New AMA President to ‘speak up fearlessly’

The Australian Medical Association’s new president has told reporters that he’d like to build a more constructive relationship with the Turnbull government if they’re re-elected, “but we will speak up fearlessly when they produce bad policy.”

Western Australian obstetrician and gynaecologist, Dr Michael Gannon was voted into a two year term as President at last weekend’s AMA National Conference in Canberra.

Dr Gannon is the outgoing president of the WA branch of the AMA and is the head of the Department of Obstetrics and Gynaecology at the St John of God Subiaco Hospital.

On ABC’s Radio National this morning, he said: “I think that the AMA should always try and be constructive when it criticises policy of governments or opposition to come up with alternatives.”

One particular campaign that the AMA won’t be backing down on is the Medicare rebate freeze, a policy of key debate prior to July’s federal election.

“What we’ve tried to say for many years now is that successive governments have under-invested in quality general practice. That is the cornerstone of the health system: GPs providing quality care in decent visits will give you a saving. So even if you want to make an economic argument, you will have less people requiring hospital admissions, which are a lot more expensive down the track. Quality general practice is an investment in our community, it’s not a cost,” he told the ABC.

Dr Gannon did say that he intends to tone down the criticism of the asylum seeker policy, an area that Brian Owler’s leadership often commented on.

“If you ever hear me talking about it I’ll be talking about the health of asylum seekers, I won’t be making any comments about broader policy,” he explained.

The AMA conference also saw Victorian GP and outgoing President of AMA Victoria, Dr Tony Bartone elected Vice President.

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Nothing neat about lives put at risk

Patient lives are being put at risk by cuts to a program that was working to reduce deaths among emergency department patients, AMA Vice President Dr Stephen Parnis has warned.

As the pressure mounts on the major political parties to detail their plans for public hospital funding, Dr Parnis – who is an emergency physician – has called for both the Coalition and Labor to commit to specific Commonwealth funding for the National Emergency Access Target (NEAT).

His call follows the publication of a peer-reviewed study published in the Medical Journal of Australia that linked the NEAT with lower in-hospital mortality rates for emergency patients.

When NEAT was introduced, the goal was to ensure that, by 2015, 90 per cent of ED patients were to be admitted, discharged or transferred within four hours. This goal was supported by specific Commonwealth funding.

The MJA study found the policy was working, concluding that “as NEAT compliance rates increased, in-hospital mortality of emergency admissions declined”.

But the Abbott Government axed funding for the program in the 2014-15 Budget, and Dr Parnis said improvements in hospital performance had since stalled.

After improving every year since 2011-12, performance against the NEAT at the national level had “now plateaued, with no further improvements in 2014-15, with the likelihood that the situation could deteriorate as a result of the Budget cuts,” he said.

“A target that was working to improve performance has stopped delivering further improvements.”

The cut the NEAT fund was part of a broader Government policy to slash up to $57 billion from public hospital funding by the mid-2020s by disowning National Health Reform Agreement commitments and lowering the indexation of funding to inflation plus population growth.

The AMA has been highly critical of the massive funding cut, which has also drawn the ire of State and Territory governments.

In an effort to neutralise public hospitals as an election issue, Prime Minister Malcolm Turnbull last month announced the Commonwealth would inject an extra $2.9 billion into the public hospital system over the next three years.

But Dr Parnis said that although the extra money was welcome, it was “clearly inadequate” in enabling hospitals to meet the needs of patients in the long term.

“The MJA article is further evidence that arbitrary public hospital funding cuts have real consequences for patient mortality,” he said.

Adrian Rollins

[Comment] Six ways for governments to get value from health IT

Substantial progress is being made in the implementation of electronic health records (EHRs) in hospitals, ambulatory care, and primary care practices globally, but uncertainty remains about how these large financial investments will translate into tangible patient, population, and societal benefits.1 This question is topical for all governments, but particularly pertinent for the UK and the USA, since important decisions on government health information technology (HIT) strategies related to EHRs are imminent.

Heard on the hustings

“We need to control the way we spend the health dollar within the limited means we have, to enable us to have the funding to put new drugs on the Pharmaceutical Benefits Scheme” – Prime Minister Malcolm Turnbull explains why the Medicare rebate had to be frozen until 2020.

