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Questions raised over new crackdown on after-hours GP service
A key health watchdog is investigating Australia’s largest after-hours GP service in the first ever inquiry into a company rather than individual doctors.
After-hours doctors are popular – but there is new scrutiny of the sector.
In a move that could send shockwaves through the after-hours sector, the Federal Government’s Professional Services Review (PSR) – which usually focuses on individual healthcare practitioners – is investigating the National Home Doctor Service (NHDS), according to the ABC.
The PSR is reportedly investigating whether the service ‘knowingly, recklessly or negligently’ allowed some of its 800 doctors to engage in ‘inappropriate practice’.
The claims centre on the use of ‘urgent’ after-hours Medicare Benefits Schedule (MBS) items, according to NHDS chief executive John Pappalardo.
The company – also known as 13SICK – denies the claims and has mounted a Federal Court challenge on the basis its doctors are contractors rather than employees.
‘We are confident that we have at all times met the expectations of the [PSR] and the governing legislation,’ Mr Papparlardo told the ABC.
The PSR’s move raises broader questions over its decision to investigate a company rather than individuals.
RACGP President Dr Harry Nespolon told newsGP that while he supports the PSR’s right to scrutinise improper billing, he has questions over the potential expansion of the agency’s role.
‘This is the first time that a corporation is being investigated,’ he said.
‘It is reported that some GPs have been caught up in the PSR process through no fault of their own due to the backroom activities of, especially, non-medical owners.
‘The outcome of this case will show us the extent and possibly the operation of these new laws.’
PSR executive officer and general counsel Bruce Topperwien told newsGP he could not comment on the specific case due to the pending legal action. But he did confirm that the case represents the first time the PSR has investigated a corporation rather than individual practitioners.
‘The Health Insurance Act talks about persons, and “person”’ can also include a corporation,’ he said.
Section 80 of the act states the PSR scheme is for ‘reviewing and investigating the provision of services by a person to determine whether the person has engaged in inappropriate practice’.
Mr Topperwien said the PSR only investigates matters referred to the agency by the Department of Health.
‘We have no role at all in what gets sent to us. That’s from the compliance area within the Department of Health,’ he said.
The investigation comes after the Government cracked down on the after-hours bulk-billing sector, restricting the use of urgent after-hours item numbers and changing rebates to reflect the level of qualification attained.
The Government required doctors working for after-hours services to assess and record the details of any urgent service.
The definition of ‘urgent assessment’ was changed to cases where medical opinion is that the condition requires assessment that same night or other unbroken after-hours periods, and that assessment could not be delayed until the next in-hours period.
The use of urgent after-hours MBS items increased by 157% between 2010–11 and 2016–17, a phenomenon the Medicare Review Taskforce stated had ‘no clinical explanation’ in a 2018 Q&A document.
‘The growth had been driven by a corporate model of advertising on the basis of convenience, rather than urgent medical need,’ the document states.
However, the urgent after-hours arrangements did not change in rural and regional areas, in recognition of the existing difficulty Australians in those areas had in accessing after-hours care.
The RACGP supported the restrictions over concerns the popular bulk-billing services were often staffed by doctors who were not suitably qualified.
In a 2018 position statement, the RACGP argues that bulk-billed after-hour services should be restricted to GPs, general practice registrars with supervision, doctors working towards Fellowship, or doctors with more than 10 years’ experience.
Up to 100 doctors make agreements to repay rebates every year following a PSR investigation.
Correction: This article previoulsy stated the Government had ‘tightened’ the definition of urgent assessment.
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