Health Minister challenged on ‘Robodebt’ compliance letters

Former RACGP South Australia Chair Dr Danny Byrne has taken his grievances about a recent Department of Health and Aged Care (DoH) compliance campaign to the very top.
 
This week, nearly 600 GPs have been sent letters related to the co-claiming of chronic disease management and practice nurse support services on the same day, requesting that they review their billing of MBS item number 10997 and potentially repay money deemed to have been claimed incorrectly.
 
The compliance drive has come during a time when the Federal Government has been promoting the use of multidisciplinary care and healthcare workers, such as nurses, working to the ‘top of their scope of practice’ as a solution to Australia’s ailing Medicare system.
 
The irony of the seemingly conflicting messages was not lost on Dr Byrne, who called in to a live ABC radio segment on Thursday featuring Federal Health and Aged Care Minister Mark Butler to challenge him on the merits of his department’s recent compliance activity.
 
‘I got my “Robodebt” letter on Monday from Mark Butler,’ Dr Byrne told ABC 891.
 
‘I’m overusing the nurse Medicare items [10997]. I’m under threat of an audit. I’ve been asked to repay the money.
 
‘I don’t really care about the money. I care about being threatened by the Government and called a cheat – that I’m cheating the system.
 
‘All I’m trying to do is provide good care for my patients [and] get them to see the nurse instead of me for this care. It costs Medicare $40 to see me and $12 to see the nurse.
 
‘I’m really upset as you can tell.’
 
Dr Byrne went on to describe the compliance campaign as ‘mind-boggling’ given GP-coordinated multidisciplinary care is being promoted as a one of the Government’s key solutions to reforming Medicare.
 
‘We know the future is to have more nurses helping us out and for nurses to do this work,’ he said.
 
‘A lot of these [elderly] patients, their children take the day off work … for the care plan appointment. It’s an hour to 45 minutes with a nurse, 15 minutes with me and we try and do everything in the one visit, which makes common sense.
 
‘But now we’re going to [have to] say, “Oh no you have to come back next week for that immunisation. Come back next week to discuss your aged care issues.” It’s just mind boggling.’
 
Another doctor also reportedly sent a text message into the program supporting Dr Byrne, saying compliance campaigns like the recent round of letters were the reason why they left general practice.
 
Given the opportunity to respond, Minister Butler was sympathetic to Dr Byrne’s frustration and promised to look into the merits of the campaign.
 
‘I am sorry for the experience Danny’s had,’ he said. ‘I can’t comment on the case. I haven’t had a look at the letter, I’m sorry. A whole range of these things happen on a regular basis with the department, without me necessarily knowing the precise details.
 
‘But the first thing I’ll say is, Danny is absolutely right. This is what the Government wants more of – nurses to be able to work in a team with doctors.
 
‘Currently there are very strict rules that doctors’ groups generally say they want to retain, which ensures pretty strict oversight by doctors about what the nurses are doing in their practice.
 
‘There was a really deep conversation in the [Strengthening Medicare] Taskforce about whether nurses could be working a little bit more independently, frankly, than they’re able to do under those existing rules called collaborative arrangements. This is precisely the sort of thing we’re trying to free up so that we’re not hidebound by these regulations.’
 
Minister Butler also referenced the ongoing review of the compliance regime instituted in the wake of the joint Nine Newspapers and ABC ‘Medicare rorts’ series of articles, which he said will conclude in the coming weeks.

Dr Danny Byrne has described the current compliance campaign as ‘mind-boggling’.
 
When asked for a response, Dr Byrne said that Minister Butler is ‘saying all the right things’, but questioned whether he and the department were on the same page considering the targets of the recent compliance campaign.
 
‘[Minister Butler’s] got 100% support from me as far as increasing nurses and allied health and helping me manage these patients,’ he said.
 
‘I do a lot of things for $40 that the nurse or podiatrist or physio could be doing for cheaper.
 
‘But his department is sending out these “Roboletters” to [nearly] 600 GPs around Australia who are actually ahead of the game.
 
‘We’re leading the pack in this chronic disease management and use of nurses, and we’re being asked “please explain”. And I will explain, but I just don’t see why we should have been targeted like this in the first place.’
 
GPs who have received the letters – some of whom have been asked to review hundreds of claims by 17 March – have reportedly contacted the RACGP to express reservations about the vague and confusing nature of the MBS item number descriptor.
 
The letter, seen by newsGP, states that item 10997 can be claimed if the patient has an existing GP Management Plan (GPMP), Team Care Arrangement (TCA) or Multidisciplinary Care Plan in place.
 
However, the AskMBS Advisory on GP services (page 5) states that it ‘would not be expected’ that it be ‘routinely claimed’ on the same day as items 721 or 723, raising questions as to whether co-claiming is allowed, or if GPs can only bill both items for a patient on the same day if they present for two separate attendances.
 
It also appears to contradict itself by stating that item 10997 should not be claimed for assistance provided to a GP to prepare or review a GPMP/TCA, despite suggesting that billing these items on the same day is not restricted.
 
Additionally, while item 10997 is intended for use between structured reviews of a care plan by the patient’s usual GP, the AskMBS Advisory states that it can be used to collect information to support GP/medical practitioner reviews of care plans.
 
Likewise, neither the AskMBS Advisory nor the explanatory note (MN.12.4) explicitly state that 10997 is not able to be co-claimed with item 732 (review of GPMP/TCAs). A college spokesperson told newsGP the RACGP intends to seek clarification from the DoH on these issues.
 
Minister Butler also said that he intends to seek advice from the DoH on the recent campaign, and suggested that reforms will make shared care arrangements more flexible in future.
 
‘I think the point Danny is making … is that he has clearly structured his general practice in precisely the way we want to see happen across the country,’ he said.
 
‘This way in which he is practising is clearly the sort of thing we’ve talked about over the last several months and want to see more of.
 
‘It’s just that the systems, these regulations, these rules are restricting the ability for that to happen freely.’
 
In the meantime, GP and practice owner Dr Todd Cameron told newsGP the compliance campaign will counteract the Government’s stated aim of increasing bulk billing and access to affordable general practice care.
 
‘What I would expect is that GPs will just tire of this, up their private billing rates and distance themselves from Medicare altogether,’ he said.
 
‘It’s disappointing because health equity will be left behind and that will be a consequence of some of this behaviour from the audit team, in particular.
 
‘This is one of the more ridiculous ones as it actually targets people who manage more chronic disease, which is exactly what the Government has said they want us to manage more of via these other people having independent access to MBS item numbers.’
 
Log in below to join the conversation.

compliance Department of Health and Aged Care Medicare multidisciplinary care