Aged care sector prepares for fight with Government

Aged care providers are preparing to campaign against the Government, accusing it of stripping $3.1 billion from the sector over the past year alone.

The Government plans to save $1.2 billion by “refining” the Aged Care Funding Instrument (ACFI) so that fewer patients fall into the complex health care (CHC) category, following a blowout in claims.

Currently, almost 50 per cent of patients are classified in the highest CHC bracket, receiving $66.82 a day on top of the usual subsidies.

Treasurer Scott Morrison said the ACFI needed fine tuning so it did not “encourage distortions in claiming behaviour and care delivery”.

Health and Aged Care Minister Sussan Ley told The Australian that ongoing overclaiming by providers “demonstrates a clear need to restructure the way (funding) is assessed”.

While the move received support from the Council on the Ageing, it was condemned by the peak lobby group, Leading Aged Services Australia (LASA), which accused the Government of cutting $3.1 billion nationally over the past year.

Individual providers and Aged and Community Services Australia (ACSA) also criticised the measure, with ACSA launching a federal election campaign called Old, Frail, and Invisible.

“There is significant and growing concern about the impact of the 2016-17 Budget cuts arising from changes around the ACFI, ACSA President Paul Sadler said.

“These will directly impact on older people in our residential care facilities that need specialised and complex care and support.

“These changes to ACFI have not been implemented in the spirit of consultation, and the modelling of the impacts we have seen so far has caused considerable distress in our sector as we seek to provide the appropriate service, care and support to our current and future residents.”

Ansell Strategic, a consultancy specialising in aged care organisations, released projections showing that the changes would result in cuts of $350 million more than announced.

“While the cuts compromise the viability of the sector, the threats to the vulnerable aged are even more concerning,” managing director Cam Ansell said.

“The ACFI changes create a disincentive to admit high dependency people and will ultimately result in their displacement to hospitals.”

In a separate fight, Victoria’s largest provider, Shepparton Villages, has reportedly launched a campaign against a Government decision to shift almost 150 beds from the Shepparton region to Melbourne.

LASA’s Victorian policy and government relations director, Jenny Matic, told The Australian that the Shepparton region had been stripped of beds despite having the third highest rate of dementia in Australia.

“Four hundred residential aged care beds were meant to allocated, but only about 250 were. That’s a 40 per cent loss,” she was quoted as saying.

“There doesn’t seem to be a level of transparency around these deferred allocations. You don’t know who got what and how many.”

Shepparton is in the federal seat of Murray, where the Liberal and National parties are each standing a candidate following the retirement of long-serving Liberal MP Sharman Stone.

Maria Hawthorne

Labor’s antifreeze policy puts heat on Coalition

Main points

Labor promises to resume Medicare rebate indexation
Policy to cost $12.2 billion over 10 years
Welcomed by AMA as a win for patients

Labor has pledged to resume indexation of the Medicare patient rebate from 1 January next year if it wins the Federal Election, in a $12 billion commitment hailed as a big win for patients.

Seeking to outflank the Coalition on health, Opposition leader Bill Shorten has announced that a Labor Government would lift the Medicare rebate freeze and reinstate indexation, at a cost of $2.4 billion over four years and $12.2 billion over a decade.

The announcement came just days after the AMA launched a national campaign against the freeze, warning it would force many GPs to abandon bulk billing and begin charging patients up to $20 or more per visit.

“Nobody wants to head down the same path as America when it comes to our health system,” Mr Shorten said. “We will reverse Mr Turnbull’s cuts, which will reduce bulk billing and hit Australian families every time they visit the doctor.”

AMA President Professor Brian Owler said Labor’s announcement established a “real difference” between the major parties on health policy.

“Labor’s promise to lift the Medicare rebate freeze will be welcomed by doctors – GPs and other specialists – and patients across the country,” Professor Owler said. “Patients are the big winners from this announcement, especially working families with a few kids, the elderly, the chronically ill, and the most vulnerable in the community.”

In its Budget unveiled earlier this month, the Government announced that it would save $925 million by extending the Medicare rebate freeze, already in place from 2014 to 2018, through to 2020.

Medicare rebates were first frozen by Labor in November 2013 for eight months, but they have since been extended twice by the Coalition Government after failing in its attempts to introduce a patient co-payment.

Professor Owler said the freeze amounted to a “co-payment by stealth” by forcing medical practices to dump bulk billing and begin charging patients if they were to remain financially viable.

He said that for years GPs have done their best to shelter patients from the impact of the freeze, but the decision to extend it to 2020 would push many medical practices over the edge.

“Many GPs are now at a tipping point. With the freeze stretching out for seven years, they have no choice but to pass on the increased costs of running their practices to patients,” the AMA President said. “The Medicare rebate freeze is bad policy, and it should be scrapped.”

