Medicare claims shopped around

Fears that patients will face increased delays in receiving reimbursements from Medicare under plans to close shopfronts and consolidate processing centres have been dismissed by the Federal Government.

Department of Human Services staff told the Sunday Herald Sun that the Government planned to shut Medicare shopfront services, with all claims to be processed in one of 17 centres operating nationwide.

They warned this was likely to cause a blow-out in the time taken to reimburse patients.

But Human Services Minister Alan Tudge told Fairfax Media rejected the claim and said most patients would not detect any change, adding that the vast majority of claims were undertaken online.

“There has been a huge reduction in demand for face-to-face claiming so we are consolidating back-of-house processing work to ensure we provide high quality, consistent services,” the Minister said. “Some 96 per cent of all Medicare claims are lodged electronically.”

Mr Tudge said that even with the consolidation of shopfront services undertaken in recent years, most people would be able to find one within a few kilometres of where they lived.

But Labor seized on the Sunday Herald Sun report, claiming the changes would make it harder for patients to make a claim, and force them to wait longer for their rebate.

Shadow Health Minister Catherine King said the changes would not only make it harder for patients, particularly the elderly, but paved the way for the potential privatisation of Medicare – an suggestion vehemently rejected by Mr Tudge.

“Every single aspect of Medicare which is currently operated by Government will continue to be operated by Government, including the processing of the Medicare rebate,” he said.

Adrian Rollins

Cancer registry privacy fears

The AMA has raised concerns sensitive patient information will be in the hands of a for-profit operator following the Federal Government’s decision to award a $220 million contract to Telstra to build and operate a national cancer screening register.

The AMA has told a Senate Committee inquiring into the decision that although it did not have any in-principle objection to outsourcing clinical registries, it was worried by Telstra Health’s lack of experience in the field, and the implications of giving a profit-making enterprise access to commercially valuable and highly sensitive personal information.

“Telstra Health does not have direct previous experience in operating registries of this kind,” the AMA said in a submission to the Senate Standing Committee on Community Affairs.

Under the Government’s plan, data from nine separate cancer screening registers will be consolidated into a single National Cancer Screening Register containing the bowel and cervical cancer screening records of all participating Australians. Information on the register will be used to support the expansion of bowel cancer screening to cover almost 10 million people, and cervical screening for 1.4 million women.

The AMA said it would be “more comfortable” if the registry, which will contain sensitive information about a person’s cancer risk, medical procedures and health status, was in commercially disinterested hands.

“Given the potential commercial value of the data contained in the register, the AMA would be more comfortable with it being operated by Government, a tertiary institution, or not-for-profit entity that has little interest in how the data in the register might otherwise be used,” it said. “This would go a long way to allaying concerns about the secondary use of data for commercial reasons.”

The AMA’s concerns were echoed by health policy expert Professor Lesley Russell, of the Menzies Centre for Health Policy.

“Telstra Health will have the ability to access data from the Australian Immunisation Register, from the Australian Institute of Health and Welfare, and from Medicare claims, and the registers will be integrated with GPs, specialists and pathology laboratories,” Professor Russell said in a submission t the Senate Committee.

“Will the Australian population be comfortable with the fact that a for-profit business knows whether they have had a full or partial hysterectomy, if they are at risk of bowel cancer…and when they last had a colonoscopy?

“Will GPs, specialists and diagnostic labs be happy that Telstra Health can, at least potentially, scrutinise their diagnoses and treatment?”

Privacy Commission Timothy Pilgrim said the centralisation of such sensitive information in a database that can be accessed from many points posed “a number of security and privacy risks”, and suggested the operation of the register be subject to additional requirements under the Privacy Act.

But Telstra Health said it was “uniquely placed” to provide the register, with the size, scale and expertise to ensure its secure and successful operation.

It said Telstra already manages “extremely sensitive” data for hospitals, financial institutions and Government, and all information contained in the register would be hosted in Australia and controlled by the Government.

“Telstra will build and operate the Register in accordance with strict data security requirements determined by the Australian Government. These are the same requirements that would apply to any Australian Government or not-for-profit agency.”

Concerns have also been raised about how Telstra Health was awarded the job, and what might happen to the register and the data it contains when the five-year contract expires.