“I understand for doctors that the GP freeze has been difficult and I appreciate their working with us. I have said to doctors that I want that freeze lifted as soon as possible, but I appreciate that Finance and Treasury aren’t allowing me to do it just yet” – Health Minister Sussan Ley says the rebate freeze extension isn’t her doing.

“Nobody wants to head down the same path as America when it comes to our health system. We will reverse Mr Turnbull’s cuts, which will reduce bulk billing and hit Australian families every time they visit the doctor” – Opposition leader Bill Shorten makes the first big announcement of the election campaign, unveiling Labor’s $12.2 billion plan to restore Medicare rebate indexation from next year – to be paid for by axing company tax cuts and the new baby bonus.

“What happened in 2011 was a previous Government” – Bill Shorten ducks responsibility for Labor’s decision to freeze Medicare rebates in November 2013.

“The Government is shifting its responsibility from providing health care services back to the hip pocket of patients. It is inevitable that, under the freeze, out-of-pocket expenses are going to rise. Labor’s policy protects the Medicare rebate. It actually supports and cements one of the most important factors in our Medicare system, and that is its universality” – AMA President Professor Brian Owler welcomes Labor’s announcement.

“One thing that I’m pleased about is that the many medical practitioners who are out there, on the first of July, they will get a company tax cut, those who are operating in those structures, but also those who are in unincorporated structures” – Treasurer Scott Morrison argues the Government’s company tax cuts will offset the hit to doctor incomes from the Medicare freeze.

“Bill Shorten and Labor can’t pay for their health spending promises, and what they can’t pay for they will never deliver. Bulk billing rates remain higher under the Coalition than Labor. Many GPs are also small business owners and employers, and the Coalition’s 10-year enterprise tax plan will benefit them directly” – Sussan Ley.

“The issue about the Medicare systems is the payments. It’s not actually about the doctors’ incomes. And certainly, the cost pressures that doctors are experiencing in their practices have nothing to do with tax cuts. It has to do with the rising costs of staff, leases, equipment and all of the things that go along with that” – Professor Brian Owler says the Coalition is missing the point.

“To be frank, on the current rebate we make less than $1 per consultation, which doesn’t provide for the renewal of fixed assets. You get by day-to-day but you don’t have the capacity for future provision” – Dr Rodney Beckwith, who owns a medical practice on the NSW central coast.

“At this stage, the black hole of unfunded promises keeps on getting deeper and darker” – Malcolm Turnbull tries to shift the focus from health to financial management.

Tax cuts compensate for freeze: Govt

Any hit to doctor incomes from the Medicare rebate freeze will be offset by cuts in the company tax rate, according to the Federal Government.

Resisting calls to match Labor’s commitment to reinstatement Medicare rebate indexation from 1 January next year, Coalition MPs have instead argued that doctors and medical practices will benefit from company tax cuts detailed in the Budget.

The Treasurer’s claim was echoed by Health Minister Sussan Ley, who said that, “many GPs are also small business owners and employers, and the Coalition’s 10-year enterprise tax plan will benefit them directly”.

The changes include a 1 percentage point cut in the tax rate for companies with an annual turnover of less than $10 million down to 27.5 per cent, and expanded tax discounts worth 8 per cent of personal taxable income, capped at $1000, for unincorporated businesses with a turnover of less than $5 million.

But AMA President Professor Brian Owler told the Sydney Morning Herald the Treasurer’s “surprising” comments missed the point, and suggested a lack of understanding of how most doctors were remunerated.

“The issue about the Medicare systems is the payments. It’s not actually about the doctors’ incomes,” Professor Owler said. “And certainly, the cost pressures that doctors are experiencing in their practices have nothing to do with tax cuts. It has to do with the rising costs of staff, leases, equipment and all of the things that go along with that.”

Adrian Rollins

Parties declare war over drugs

Access to medicines has become an election battleground, with the Coalition warning a Labor pledge to keep the cost of prescription drugs down will push many lifesaving treatments out of reach.

In his second major health announcement of the campaign, Opposition leader Bill Shorten announced a Labor Government would scrap Coalition plans to increase the patient co-payment for Pharmaceutical Benefit Scheme medicines and lift safety net thresholds.

