient care, we ask for:
  • the immediate cessation of the inappropriate and targeted campaign for co-claiming professional attendances and GP Mental Health Treatment items (2700–2717)
  • amendments to the Medicare Benefits Schedule (MBS) for GP Mental Health Treatment items (2700– 2717) to remove ambiguity and allow co-claiming of professional attendances where clinically indicated.
Widespread effect on access to high-quality holistic general practice care
The RACGP has been inundated with queries from members (many of whom have not received a letter as part of the campaign) who are deeply concerned about the intent of the letters given GPs treat the whole person and many patients do not present for a single issue. Core to their role, GPs provide comprehensive and holistic patient-centred care and understand the interplay between bio-psycho-social contributors to health. Our members consider their ability to provide specialist generalist healthcare has been threatened by the campaign and its intent.
 
It is well known that more Australians are seeing their GP for mental health concerns, with mental health now the most common reason why people visit their GP. Some GPs have a patient cohort that consists primarily of patients with serious mental health conditions, many of whom also have physical health concerns. GPs do not treat a mental illness or physical ailment in isolation. GPs treat the person, which includes both their physical and mental wellbeing.
 
This compliance campaign has prompted all GPs to rethink the way they provide care, to the detriment of the community. Requiring GPs to focus on only one condition undermines both patient health and health system efficiency. Forcing patients to schedule a separate consultation for a physical condition often involves significant delays, and sometimes even results in conditions being left untreated, which can develop into more serious conditions in future. Such a result is a poor outcome for both individual patients and the broader community, and can result in significant and avoidable costs to the health system.
 
Amend the MBS to resolve this issue and support holistic, high-quality care
The RACGP has consistently highlighted that the requirements for claiming certain MBS items are unnecessarily prescriptive, restrictive and focus on process rather than the quality of the healthcare provided.
 
Therefore, in addition to ceasing the current campaign, we strongly recommend that government review the GP Mental Health Treatment item descriptors to remove the current ambiguity on co-claiming mental health and professional attendance items for the same patient on the same day. Addressing this issue through a descriptor change will support high quality medicine, and ensure people get the best possible outcomes.
 
We will continue to advocate for the cessation of the inappropriate campaign for co-claiming professional attendances and GP Mental Health Treatment items, and amendments to the descriptors for the mental health items, to ensure that patients can access the type of care they need, when they need it.
 
I kindly request an urgent meeting with you and/or a representative from your Department so we can discuss the impact of this campaign and our suggested amendments to the GP Mental Health Treatment items.
 
Yours sincerely,
Dr Harry Nespolon RACGP President



compliance Medicare Medicare Benefits Schedule mental health



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Dr Christopher David Mitchell, AM   20/02/2020 6:32:25 AM

This is a great response thanks Harry, I’d also like some accountability from the department. Who approved this and what is the consequences for their career


Dr Claire Elizabeth Cupitt   20/02/2020 6:38:12 AM

I am glad our college is finally recognizing the destructive effects of the DoH and their scrutiny of medicare use.


Dr John Christie   20/02/2020 7:13:09 AM

What a shame that the noble profession of General Practice has been become so degraded. To sacrifice so much of our lives to the service of our patients and communities only to be subjected to treatment as criminals trying to defraud the system. Instead of gratitude we receive threats from clueless and impersonal beurocrats. Ive often tried telling patients to come back for another consult due to medicare constraints only to be met with looks of disgust and to lose any therapeutic relationship that I had. Im sick and tired of trying to keep up with medicare intricacies and fear of wrong billing when all I want to do is care for my patients. We only have ourselves to blame for accepting such an overcomplicated and faulty beurocratic system. What a mess. I think that the college and the AMA need to be a lot more proactive in fixing a sick and faulty system.It is obvious that MBS needs to be a lot simpler and clearer and better still overhauled alogether.


Dr Partha Sarothi Modak   20/02/2020 7:40:55 AM

While I broadly agree with Dr Nespolon's letter I would go a step further, I would demand Federal Government to change the Act to accommodate co-claiming, after all it was the medicare act that was the basis of the medicare/ DoH letter. Therefore if we do not campaign for the act to be amended rather demand for the letter to be withdrawn we would lend credibility or at least not explicitly oppose the very root of the problem to this deterrent of comprehensive care that the very government wants us to provide to the people of this country. Furthermore, RACGP should consider building on this campaign to oppose current medicare ban on co-payment on all medicare payable service. This should serve the purpose of good health care in this country by bringing both fairness in pay for service system and hopefully accountability if medicare can back it up by bringing its acts together.


A.Prof Christopher David Hogan   20/02/2020 7:45:35 AM

Ah lies , damned lies & statistics- the curse of politicians since at least 1891. It is a shame too few people learn from history .


Dr Bev Ryman   20/02/2020 8:02:12 AM

They know we’ll keep providing the care because that is what we do. It’s a tactic to scare doctors into not using the item numbers that are apparently there to be used, so that the government doesn’t have to provide the rebate. Cost-cutting at its very best, hey?