Telstra said it won the contract following an open tender, but the AMA is among those complaining the process has been opaque.

“There has been a lack of transparency around the process for awarding this contract,” it said. “The awarding of such a contract to an entity that has hitherto had no direct role in establishing or operating a register of this kind sets a challenging and potentially troublesome precedent.”

Professor Russell said the basis on which Telstra won the contract over other applicants had not been disclosed, and the Government had not explained why other entities such as the Department of Human Services, the AIHW and Cancer Australia had not been considered for the work.

“What happens when the Telstra Health contract expires in five years’ time – will it automatically be renewed, will it be up for competitive bids? How will this contestability affect the continuity, ongoing resources and work needed for the registers?” she asked.

Shadow Health Minister Catherine King said “clearly there are questions that need to be answered about handing these records to a for-profit company with no experience in this area”.

“This is sensitive, personal information about people’s health – we need to get it right,” she said.

Latest news

WMA condemns denial of medical care to prisoners

The World Medical Association has condemned Iran for withholding medical care from political prisoners as a form of punishment.

In a letter to Iran’s leader, the Ayatollah Sayed ‘Ali Khamenei, WMA President Sir Michael Marmot said the WMA was deeply concerned by issues raised in an Amnesty International report giving details of medical care being denied to political prisoners, including prisoners of conscience, as a form of additional punishment, coercion or to elicit confessions.

Sir Michael said the provision of adequate medical care is a key human right, which under international law must not be adversely affected by imprisonment. United Nations Rules for the Treatment of Prisoners provides that, “prisoners should enjoy the same standards of health care that are available in the community, and should have access to necessary healthcare services free of charge without discrimination on the grounds of their legal status”.

Sir Michael called on the Iranian authorities to stop withholding medical care as a punishment, and to ensure that security officials and prison staff, including medical staff, suspected of deliberately denying medical care were investigated and, where there was evidence, prosecuted.

“We appeal to your humanity and sense of justice and trust that you will take promptly all the necessary steps related to our demands,” Sir Michael wrote.

Kirsty Waterford

[Series] HIV and tuberculosis in prisons in sub-Saharan Africa

Given the dual epidemics of HIV and tuberculosis in sub-Saharan Africa and evidence suggesting a disproportionate burden of these diseases among detainees in the region, we aimed to investigate the epidemiology of HIV and tuberculosis in prison populations, describe services available and challenges to service delivery, and identify priority areas for programmatically relevant research in sub-Saharan African prisons. To this end, we reviewed literature on HIV and tuberculosis in sub-Saharan African prisons published between 2011 and 2015, and identified data from only 24 of the 49 countries in the region.

[Correspondence] Improving public defibrillator use in China

On June 29, 2016, a 34-year-old man fainted and fell on a subway platform. His sudden death increased public calls to make critical first aid equipment available in public places. The live video showed that several passengers who tried to give cardiopulmonary resuscitation (CPR) didn’t press the man’s chest fast enough and for long enough. No automatic external defibrillators (AEDs) were available in the subway station and a subway employee only made calls to emergency services and took no other action.

Rebate freeze threatening quality GP care

The nation’s GP leaders have warned the Federal Government’s Medicare rebate freeze is undermining the quality of care and will have “serious repercussions” for patients.

The nation’s peak general practice representative group United General Practice Australia (UGPA), which includes the AMA, the Royal Australian College of General Practitioners, the Rural Doctors’ Association of Australia and several other doctor organisations, has told the Government that financial pressure caused by the Medicare rebate freeze was threatening the kind of services general practices could provide.

“Modern general practice relies on sophisticated infrastructure to support quality care. The Government’s policies are eroding this infrastructure,” UGPA said in a statement. “It is challenging for practices to even maintain the status quo as the impact of the Medicare freeze compounds year on year.”

The peak group said GPs were being caught in a financial squeeze between increasing patient demands and rising running costs on one side, and stagnant income from Medicare on the other.

“Like all small businesses, general practices must cover many costs, including for staff, equipment, technology, building, insurance, and medical indemnity,”. “Many general practices are reviewing their practice costs and business operations in order to remain viable. The ongoing freeze is eroding the ability of practices to continue to meet demand and maintain the highest possible levels of primary care.”

