Health Minister responds to RACGP calls to end co-claiming crackdown

Anastasia Tsirtsakis

5/03/2020 2:11:49 PM

Greg Hunt acknowledged consultation for the campaign ‘should have been better’.

Greg Hunt
Minister Hunt indicates the recent compliance activity ‘was not intended to discourage holistic or person-centred care’. (Image: AAP)

Federal Health Minister Greg Hunt has formally responded to a letter by RACGP President Dr Harry Nespolon calling for an end to the Federal Government’s recent compliance push, acknowledging consultation in the case of the recent letter ‘should have been better’ and that the Department of Health (DoH) is ‘revising its internal processes’.
The letter, sent to 341 GPs, discouraged co-claiming mental health treatment items with Medicare Benefit Schedule (MBS) professional attendance items.
Dr Nespolon had questioned whether the letter was appropriately targeted, given it is the role of a GP to treat the patient holistically.
However, in his response to Dr Nespolon, Minister Hunt indicates the recent compliance activity ‘was not intended to discourage holistic or person-centred care for patients being seen for their mental health’.
‘There is no suggestion in the letter that it is not appropriate to treat mental and physical health in the same visit if a clinical assessment determines that a separate health concern needs to be treated,’ Minister Hunt writes.
‘Medicare legislation recognises that a patient being treated for their mental health may also require treatment for their physical health, with the letter providing information about when it is appropriate to co-claim a general attendance item.’
Minister Hunt acknowledged that some recipients of the compliance letters had reported feeling distress or anxiety, but said ‘this is not the intention’.
‘Compliance education letters are intended to be helpful, and respect a practitioner’s expertise and clinical judgement,’ Minister Hunt writes, adding that the DoH recognises that ‘the vast majority of health practitioners and practice staff do the right thing, and where non-compliance is identified, it is often inadvertent’.
In his letter to Minister Hunt, Dr Nespolon had also raised concerns that the analysis of Medicare data does not consider the context of the specific GP and their patient cohort, a point the minister refuted.
He said no further action is required if the GPs pinpointed as having unusual claiming patterns are satisfied that their practice is appropriate. Rather, the DoH had found unusual claiming patterns to be ‘the result of a lack of understanding around the claiming requirements for particular items’.
‘As such, the letters provide information about the requirements of these items, with individualised feedback on claims. This was the case for the recent letter concerning the co-claiming of GP mental health treatment items with professional attendance items,’ Minister Hunt writes.
‘Specifically this compliance action responds to concerns that some GPs may be unaware that the GP mental health treatment item rebate includes the professional attendance associated with developing a mental health treatment plan, and outlines the expectation that when claiming a mental health treatment plan item, the consultation should focus on the patient’s mental health.’
The Government’s compliance push has received significant backlash, with more than 38,000 people having now signed Dr Gillian Riley’s petition against the ‘nudge’ campaign.
Minister Hunt, however, insists that the letter was intended to provide GPs with an opportunity to self-identify incorrect billing and voluntarily make repayments, allowing them to avoid escalated compliance action, such as audit and Professional Services Review, and incurring administrative penalties.
Stressing the Government’s commitment to Medicare, Minister Hunt said a compliance program is essential to ensure it is meeting the needs of Australians.
In addition to Dr Nespolon, the minister revealed that the Australian Medical Association and individual GPs had also expressed concerns – feedback he said would be considered in future compliance actions, including correspondence with practitioners.
Minister Hunt said he has requested the DoH to work closely with the RACGP ‘to consider improvements that provide greater clarity regarding the appropriate use of GP mental health treatment items with other Medicare services’.
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Dr Gonasagaran Ruthnam   6/03/2020 6:32:49 AM

Totally in agreement with all issues raised by Dr Nespolon as biologically mental and physical problems inherently linked with biology does not read regulations, DSM or compartmentalise for bureaucrats.

Dr Justin Alexander Edward Oughton   6/03/2020 8:12:11 AM

This is rubbish, the exercise is designed to scare GPs and prevent them from co-billing. That is quite clear. For GPs it means that they have to continually second guess themselves. Compliance will be assessed by the data first then the medical notes. It takes time to write those notes. Time that is taken away from the patient, the running of the practice, the GP and their family. At the end of the consult you make a decision about the billing., That decision has to weigh up the risk of inciting a Medicare audit. You have to decide which took more priority, the mental health or the physical health. On top of this If you think there is any chance your notes aren’t able to reflect the scope of what you have covered in your consult and you don’t have time to make them more comprehensive you are now being forced to dump the billing. This results in GPs billing less just to be on the safe side. And being underpaid for the work.

Dr Mahavir Prasad Gupta   6/03/2020 8:24:25 AM

Recent letters and medicare actions discourage me to provide care that I had been in the past or any good GP would like to provide. If I commit an "error" of treating a fracture and the patient returns in the next few weeks eg "acne", the claim is rejected saying it is 'aftercare'. The practice I work in is used in place of ED since we have imaging. In view of recent letter from DOH, I did not order an Xray on a patient initially only to find a nasty fracture the next day. Medicare had rejected all claims for physical issues when claimed with Mental Health Care Plans. I don't do that any more leaving the patients upset as they have to come again.

Dr Justin Alexander Edward Oughton   6/03/2020 8:31:16 AM

I remember being taught in both medical school and in GP training to focus on the patient, don’t spend too much time in the consult writing notes, give the patient time to tell their story, always check for the hidden things that might be affecting their health like depression, anxiety, not up to date with immunisations or screening, not coping at home, domestic violence, etc, etc.
So it turns out that this was all wrong. A good GP takes thorough careful notes, only addresses a single issue, pushes the patient out the door after 10 minutes, and definitely doesn’t ask about mental health, safety at home or lifestyle risks. Thanks for clarifying this Mr Hunt, I just hope that the RACGP, ACCRM and the universities take this point and start training their Doctors to be “better” - as judged by Medicare. The Government needs to be brought into line with community expectations and best practice. If it takes is a class action to do this then so be it.

Dr John Kelsall Lamb   6/03/2020 3:51:39 PM

Even in his reply he can’t help taking a swipe! ‘the vast majority of health practitioners and practice staff do the right thing, and where non-compliance is identified, it is often inadvertent’. So he is accusing (some of) us of incompetence as well!