SD   20/02/2020 9:31:13 AM

This is a positive step. GP’s need to be reassured that this overall compliance push is actually for catching fraudulent activities rather than a process of digging into clinical details of the consultations to find something to prosecute and raise revenue to justify the money that our government is spending on compliance.


Dr Sherif Francis   20/02/2020 1:08:47 PM

Thank you for the response Dr. Nespolon. General practice has been under constant and increasing pressure from bureaucrats and valuable clinical time is now spent on admin and red tape. I don't believe that there is any other profession in Australia that provides such a great value for money service as the Australian GP. Having government oversight on compliance is fine and needed, but the constant assault on GPs with more red tape and interference is no oversight. It's a waste of valuable time.


Dr Peter James Strickland   20/02/2020 3:24:30 PM

Please all remember this has nothing to do with patients' care. Public service bureaucrats are only interested in saving dollars---they are not interested in the care of your patients, except when it concerns them personally. I distinctly remember when the Labor Health Minister, Neil Blewett, had his child admitted to a public hospital with acute appendicitis, and complained when he did not receive priority from the surgeon for the care! Medicare bureaucrats put in the item numbers for claiming ---just keep doing the ethical and right thing by your patients, and ignore the bureaucrat letters, OR send back letters (hundreds of them) saying you are calling for a "ministerial" on the matter. They fear 'ministerials" as that can affect their future incomes. GPs rebates are a disgrace now ---compare them to specialists or legal aid lawyers.


Dr David Zhi Qiang Yu   20/02/2020 9:27:41 PM

I am fully support your action on behave of all GPs around the nation in this issue, Harry. Dr Nespolon, you are one of the best outspoken president of FRACGP I have met. As a GP, I always use holistic approach by using physical, psychological, social and spiritual model to deal with our patients in the daily bases. Some patients not only have psychological problems as well as have physical illness in the same presentation. We have not options but we have to deal with both issues in the same consultation.


Dr Ham   20/02/2020 11:39:39 PM

Will be interesting to see Health Minister bothers to respond back to peasants !!!


Dr Simon Titus Wamono   21/02/2020 6:43:33 AM

We GPs and RACGP have been too conservative in our dealings with DoH to effect change. We cannot keep using the same old methods over and over and expect different results. Let us be innovative on how we run our GP profession instead of laypeople, bureocrats and businessmen running our show.


Dr Sherif Francis   21/02/2020 11:51:44 AM

Thank you for the response Dr. Nespolon. General practice has been under constant and increasing pressure from bureaucrats and valuable clinical time is now spent on admin and red tape. I don't believe that there is any other profession in Australia that provides such a great value for money service as the Australian GP. Having government oversight on compliance is fine and needed, but the constant assault on GPs with more red tape and interference is no oversight. It's a waste of valuable time.


Greg Hunter   21/02/2020 6:05:27 PM

Thank you, Dr. Nespolon. Can I call you Harry? (Just as many patients call their GP by a first name.) I am most appreciative of your sensible letter to the minister who needs to think before letting his attendant workers send out such letters to primary care physicians. I may feel rather smug since my co-claiming comes in at a mighty fine 91%. Perhaps my peers do not see as many people in misery and despair as I do in aged care, the vulnerable unemployed, the fringe-dwellers and the depressed; or they may prefer to abandon the use of the available items altogether after this campaign. Perhaps the lack of access to MH care plans for people in RACF's could be addressed as well, or is there more coming our way in the wake of the recent Royal Commission into Aged Care? Perhaps young Scotty from Marketing will reveal all in a pre-election special. And I might upgrade my old bomb with 500,000km on it with my ill-gotten gains.


Dr Sugan Appasamy   22/02/2020 10:55:29 AM

I think that we have to increase our private billing. We have become slaves to Medicare and their whims and rules
We should become as powerful as the Pharmacy Guild and stop being like the proverbial lamb to the slaughter.
Start charging and get the public to write to their MPs and complain. The time for passively accepting everything must come to an end.


Dr Emma Keeler   23/02/2020 6:51:09 PM

I refuse to allow these letters to dictate the way I care for my patients. Using the fact that the very rare doctor who chooses to rort Medicare is continuously used to attack the quality majority and make us feel guilty needs to stop. I personally throw these helpful letters away, but I do think that striking back to illustrate to politicians etc the effect these letters have on us individually and as a profession is overdue. Well done Mr RACGP President.


A. Prof Malcolm James Clark   23/02/2020 7:36:20 PM

For so long it’s been I have charged for a mental health item number because the patient needs the rebate, but have been too worried to charge for the other medical care - work I have done - because I don’t want the stress and misery of an audit. Patients don’t understand - they shouldn’t have to - and boo to Scarborough House for once again successfully saving money by scaring GPs - their best value doctors - into accepting less for their time. Well done Harry & looking forward to Greg’s response.