The warning follows the release of data showing that patient out-of-pocket costs have surged as struggling practices have moved to offset the relative loss of income caused by the rebate freeze.

Medicare figures show that GP patient fees jumped 6.5 per cent last financial year, the biggest rise in four years, to reach an average $34.25, underlining AMA warnings that Government policies were pushing many general practices to the financial breaking point, with serious consequences for patients and access to quality care.

“GPs are caught in a diabolical squeeze,” AMA President Dr Michael Gannon said recently. “They are caring for increasingly sick patients while the Government tightens the financial screws in the name of budget repair. GPs are now at breaking point. Many patients who are currently bulk billed will face out-of-pocket costs well over $20.”

Health Minister Sussan Ley has claimed the record high bulk billing rate of 85.1 per cent showed that patients continued to get ready access to care.

But UGPA said this ignored the enormous pressure being placed on GPs and the increased costs imposed on patients.

“With an ageing population and a dramatic increase in the number of patients with complex and chronic conditions, the demand on quality health care from GPs is growing significantly and quickly,” the peak general practice coalition said. “The Medicare rebate freeze is squeezing general practice. It will have serious repercussions for our patients, especially the most vulnerable, and the health of the economy.

The group has added its voice to AMA calls for the Government to immediately scrap the rebate freeze.

Adrian Rollins

[Comment] Virtual reality and the prevention of falls in the real world

Falls are a leading cause of morbidity and mortality in older adults.1,2 Studies conducted in Europe, the USA, and Australia show that roughly a third of community-living people aged 65 years or older fall at least once per year, with half of this number having multiple falls in this period.2 Falls impose major social and economic burdens for individuals, their families, health services, and the economy. With the number of older people increasing across the world, the costs associated with falls will increase substantially in the coming decades,3 making the prevention of falls an urgent public health challenge.

Many living a long but not-so-healthy life

Australia’s latest check-up shows that although we are living longer than ever before poor diets, excessive drinking and inadequate exercise are undermining our health and almost half have a chronic illness.

In a comprehensive snapshot of the nation’s health, the Australian Institute of Health and Welfare reported that a baby boy born between 2012 and 2014 will, on average, live for 80.3 years and a baby girl born at the same time will live even longer, to an average 84.4 years.

However, more than 11 million Australians had at least one of eight chronic conditions, including about 1.2 million identified with diabetes – 85 per cent of whom had the largely preventable type 2 version of the condition.

In addition, 13 in every 100 smoke daily, 18 drink alcohol at risky levels and 95 do not eat the recommended servings of fruit and vegetables. Despite 55 out of 100 completing daily recommended physical activity levels, 63 per cent of Australians are overweight or obese.

The long-term decline in smoking rates has continued. The proportion of people aged 14 years and older who report never smoking rose from 58 per cent in 2010 to 60 per cent in 2013.

What kills us is changing. Cancer has overtaken heart disease for the first time as Australia’s biggest overall killer. It is predicted that 46,900 Australians will succumb to cancer this year – slightly more than 128 people a day. Nonetheless, survival rates for cancer are increasing.

More than 45 per cent of Australians aged 16 to 85 will experience a common mental disorder such as depression or anxiety, and one in seven will have suicidal thoughts in their lifetime.

Indigenous Australians continue to have a lower life expectancy and higher rates of many diseases, including diabetes, end-stage kidney disease and coronary heart disease.

AMA Vice President Dr Tony Bartone told ABC Radio National’s PM program that it was good news that Australians were living longer and that cancer survival rates were increasing, but lamented that around half of Australians had a chronic disease that was mainly caused by lifestyle choices.

“We still need to ensure the lifestyle prescription is the cornerstone of good preventative health care,” Dr Bartone said.

“Good preventative care is worth exceedingly more than the cost of the consultation, in terms of improved outcomes.

“Thirty-one per cent of the burden could have been prevented by reducing risk factors such as smoking or excess weight, and that’s a significant amount of suffering, morbidity, and of course health care.”

In 2013-14, $2.2 billion or 1.4 per cent of total health expenditure went to public health activities, which included prevention and health promotion. This proportion has fallen from 2.2 per cent in 2007-08.

