Bill introduced to further improve PSR processes

The introduction of the second Health Insurance Amendment (Professional Services Review Scheme Number 2) Bill 2023 comes following the recent passing of the first Bill.
 
Aimed to strengthen the operation of the Professional Services Review (PSR) by addressing issues and ambiguities in the Health Insurance Act, the Bill forms part of the Federal Government’s response to the Independent Review of Medicare Integrity and Compliance (Philip Review), which recommended a comprehensive evaluation of the Medicare legislative framework to ensure it is fit for purpose.
 
Like the first Bill, which the RACGP previously supported, the new legislation makes key amendments to clarify and improve administration of the PSR Scheme.
 
Dr Emil Djakic, who sits on the RACGP Expert Committee – Funding and Health System Reform, provided responses to newsGP on these key points.
 
To better align requirements for qualifications of Committee members to the definition of inappropriate practice and clarify how these requirements should be applied.

Dr Djakic said this amendment represents a positive step to safeguard skill sets and ensure activities are clearly appropriate and well fitted to the task practitioners are asked to do.
 
‘This will make sure the people who are reviewing what is defined as an inappropriate practice, actually have qualifications and experience in that field,’ he said.
 
‘It highlights some challenges where people are across fields, [for example] it might be a GP with a special interest in dermatology. So, you might make sure that committee is constituted as people who are both GPs and dermatologists, rather than just dermatologists.
 
‘It’s a nuance but they’re making sure that that person who is deemed to be inappropriate in part of their practice has been assessed by people with the experience and skillsets appropriate to that area of medicine.’
 
The explanatory memorandum states committees can be ‘properly established for reviewing the provision of services by a practitioner with a rare combination of specialties or where the practitioner is providing services in a different field from their formal specialist qualifications.’
 
To make it clear, where appropriate, that a reference to a practitioner includes a practitioner who is not currently registered to ensure the PSR Scheme applies consistently.

‘This is their clarification around wanting to embrace people who are both an obviously actively practitioner in practice, and someone who might not be currently registered, and may have unusual circumstances,’ Dr Djakic said.
 
‘Letting your registration lapse isn’t a way of finding yourself outside the remit of the PSR, but those without anything to be afraid of have got nothing to be afraid of.
 
‘Someone who chose to stop practising to avoid the potential that they’re going to be somehow reviewed under this PSR arrangement, and under these readings might fall outside their remit.
 
‘I don’t see a lot of fear and loathing in that.’
 
To clarify the requirements for a person under review notifying a Committee they are unable to attend a hearing due to a medical reason, including that the person must provide a medical certificate supporting this.
 
‘Like any empowered review committee or corporation, you would like to have more clarification as to why you can’t present,’ Dr Djakic said.
 
‘As much as it is known to be a pretty rigorous process, at the end of the day it is a committee that is acting on behalf of the citizens of the country, and we don’t have a philosophical disagreement with the PSR and some of the ways it goes about things.
 
‘If there is a person who has been brought to examination or inappropriate practice who’s trying not to appeal on the grounds of ill health, I think some justification as to that basis is appropriate.’
 
To provide the PSR Director with the power to extend the statutory timeframe of 12 months for deciding a matter if the person under review leaves Australia or if there are ongoing court proceedings in relation to the matter.
 
Extending the statutory timeframe of 12 months for deciding is a legal discussion, according to Dr Djakic.
 
‘That’s a discussion about ensuring other processes that are running are allowed to happen and if the PSR timeframe is up, they really want the ability after the legal battle is resolved to be able to come back to it,’ he said.
 
‘I don’t see it as fearful. They’re arguing that under their area of legislation that they are responsible to, they feel like they need a tool to allow them to continue to examine that accusation of inappropriate practice.’
 
Overall, Dr Djakic does not see the Bill’s amendments coming into direct conflict for those who are practising.
 
‘Like a lot of rules and legislation that find their way into reviews or court settings, there are laws and regulations written to try and address people who are found to be inappropriately practising,’ he said.
 
‘Most of us, given the chance, have got very little to fear in that.’
 
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