Readers reject alleged scale of Medicare leakage

Nearly 80% of voters in the most recent newsGP weekly poll have rejected allegations that doctors are gouging billions of dollars from Medicare each year.
 
More than 3300 people took part in the poll, with only 10% indicating a belief that the quoted figure is accurate, while another 10% were unsure.
 
GPs have described the coverage as a ‘kick in the guts’, especially after the sacrifices many have made during the pandemic, while multiple experts have questioned the scale of the issue, the evidence used to support the claim, and the way it has been characterised in the reporting so far.
 
Nonetheless, Nine Newspapers and the ABC continued their coverage over the weekend, with the latest article in the series calling for a royal commission into Medicare.
 
RACGP President Adjunct Professor Karen Price has long said that elements of Medicare are broken and in need of reform, but warned the exaggerated focus on fraud has the potential to do longstanding damage to general practice.
 
She also pointed to more recent reporting as a sign that people are increasingly beginning to question the ‘greedy doctor’ narrative contained in the series of articles.
 
‘The tide is turning quickly and for good reason – the vast majority of doctors do the right thing and certainly don’t deserve to be slurred by sensationalist media coverage,’ she said.
 
‘The problem is not dishonest doctors; it is the complexity of the Medicare system and the headaches this causes for busy GPs every single day.’
 
Professor Price pointed to team care arrangements as an example of unnecessary Medicare complexity in need of reform, saying it takes a toll on GPs and impacts patient care.
 
‘There are over 30 mandatory requirements for a GP Management Plan and Team Care Arrangements … [that] are overly prescriptive and are all about box ticking as opposed to the quality of care actually provided to the patient,’ she said.
 
‘This is why the RACGP has been calling for increased resources for Medicare education to support GPs to better understand billing requirements and to give them a chance to correct any inadvertent mistakes.
 
‘More than three-quarters of respondents to the Health of the Nation survey said that ensuring compliance with Medicare takes time away from actually caring for patients. It is, therefore, hardly surprising to find 61% reported that the complexity of Medicare is something that worries them outside of their workday when they head home.’
 
Associate Professor Terry Hannan, a consultant physician and at Macquarie University’s Centre for Health Informatics, has also warned that placing too much emphasis on practitioners could mean larger systemic problems are overlooked, such as a reliance on excessive diagnostic testing.
 
‘When you look at routine day-to-day care, the amount of wastage, overuse and underuse of resources and inappropriate care which leads to poor patient outcomes, that is 10 times bigger than the cost of fraud,’ he told the ABC.
 
‘We know that the more tests you do, the further you can get away from the diagnosis and ultimately you will find an abnormality in the tests and declare that as the problem, but it’s an incidental finding.
 
‘The variation in clinical care is based on individual decision making which is not supported by the evidence.’
 
Research conducted by Associate Professor Hannan has reportedly uncovered systemic flaws that are far more common than doctors deliberately setting out to defraud Medicare, such as a hospital unnecessarily conducting the same blood tests twice on individual patients – in the ED and again after being transferred to a ward – at the cost of around $1 million per month.

‘There’s no communication and the system design is wrong,’ he said.
 
‘Any rorting we see is really an end product of poor delivery of care.
 
‘If you improve the delivery of care, reduce the variation in care, support appropriate decision making, then that will improve outcomes in care.’
 
But while there is widespread agreement that Medicare is in need of reform, it is unlikely to occur in the short term. In the meantime, Professor Price is worried about the ongoing damage the negative coverage is having on general practice now – and into the future.
 
‘I fear this will reverberate for years to come and have a negative impact on the future of an already teetering GP workforce,’ she said.
 
‘We are having enough difficulty attracting doctors to the profession and keeping them … This story certainly will not make that task any easier, especially since the morale of the profession is now at rock bottom.’
 
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