Health Minister responds to RACGP concerns over latest compliance campaign

In February, hundreds of GPs were sent compliance letters by the Department of Health and Aged Care (DoH) questioning their use of the MBS item number 10997.
 
Specifically, the department took issue with claiming of the practice nurse item with a chronic disease management (CDM) item for the same patient on the same day.
 
GPs were upset and confused, and the college called on Federal Health and Aged Care Minister Mark Butler to intervene via an open letter in which RACGP President Dr Nicole Higgins outlined members’ ‘significant concerns’ about the approach.
 
Now the Minister has responded.
 
In a reply received by the college on 23 March, he acknowledged the RACGP’s concerns, including those related to the complexity of the item numbers, and said he has asked the DoH to consider how further guidance could be provided to assist health practitioners to correctly bill the items.
 
Minister Butler also tried to provide clarity on the intended use of the item number, noting that MBS items are ‘complete medical services’.
 
‘This means that many tasks that would be considered integral to a particular service should not be claimed separately under another MBS item,’ he wrote.
 
‘There are rare circumstances where item 10997 may be claimed on the same day as the CDM items, [but] these must be consistent with broader principles underpinning the MBS, and when that service is a separate, clinically relevant service from the services provided under the CDM items.’
 
He said the intention of item 10997 is to ‘provide additional support and monitoring for patients with chronic health conditions in between the more structured reviews by their GP’.
 
‘There are just five of these services available per year,’ Minister Butler wrote.
 
‘When this item is appropriately claimed on the same day as the CDM items, it reduces the number of services later available to patients under their entitlement.’
 
Following the compliance push, the Health Minister said a number of GPs contacted the DoH advising that their practice nurse spends a significant amount of time with a patient prior to the GP meeting with them to review and discuss the assessment and finalise their care plan. However, Minister Butler said that in this scenario it is not appropriate to co-claim.
 
‘The department acknowledges the invaluable assistance performed by their practice nurse and the positive impact on the patient’s health and wellbeing,’ he wrote.
 
‘However, the Medicare benefit a GP can claim for these CDM items includes assistance by the nurse in developing or reviewing these plans. A separate item should not be claimed for this assistance.
 
‘Should a GP have unique circumstances that could explain their claiming they are encouraged to discuss these with the department.’
 
Commenting on the reply, Dr Higgins told newsGP that the letter has provided much-needed clarity, but improvements to the compliance process are still needed.
 
‘The problem with the 10997 is that the advice from AskMBS and from the compliance unit was not consistent – it was ambiguous,’ she said. ‘It was really hard for GPs to understand what they wanted.’
 
Having been the recipient of a ‘nudge’ letter in the past, Dr Higgins said she understands firsthand that they can be ‘demoralising’ for GPs who are doing the right thing and have far reaching consequences.
 
She also noted that in this instance, it was most likely full-time GPs working in areas with complex disease who received a letter.
 
‘Many of these doctors have contacted me and have said that they’re going to reduce their working hours, which means reducing access to patients, so they don’t come to the attention of the compliance unit,’ Dr Higgins said.
 
‘The unintended consequences of a compliance activity means that it reduces access for patients to see their family doctor and impacts the mental health and wellbeing of GPs.’
 
Likewise, with recent Australian research revealing GPs under-bill in more than 10% of consultations, Dr Higgins said the profession has been ‘vindicated’ when it comes to Medicare compliance.
 
‘GPs save the system money [and] have been subject to numerous inappropriate compliance campaigns, which has caused harm to doctors,’ she said.
 
‘What now needs to change is we need to change the system – this is a system problem, it’s not a GP problem.’
 
To address this, Dr Higgins said the college will be meeting with the Medicare compliance team more regularly.
 
‘You can’t audit your way to compliance. We actually need to make these educational, not punitive, and they’ve committed to that process,’ she said.
 
‘We’re going to make sure that we will get resources, we will get the compliance team to actually talk to GPs about what they do and how they do it to raise awareness, but also to be able to influence the type of activities that are undertaken.
 
‘[We] need to move away from post-activity compliance because … information in their system is out-of-date and might not actually be getting the outcomes that they seek to achieve.’
 
In his reply to the college, Minister Butler did note that ‘most of Australia’s doctors and health professionals are honest, hardworking and comply with Medicare rules’, but that non-compliance does occur and that it is the DoH’s obligation to ‘maintain integrity of the Medicare scheme’.
 
‘This work is critical to support an equitable health system and to maintain community trust and confidence in Medicare,’ he said.
 
Minister Butler went on to acknowledge the ‘important role of general practice and GPs’ in providing holistic care to patients with chronic diseases to achieve best patient outcomes.
 
‘A principal finding and recommendation of the Strengthening Medicare Taskforce report is how funding arrangements need to be remodelled to more effectively support team-based treatment care in the primary care setting,’ he wrote.
 
‘It is encouraging to me that we are in agreeance on multidisciplinary care in general practice and that coordinated patient care for the management of chronic conditions should be the standard a patient receives.
 
‘I look forward to the RACGP and the department continuing to engage on the outcomes of the review and working together to ensure the integrity of Medicare into the future.’
 
The RACGP has said it is currently working to set up a webpage with links to information on MBS items and compliance processes in one central location. The links will reportedly be grouped by theme so that members can find the information they are looking for more easily.
 
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