The measure, which Labor estimates will cost $971 billion over four years and $3.6 billion over a decade, seeks to undo changes unveiled by Joe Hockey in the 2014 Budget to add $5 to the $38.30 PBS co-payment for general patients and 80 cents to the $6.20 co-payment for concession card patient.

In addition, Labor has promised not to increase safety net thresholds (currently at $1475.70 for general patients and ($372 for concessional patients) faster than inflation – as opposed to Coalition plans for an annual 10 per cent increase.

Legislation to implement the 2014 Budget changes has been stalled in the Senate but was included in the most recent Budget, indicating that the Government remains committed to its implementation, and creating an opening for Labor.

“Malcolm Turnbull confirmed his commitment to these cuts by building them into his first Budget earlier this month,” Mr Shorten said. “Labor will not stand by and let Malcolm Turnbull and the Liberals dismantle universal health care. Labor believes every Australia deserves access to affordable medicine.”

Mr Shorten said Labor’s promise would be funded from the proceeds of ditching the Coalition’s planned $50 billion company tax cut.

But the Prime Minister hit back by calling into question whether a future Labor Government would be able to afford to subsidise access to new but often hugely expensive treatments for cancer, hepatitis and other serious illnesses.

Mr Turnbull said that by managing “the health budget well, we have been able to bring onto the PBS $3 billion worth of new medicines”.

The Government claims that since coming to office it has funded the addition of almost 1000 medicines worth about $4.4 billion to the PBS, including treatments for hepatitis C, melanoma, breast cancer and diabetes.

Health Minster Sussan Ley accused Labor of having “no plan for listing medicines at all. I see increased spending, poorly targeted. I do not see any of the reforms necessary to do what the Coalition has been able to do in the medicines listing space”.

Among its election promises, the Coalition has announced it will invest $7 million to make Australia an easier place to conduct clinical trials – potentially giving Australians early access to access to breakthrough treatments.

The Minister said the Coalition had a much stronger record than Labor of listing new drugs – “We are talking about breakthrough cures here. There is no time to wait. We know we will list it and the Labor Party will not”.

But Shadow Health Minster Catherine King said Labor would maintain the arrangement under which new drugs were assessed for listing on the PBS by the Pharmaceutical Benefits Advisory Committee, including the threshold set by the Coalition over which approval must be considered by Cabinet.

AMA President Professor Brian Owler welcomed Labor’s pledge to dump the planned PBS patient co-payments and changes to safety net threshold indexation.

Professor Owler said the Coalition had sought to impose new and higher costs of patients “at all levels” of the health system, including GPs, pathology, diagnostic imaging and prescriptions.

“This is deterring those that can least afford it from going and filling their prescription,” he told Sky News. “So Labor’s pledge is very welcome, and I think patients should be very pleased about that. Particularly those with complex and chronic illnesses.”

Professor Owler said it was wrong for the Minister to claim Labor would not list new drugs.

“The recommendations [to list drugs] come through an independent committee through the PBAC process, and that’s a very robust assessment process, and then the recommendations are made,” he said. “Now, there have been some very good things that have been done, particularly around the hep-C medicines that have been funded, and that’s been very good for those patients, but that doesn’t preclude that happening under Labor’s plans.”

Adrian Rollins

Health a vote winner

The Federal Government’s decision to inject almost $3 billion into public hospitals was the most popular measure in the Budget, underlining the high value voters put on health care.

A survey of voters by polling company JWS Research and reported by the Australian Financial Review has found that 75 per cent approved the allocation in the Budget of $2.9 billion over four years to support public hospitals, overshadowing the 72 per cent who welcomed an extra $50 billion for road, rail and water infrastructure and the 65 per cent who approved an extra $840 million for youth employment programs.

The result suggests that Labor is playing to the concerns of a majority of voters with its push to make health a key election battleground, including through its commitment to unfreeze the Medicare patient rebate from January next year.

Highlighting the Government’s failure to get much of a pre-election bounce out of Treasurer Scott Morrison’s first Budget, the survey found that only 17 per cent thought it would be good for them personally, and just 21 per cent said it would be good for the country. Thirty-seven percent thought it would be bad for them, and for the nation.