AMA President Dr Michael Gannon recently urged the Government to invest in preventive health measures to improve the health and wellbeing of all Australians.

“The lack of investment, coupled with the freeze on Medicare patient rebates and cuts to bulk billing incentives for pathology tests and x-rays, is affecting GPs’ ability to provide primary health care,” Dr Gannon said

“Preventive health is not only an investment in the health of our nation, it is an investment in Australia’s economic productivity.

“When risk factors for chronic diseases and conditions are detected early and addressed, it reduces the need for more expensive hospital admissions.

“Australia spends significantly less on prevention and public health than comparable countries including New Zealand, Finland, and Canada.

“With the exception of tobacco control, there has been little or no progress against the national targets for preventing and controlling risk factors for chronic disease.”

The AMA calls on the Government to commit to:

fund prevention and early intervention as a sound and fiscally responsible investment in Australia’s health system;
increase investment to properly resource evidence-based approaches to preventive health; and
deliver sustainable funding for non-government organisations (NGOs) that advocate, educate and provide services to those affected by chronic diseases and health problems, including alcohol and substance abuse, domestic violence, blood-borne viruses, aged care, mental health and public health awareness.

The AIHW report is available at http://www.aihw.gov.au/publication-detail/?id=60129555544

Kirsty Waterford

Women, doctors largely in sync on health concerns

Australian women are most worried about gaining weight, but their doctors think they are more concerned about their mental health, a new study has found.

Overall, however, health professionals are pretty much in touch with their female patients, the Women’s Health Survey found.

The Jean Hailes group surveyed 3035 women, average age 48, and 20 health practitioners between February and May 2016. The health practitioners included GPs, nurses, naturopaths, and community and allied health services.

Overall, the women rated their health as good or very good.

On average, they visited their doctor three to five times a year, and felt confident asking their doctor questions and discussing health issues and concerns.

They undertook regular health checks, including pap smears, breast screening, and bowel screening, but not sexual health screening for STIs.

The top five health concerns nominated by the women participants were:

Weight management, and specifically weight gain (23 per cent)
Cancer, including breast, ovarian, and skin cancer (17 per cent)
Mental and emotional health, particularly anxiety and depression (15 per cent)
Menopause (9 per cent), and
Chronic pain (8 per cent).

Asked to nominate what most concerned their female patients, the health practitioners listed:

Mental and emotional health (28 per cent)
Menopause (27 per cent)
Weight (25 per cent)
Breast cancer (17 per cent), and
Fertility (16 per cent).

Nearly half of all women surveyed said they wanted more information on healthy eating and nutrition, anxiety and worry, and weight management.

Interestingly, four in five of the health professionals said their patients needed more information on vulval irritation and painful sex, yet very few women surveyed reported needing more information on these topics.

The women were most likely to get their health information from health professionals, followed by internet searches. They rated information from commercial organisations and social media as the least trustworthy.

More than 70 per cent of women rated their health as good or very good, and 93 per cent agreed with the statement that “good health is one of the most important things in my life”.

The survey is conducted each year to identify gaps in health information, understand future health needs, and identify trends in women’s health behaviours.

Maria Hawthorne

AMA in the News

Your AMA has been active on policy and in the media on a range of issues crucial to making our health system better. Below is a snapshot of recent media coverage.

Print/Online

Lift freeze on Medicare rebate, AMA tells Libs, The Australian, 18 August 2016

Australian Medical Association President Dr Michael Gannon has called on Malcolm Turnbull and Health Minister Sussan Ley to “stare down” their cabinet colleagues and restore funding to the sector.

Health funds put profits first, Australian Financial Review, 18 August 2016

Dr Gannon wants the Federal Government and regulators to check private health insurers’ increasingly aggressive behaviour that he says puts profits above patients.

Show us the money, Adelaide Advertiser, 18 August 2016

Doctors will boycott the Federal Government’s Health Care Homes program unless it is better funded, the Australian Medical Association warns. Dr Gannon, in his first address to the National Press Club, listed primary prevention as one of the key priorities of the doctors’ group.

Health insurance fee crisis put down to prostheses costs, The Australian, 22 August 2016

Dr Gannon talked about claims by health insurers that the price of pacemakers and replacement hips and knees is the cause of Australia’s rising health insurance premiums. Dr Gannon said that he did not believe that Australia’s healthcare costs were out of control.

