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AROUND this time of year many NSW country towns hold their annual shows, with all sorts of entry tickets available, such as single entry or a day pass.
At our local show one poor bloke was protesting at the gate, saying he had paid for a ticket but had been called away. The gatekeeper wanted him to pay again as he only had a single entry ticket and had left the showground.
The unfolding drama reminded me of similar issues that those of us in private practice have with Medicare about postoperative treatment. Not a week goes by without me having some argument with Medicare after it has rejected a billing because it has deemed my service as aftercare.
The aftercare rules, described on the Medicare website, can be confusing and almost impossible to remember. Some items are exempt from aftercare while others are not. The aftercare period is highly variable and for some items can extend to several weeks.
When a public patient who has been treated in a public hospital chooses to consult privately for aftercare, Medicare will cough up the money. The Medicare information document states that the public hospitals should do their own aftercare unless “a public patient independently chooses to consult a private medical practitioner for aftercare”.
The public hospitals have clearly worked out that it makes sense to discharge a patient to private care as soon as possible, which is a subtle form of cost-shifting.
In my experience public hospitals routinely tell patients to “go back to your GP” or “go to the surgeon’s private rooms”.
However, when a private hospital patient needs aftercare, Medicare does not pay, so it is up to the proceduralist to assign part of the fee towards aftercare. And this is where it gets hairy.
I know of only rare instances where a doctor who has not done a procedure has been paid a fee by the proceduralist for aftercare. This is especially pertinent with the fly-in fly-out services outside of metropolitan areas, where GPs and others are left with the burden of aftercare, as well as the burden of rejected Medicare claims.
A recent study in the Australian Family Physician highlighted the burden of wound care on general practices. Since the previous government scrapped the Medicare practice nurse wound care items, many practices have been out of pocket for wound care. Difficulties in claiming for aftercare only make this situation worse.
One way to solve this problem is to overhaul the fees for procedures so that aftercare is no longer included. Aftercare could then be provided by any medical practitioner in good faith without fear of rejected claims.
In recent times there has been much talk of Medicare reforms, including introducing co-payments and updating models of remuneration and care.
If the federal government wants to prevent a ruckus at the showground gate, it is time the gatekeepers added aftercare to the reform discussion.
Dr Aniello Iannuzzi is a GP practising in Coonabarabran, NSW.
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I anguished about this issue when I was younger. When I discussed this with a wiser colleague he told me to simply ask the patient how the cat/dog fared when he was in hospital for the operation. He said this usually opens up a pandora’s box and brings out issues that require medical advice and the GP could give his share in that regard. That advice would completely and legitimtely not be part of after care, therefore you could claim for a consult on its own right. I have been doing that for many years and just add the notation on the bill to Medicare “Not after care”. I have never been rejected a bill for the visits since.That wise colleague became a medical advisor to Medicare years later
Medicare is ripe for reform. Like our outdated pencil and paper voting system for elections, Medicare is outdated and inadequate for our times. It is cumbersome, often very difficult to interpret, overly bureacratic and rewards doing procedures over complex management. It rewards 6 minute medicine, referring to specialists without workup and doing skin excisions. Is this what we really want??
Aniello
Well thought out
I am one of those rare surgeons: I teach with you, and pay the aftercare (25% MBS) when patients from another town go home.
Have probably missed or stuffed up a couple of times in 30 odd years.
Separating the fees is a great idea.
A doctor ,at this stage anyway,can charge a fee to the patient.It just won’t be covered by medicare.
Tell the patient to call their local politician if they are unhappy.