Pollster John Scales, who oversaw the survey, told the AFR the results showed that the Government’s attempt to sell the Budget as an economic plan, encapsulated in its “jobs and growth” mantra, had failed to resonate with voters.

The Government made company tax cuts the centrepiece of the Budget, arguing that they would boost the economy by encouraging investment and employment.

But Mr Scales told the AFR that although the message had been understood at the “micro level, that’s been missed by the general population. They’re asking what is in it for them, they’re saying, ‘there’s nothing in it for me’.”

Adrian Rollins

Pathology deal a fresh assault on medical practices

The Federal Government has intensified its assault on medical practice incomes, promising to clamp down on rents charged for pathology collection centres in exchange for an end to the pathology sector’s damaging campaign over cuts to bulk billing incentives.

Just two weeks after it announced a two-year extension of the Medicare rebate freeze to 2020, ripping $925 million out of primary and specialist care, the Government has sliced further into practice earnings by stitching up a peace deal with Pathology Australia that analysts predict will force collection centre rents down by 30 per cent and leave major players like Sonic Healthcare and Primary Healthcare up to $100 million a year better off.

Prime Minister Malcom Turnbull announced the agreement during his first televised debate with Opposition leader Bill Shorten, declaring that it meant that “the concern that has been expressed about patients who go to have their blood tests done and so forth being charged extra, not being bulk billed, is… that concern is gone; the pathologists have agreed to continue bulk billing”.

But the Prime Minister’s boast could be premature.

Primary Healthcare, which holds 34 per cent of the market and is not a member of Pathology Australia, has written to doctors to distance itself from the deal, and smaller pathology providers complain it does little for them and they will have to begin charging patients a co-payment of up to $50.

AMA President Professor Brian Owler said the deal “doesn’t guarantee anything”.

“The cut to bulk billing incentives for pathology has merely been deferred. The cuts are still there, they’re still taking $650 million out of health over the next four years,” Professor Owler said.

Professor Owler said he had been in contact with Pathology Australia about the deal, and they had admitted there was no guarantee the pathologists would continue to bulk bill.

“They don’t have the ability to make that guarantee, and it will be up to the individual pathology companies to actually make that decision over time,” he said.

Under the deal, the Government has committed that, if it is re-elected, it will delay bulk billing incentive cuts by around three months while it introduces provisions to the Health Insurance Act to clarify what is meant by ‘market value’ and link it with local commercial market rents.

This will be backed by “appropriate compliance mechanisms”, and those seeking to register collection centres will need to provide more information.

Pathology Australia said the reduced rents would enable its members to absorb the bulk billing incentive cuts and sustain current rates of bulk billing. As a result, the organisation has agreed to drop its national “Don’t Kill Bulk Bill” campaign.

The announcement amounts to a backflip by Health Minister Sussan Ley.

In a review of Approved Pathology Collection centre arrangements last year, Ms Ley rejected pathology sector calls for a change in the definition of ‘market value’ and determined that existing regulations regarding prohibited practices and market rent were appropriate.

Macquarie Securities analyst Craig Collie told Guardian Australia that Sonic Healthcare could be up to $70 million a year better off under the Government deal.

Mr Collie estimated the company would save about $116 million a year on rent at its 2000 collection centres, which more than offset the $50 million cost of losing the bulk billing incentive.

Guardian Australia reported that both Sonic and Pathology Australia have been major Coalition donors in recent years.

There are around 4000 collection centres across the country, and medical practitioners have warned the Government will need to consult closely with general practice to ensure that the new regulations are not simply a form of price control that puts many existing leases into jeopardy.

The Government has declared there will be a moratorium on any new collection centre approvals until the new regulations are in place, and “the measure to remove bulk billing incentives will commence at the date that the changes to the regulatory framework take effect”.

But Professor Owler said that, even with the deal, there was no getting away from the fact that the Government was ripping hundreds of millions of dollars out of pathology services.

“To suggest that somehow the concern is now gone I think overstates the results of the agreement that was reached between the Government and Pathology Australia,” he said. “There will be some easing of costs pressures through this change to rents, but at the end of the day they are still experiencing a very significant cut.”

