Softer tone in new compliance letter after RACGP questions

Doug Hendrie

5/02/2020 3:58:49 PM

Hundreds of GPs will receive a warning letter this week around mental health treatment items, triggering RACGP concerns over targeting. 

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A new warning letter is targeting GPs’ billing of mental health care plans.

The new compliance letter will be sent to 341 GPs who are co-claiming professional attendance alongside mental health items around 90% of the time.
According to a sample Department of Health (DoH) letter, the average co-claiming rate is 23%.
The sample letter seen by newsGP indicates the letter will cover GPs claiming professional attendance items and GP mental health treatment items ) for the same patient on the same day. 
The language in the new letter has noticeably softened after the RACGP questioned the tone of previous letters, with no mention of GPs being referred to the Professional Services Review for investigation.
Instead, the letter requests that GPs review the claims in question, pay back any erroneous claims and states that compliance action such as an audit may take place if claims do not meet MBS requirements.
But the RACGP has still questioned whether this letter is appropriately targeted, given GPs treat the whole person and that many patients do not present for a single issue.
The percentage of Australians seeing their GP for mental health concerns has more than doubled in a decade, rising from 4.3% of the population to 8.7% since 2008–09 according to new Australian Institute of Health and Welfare data.
Almost two thirds of GPs nominated mental health as the most common health issue their patients sought help for, according to the 2019 General Practice: Health of the Nation report.  
In recent months, the RACGP has grown concerned that the Department of Health’s increasing focus on outliers is leading to GPs feeling unfairly targeted – especially when there are legitimate reasons for billing.
In a December submission to an Australian National Audit Office audit of the DoH’s approach to health provider compliance, the college called for improvements to the way non-compliant cases are identified and how issues are communicated.
‘Compliance measures are unnecessarily intimidating in some cases … [M]any of the Department’s targeted compliance warning letters state that the GPs identified may be referred to the Professional Services Review,’ the submission states.
‘Guidance on appropriate use of MBS items can be ambiguous and contradictory.
‘There is a growing perception that compliance activities are designed to monitor and target statistical outliers, as opposed to targeting fraudulent activity.’
Many GPs are now reluctant to use item numbers with higher rebates for longer consultations due to the fear of being identified as an outlier, the submission states.
The mental health letter is the latest in a string of ramped up compliance efforts by the DoH that rely on statistical detection of outliers in Medicare Benefit Scheme billing for specific items and billing ratios. The increase comes after the Government announced almost $10 million to increase MBS compliance in May 2018.
Previous letters have targeted psychotropic medication, bulk billing incentive items, acupuncture, and the 80/20 rule.
The largest compliance push in recent years was a 2018 letter sent to almost 5000 GPs warning about opioid prescribing rates. That letter triggered a strong pushback from GPs over the tone and fear that it engendered. 
Australia’s Chief Medical Officer Dr Brendan Murphy – soon to be Health Department Secretary – responded to GP concerns in an open letter in newsGP and apologised for any anxiety and distress caused.
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Dr Ham   6/02/2020 7:25:16 AM

Well done RACGP
With your impressive input,the tone of the letter will certainly change.
Just can't remember what happened to holistic approach logo.
Next time, my patient complaint about GORD during mental health consultation, our answer should be
Today mental health management is on offer, come back tomorrow for organic symptoms.

SD   6/02/2020 10:05:30 AM

The art of medicine has been turned into a mere game of numbers by Medicare just for saving money .
Fewer claims and scripts- Where is the patient centred care reflecting in those numbers. GP’s are practicing defensive medicine, spending more time on notes than on patients and claiming less to avoid being “outliers” and hence avoid paybacks.
Dollars are saved but at expense of reduced quality of patient care, reduced access to medical care and heightened workplace anxiety and stress to GP’s.

Dr James Moxham   6/02/2020 3:45:37 PM

Thankyou to the RACGP for continuing to lobby on our behalf. The 'softer tone' may give a false sense of security - ignore the letter and it goes to audit and then PSR anyway. The only safe option is to never bill mental health and consult items together. I won't be getting this letter as I stopped doing this last year. Every time they target something and I get a letter or a colleague gets a letter or I read about something, I stop doing this as I cannot afford the $500,000 penalty. So far the list includes home visits, nursing home visits, suturing, long consults, prolonged consults, skin excisions, multiple pathology and radiology tests, all opiates and all benzodiazepines. Even bulk billing is risky given the PSR now consider 60 to be the new 80.
Medicare is being shut down, one statistical outlier at a time.
RACGP - please keep up the good work!

Dr Elaine Sung   7/02/2020 6:19:47 AM

One of the beautiful things about general practice is that you develop special interests. Each of us get really good at managing certain things. This means we get a bias in patients who choose to see us. Therefore each one of us gps will be a ‘statistical outlier’ in one way or another. Perhaps in our prescribing, referring or billing patterns.

Dr AT   8/02/2020 12:03:10 PM

With these repeated gov ‘compliance campaign’, surely the logical response of GPs (hopefully RACGP too) would be to tell patients sitting in front of us that ‘I’m sorry I can’t see you for your reflux because we just consulted and managed your mental health problem’. And the patient will be confused and ask ‘why’. The doctor will said ‘the gov and Medicare disallowed me to do this or else I’ll be audited like a cheater!’. Imagine what a public outrage (to gov and health department) it will be if increasing patient numbers are subjected to this ‘health consult’! Nothing is more effective than public outrage for those in government office.

Dr RB   11/02/2020 8:36:13 PM

Just got the letter myself - my goodness! Its a request to voluntarily repay the co-claimed Level 1 MBS items. Yet an another measly, penny-pinching attempt to homogenise the profession. And an opportunity to distress already stressed practitioners. In general practice you are now encouraged to be no more than ordinary - so much for doing more. The RACGP, the MBS, Services Australia, the AMA and the PSR make a strange bedfellows indeed. Its an appalling lapse in advocacy! How did the RACGP ever endorse such a monstrosity? Shame.

Dr Anon   15/02/2020 12:16:30 PM

I’ve received one of these letters. I’m gutted, I go above and beyond for my patients. Juggling the mental health of my cancer patients, my sexual abuse victims with obesity and complex care needs, they aren’t going to come back if I say sorry, no I can’t check your physical health today:- what message is that sending out? I came into medicine to help people, and yes I could do the 23 etc, for free but why should I? I already give a good 2 hours of my day free of charge trying to do the right thing by my patients to the detriment to my own young family. Enough is enough, in the past 12 months I’ve had a patient complaint which was ludicrous which took APHRA 7 months to resolve and now this, seriously looking at my options life’s to short to be worrying that you have to keep savings just incase you need to pay money back to Medicare, and yes I get the whole ‘you should know the MBS inside out’ but the reality of it is, a lot of don’t as it’s so complex !

Dr D   22/02/2020 1:31:15 PM

The MBS system is the worse system that I had ever seen, GPs who has tried to help patients in comprehensive way through care plan , mental health plan , but now government wants to crack down this items to pay back.
So at the end of our consultation we worked very hard as a honest GP did not get anything but it is bullying from government and not respect to doctors who tried to help patients. Doctors paid high tax then they have to pay back money again to government, so at the end, doctors did not have anything alias bankrupt and government disable doctors mentally because of this complaints from DoH.
A lot of GPs now afraid to do care plan, mental health plan, so they just want to do item "23", afraid that DoH will audit and catch GPs.
So doctors who had stressed with patients and also now stressed from DoH to collect their debt from debt collector. So it is not fair this system.
I hope RACGP can SOLVE this problem not making doctors stress mentally and physically