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RACGP raises questions over impending PSR changes


Anastasia Tsirtsakis


24/05/2023 4:03:39 PM

A representative says the college supports greater transparency and fairness around compliance, but notes the approach must be balanced.

A doctor checking a policy document.
The government has said it is taking steps to make the Professional Services Review process more independent.

The Professional Services Review (PSR) process may soon undergo significant changes with greater ‘impartiality and independence’ the key drivers.
 
Four amendments to the Health Insurance Act 1973 (the Act) have been proposed, based on recommendations made by health economist Dr Pradeep Philip in the independent Review of Medicare Integrity and Compliance report that was released last month.
 
If passed, the measures contained in the Health Insurance Amendment (Professional Services Review Scheme) Bill 2023 would:

  • remove the requirement for the Australian Medical Association (AMA) to agree to the appointment of the Director of the PSR
  • amend consultation requirements for appointing other statutory office holders of the PSR to enable consultation with relevant peak bodies directly
  • establish the new statutory office of Associate Director of the PSR
  • remove the requirement for the Chief Executive Medicare (CEM) to consult with stakeholder groups prior to issuing a notice to produce documents.
The college is yet to issue a formal response to the newly introduced bill, but Dr Cathryn Hester, a member of the RACGP Expert Committee – Funding and Health System Reform (REC–FHSR), told newsGP it is seeking clarity on what the amendments – particularly the CEM change – will mean for members.
 
‘We support any changes to the Department of Health and Aged Care and PSR structure and processes that increase the clarity of function, transparency and fairness in their compliance activities,’ she said. 
 
‘We hope to continue to build a more positive relationship with these bodies, so that practitioners can feel confident when providing services, without threat of indiscriminate or poorly formed audits or campaigns.’
 
While Dr Hester acknowledged that compliance activities are a ‘necessary part of our system and ensuring medical services are appropriately utilised for our communities’, she said there needs to be ‘balance’ against the significant mental toll that they take on our members.
 
According to the Bill’s explanatory memorandum, the CEM amendment ‘will streamline the audit process without limiting the documents or other information that a person may provide’.
 
‘There will be no impact on procedural fairness requirements during an audit,’ it states.
 
‘A person being audited will continue to have the opportunity to make submissions about their matter and to provide any information or documents they consider relevant.
 
‘However, engagement with the medical profession remains an integral part of the compliance program and stakeholder groups would still be consulted as necessary to inform compliance activities.’
 
Meanwhile, the AMA’s role in representing the interests of medical practitioners who may be subject to PSR review has been identified as a ‘potential conflict’ that necessitates the removal of its ‘veto power’ over the agency’s director appointment.
 
‘The current arrangement is inconsistent with public expectations regarding the independence of the PSR and may undermine public confidence in its role as a regulator,’ the memorandum states.
 
Likewise, when it comes to appointing other statutory office holders of the PSR – such as deputy directors and panel members – the consultation requirements will no longer require the AMA to provide advice. Instead, the Act will be amended to enable direct consultation with relevant peak bodies.
 
Similarly, the Bill will also remove the requirement for the AMA to be consulted on the appointment of the Chair and other members of the Determining Authority.
 
While the memorandum acknowledges that consultation with the medical profession is ‘important to assess the suitability of candidates and to maintain the profession’s confidence in the system’, it also notes that the Federal Health Minister ‘should not be constrained by the current legislative requirement for consultation with specific organisations’.
 
‘The amendments in the Bill will remove potential conflicts of interest to enhance public perceptions of the PSR and ensure the PSR process can operate with impartiality and independence,’ the memorandum reads.
 
The Bill will also create a new statutory office for an associate director of the PSR, who will be permitted to exercise the same powers as the director for cases as necessary.
 
Under the current Part VAA of the Act, the memorandum notes that there are ‘no provisions’ in the event that the director has a conflict of interest or is otherwise unable to make decisions on a case.
 
By allowing the Health Minister to appoint one or more associate directors depending on the operational needs of the PSR, the memorandum says it will also allow for recruitment of ‘more wide-ranging medical expertise’.
 
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