St Vincent’s Health Australia Chief Executive Toby Hall told the Adelaide Advertiser the axing of the bulk billing incentive would rip $3 million from his organisation’s bottom line, forcing them to consider “some form of patient co-payment. I think we’d have to look at between $20 and $50”.

And the deal has done nothing to address the cut to bulk billing incentives for diagnostic imaging services.

The Australian Diagnostic Imaging Association warned patients still faced cuts to their rebates for x-rays, CT scans, MRIs and ultrasounds, and smaller pathology companies cautioned they would be forced to charge out-of-pocket expenses despite the Government’s deal.

Adrian Rollins

Pathology ducks MBS review

Pathology services will be quarantined from the Federal Government’s overhaul of Medicare in a major concession secured by the profession in exchange for dropping its campaign against the axing of bulk billing incentives.

The Government has opened the door to special deals regarding its MBS Review after agreeing to leave the Pathology Services Table, which lists the tests Medicare will cover and how much it will pay, untouched for the next three years.

Under the deal, the Government said it would “not change the Pathology Services Table, excluding those from the MBS Review, for the next three years, without consultation and agreement with the sector”.

Royal College of Pathologists of Australasia President, Dr Michael Harrison, said the arrangement meant “there will be a moratorium for the next three years on any further changes to [the] Pathology Services Table without agreement from the profession”.

The arrangement deepens questions about the Government’s rationale for the Medicare Review, suggesting its focus is primarily on savings rather than updating the MBS per se.

AMA President Professor Brian Owler told Sky News the AMA had been “quite happy” to participate in the review on the understanding that its primary goal was to modernise the MBS and deliver better outcomes for patients. This would involve ploughing a share of any savings made back into health, including lifting the Medicare rebate freeze.

“The conversations that I had with the former Prime Minister went along the lines of investing some of that money, if there were savings from that review, back into health,” Professor Owler said. “And it was very clear that one of the things that we’re aiming to do was to lift the MBS freeze. Now all of that seems to have fallen away. Clearly there’s no effort to lift the freeze and what this Government is determined to do is to continue the freeze…and pass the cost from the Government, through the doctor, onto patients.”

Adrian Rollins

Govt fails to put bite on dental scheme

A free dental care scheme for children, axed in the Federal Budget, will continue to operate beyond 30 June after Parliament failed to abolish it before the election.

The Government said it was abolishing the former Labor government’s Child Dental Benefits Scheme (CDBS) because it was a failure, treating less than one-third of eligible children and with $4 million of incorrect claims being investigated.

It proposed a new $1.7 billion Child and Adult Public Dental Scheme (caPDS), with the Commonwealth’s contribution to the states and territories capped at 40 per cent of the national effective price for dental services, and funding available on a first-come, first-served basis.

The CDBS was due to end on 30 June, but the Government failed to get the legislation through Parliament before it was prorogued ahead of the 2 July election.

The Australian Dental Association (ADA), which is running a campaign against the closure, has urged families to take advantage of the delay.

“The ADA is encouraging all eligible patients to make appointments for treatment under the CDBS with their preferred dentist as soon as possible,” ADA President Rick Olive said.

Dr Olive said that the lack of an agreed funding distribution model “raises the spectre of a Hunger Games-style scenario” where some states and territories ended up with the lion’s share of funding, leaving the remainder with insufficient funds to meet the new demands on their public health systems.

“Additionally there is no guarantee that eligible patients from rural areas will be able to access a public dental clinic close enough to receive treatment, widening the accessibility to dental services divide still further between rural and regional Australian and their city brethren,” Dr Olive said.
In contrast, under the CDBS, rural and regional patients can simply go to their nearest participating local dentist to receive treatment.

People living in towns like Chinchilla in Queensland and Casterton in Victoria will be forced to travel long distances for dental care, or wait for services to come to them.

“The ADA supports enshrining funding for states and territories in legislation,” Dr Olive said.

“However, without a fair distribution model and guarantees that eligible patients have the choice to either access public clinics or their local dentist appropriate to their specific circumstances, patients from smaller states and regional and rural areas stand a real risk of missing out on dental care under the Coalition’s caPDS.”

Maria Hawthorne