Australia produces more specialists, not enough GPs, The Age, 25 August 2016

The Australian Institute of Health and Welfare reported that while the number of registered medical practitioners overall has increased by 3.4 per cent a year, the ratio of general practitioners has remained steady. AMA Vice President Dr Tony Bartone, said the increase in specialists was needed, but the number of GPs remained too low, especially in rural and remote areas.

Doc drug spruiking revealed, Adelaide Advertiser, 1 September 2016

Drug companies have revealed they are paying Australian doctors up to $19,000 for overseas trips, and more than $18,000 in speaking and consultancy fees to spruik and critique their medicines. Dr Gannon said some of the payments helped doctors attend medical conferences to keep up to date with developments in their field.

Radio

Dr Michael Gannon, ABC 666 Canberra, 17 August 2016

Dr Gannon speaks about his upcoming National Press Club Address. He says health is not the problem in the Federal Budget and there will be inevitable increases in health spending due to the aging population.

Dr Michael Gannon, 2CC Breakfast, 17 August 2016

Dr Gannon talks about his upcoming address to the National press Club. He says the AMA is a voice independent from Government.

Dr Michael Gannon, ABC North West, 22 August 2016

Dr Gannon talks about a body representing private health insurance called “For Government Reforms” which they say will make private health insurance cheaper.

Dr Michael Gannon, 702 ABC Perth, 24 August 2016

Dr Gannon talks about a GP who has admitted assisting in hastening the death of a patient. Dr Gannon says that doctors have to act within the limits of the law and ethical code.

Dr Michael Gannon, 6PR Perth, 6 September 2016

Dr Gannon says the Federal Government is looking to drop the requirement for a doctor to issue medical certificates for sickness, dismissing Medicare costs and reducing the cost of the country’s medical services. Dr Gannon says doctors would miss out on health promotion opportunities.

Dr Michael Gannon, ABC 666 Canberra, 6 September 2016

Dr Gannon accused the Federal Government of unfairly blaming GPs for ballooning health costs after an interim report for the MBS Review was released.

Dr Michael Gannon, 2UE, 12 September 2016

Dr Gannon talks about a review into the Medicare Benefits Schedule. Dr Gannon said primary care lacks funding, which creates problems.

Dr Michael Gannon, Radio National, 13 September 2016

Dr Gannon talks about the warning signs of stillbirths, saying decreased foetal movement is not normal. Dr Gannon says decreased foetal movement is a sign that the baby is at risk due to placental deficiency and pregnant women who think that their babies are being quiet should take the time to rest and assess the foetal movement.

Dr Tony Bartone, Radio National, 13 September 2016
AMA Vice President Dr Tony Bartone commented about the latest report on Australian health which found alarming rates of chronic disease caused by lifestyle choices. Dr Tony Bartone said good preventive care is worth much more than the cost of consultation as many cases of chronic disease could have been avoided by preventive measures such as quitting smoking or reducing alcohol consumption.

Television

Dr Michael Gannon, ABC News 24, 17 August 2016
Address to the National Press Club by AMA President Dr Michael Gannon.

Dr Michael Gannon, Sky News, 2 September 2016

Dr Gannon discusses ethical implications from a court ruling that a child with brain cancer does not have to undergo treatment. Dr Gannon also discusses same sex marriage and foetal alcohol syndrome.

Dr Michael Gannon, Channel 7 Perth, 3 September 2016

Dr Gannon comments on swabs taken on hand rails, doors and ticket machines that revealed the presence of a range of germs responsible for many common respiratory and stomach infections.

Dr Michael Gannon, ABC News 24, 5 September 2016

Dr Gannon comments on the interim report of the Medical Benefits Schedule Review, which found patients visiting doctors for sick certificates, repeat scripts and routine test results cause costs to surge. He said patients who present for repeat prescriptions provided doctors with a health promotion opportunity. He says bashing GP as inefficient or expensive is not right.

Dr Michael Gannon, Channel 9 The Today Show, 10 September 2016

Dr Gannon talks about the MBS Review interim report, saying the current situation, with doctors prescribing medicines and pharmacists dispensing them, is working well and avoids ethical conundrums.