Bulk billing climbs

Last week, Health Minister Sussan Ley trumpeted official figures showing the GP bulk billing rate climbed to 84.8 per cent between July last year and March this year to argue that the Government was investing heavily in Medicare.

But Professor Owler said that the Government’s Budget decision to hold Medicare rebates down for a further two years was causing medical practices across the country to reconsider their finances and billing arrangements.

“The extension of the freeze for another two years under the last Budget has prompted many doctors now to contact the AMA requesting our help to transition them from bulk billing practices to ones that charge a fee,” he told Sky News. “Unless the freeze is lifted, I think we are going to see more costs being passed on to patients and so that’s why Labour’s announcement today is indeed very welcome by GPs but I think also by patients around the country.”

Labor’s promise has been costed by the Parliamentary Budget Office, and Opposition said it would be paid for by scrapping the $1000 bonus for single-income families with a child younger than one year, (saving $1.4 billion over 10 years), capping vocational education loans at $8000 ($6 billion over 10 years) and axing business tax cuts, saving more than $4.7 billion over four years (Labor would retain some relief for businesses with a turnover of less than $2 million).

The funding arrangement means Labor will be able to campaign on the claim that it is putting access to primary health care before tax cuts for business.

“This is about choices,” Shaodw Helath Minster Catherine King said on ABC Radio. “People get sick. We want people to go to what is in fact, the cheapest and most efficient part of our system, your GP, to stay well, to manage your chronic conditions, manage episodic illness, because if we don’t do that, people end up in the more expensive part of the system, the acute system where we are again, facing increasing demand.”

Ms King said that by reducing the barriers to people seeing their GP, the policy would help contain the growth in health costs.

“What we want to be able to do is actually have as many people going to your general practitioner because it is our cheapest part of the system, frankly. It’s the most efficient part of the system,” she said. “We want people to go for prevention. We want people to go and get advice about how do you manage obesity, if you find that you’ve got heart disease in the family, we want them to go and use the Medicare system to stay well and that is how you contain costs in the more expensive part of the system, our hospital system, by actually keeping people well.”

But Labor has so far resisted calls to reinstate bulk billing incentives for pathology and diagnostic imaging services.

Adrian Rollins

[World Report] Gabon hopes new plan will plug health-care gaps

The Government of Gabon has launched a new programme to improve health-care services in the country, starting with those for maternal and child health. Andrew Green reports.

AMA advocacy delivering for GPs

In reflecting on the last six years as Chair of the AMA Council of General Practice, I was reminded of the significant work the AMA does in advancing the interests of GPs and patients.

Much of this work has been in the background. The AMA has seen off many thought bubbles that thankfully have never seen the light of day.

There have, of course, been some very public battles, because successive governments have failed to appreciate the value and role of general practice.

In my time as Chair, we have had five prime ministers (albeit one twice) and four health ministers. Over that time we’ve seen some big visions in health, but progress has rarely matched the ambition.

When I first came to the role of Chair, funding had just been announced for the Practice Nurse Incentive Program (PNIP), Medicare Locals, additional GP Super Clinics, the establishment of Personally Controlled Electronic Health Records and chronic disease reform in the form of capped funding for bundled care for patients with diabetes.

The AMA welcomed the PNIP because it supported a GP-led model of team-based care, and offered significant extra funding for practices to employ a practice nurse. The AMA also won grandfathering arrangements to ensure practices were not disadvantaged by the removal of practice nurse items in the Medicare Benefits Schedule.

The former Government’s Diabetes Plan proposed the introduction of a capitated model of payment, replacing fee-for-service for eligible patients. The plan lacked detail and would have rationed access to care for patients. It was quickly dumped by the Government in favour of a trial that ultimately confirmed that the plan would have failed.

Over my term the AMA has continued to prosecute the reform of chronic disease items through its plan Improving the care for patients with chronic and complex care needs, and has outlined principles for formalising Medical Homes in Australia – elements of which have been incorporated in the Government’s recent Health Care Homes proposal.

AMA advocacy has helped ensure policy failures such as Medicare Locals and GP Super Clinics were short-lived, and after hours funding was returned back to practices via the PIP.

The inclusion of GP-referred MRI in the MBS may have taken a while, but we got there in the end. The introduction of these items is good for patients and has improved access to timely care.

I have also been delighted to see the importance of teaching championed by the AMA, with our efforts resulting in the PIP teaching incentive doubled and the ongoing funding of rural and regional teaching infrastructure grants. Our campaign to increase GP training places has borne fruit. There are now record numbers of doctors in training entering the GP training program.

Maldistribution of the GP workforce remains an issue, although the AMA has supported expansion of GP training places in rural and regional settings. We also played a big role in the establishment of the Rural Junior Doctor Innovation Fund to finance rural GP rotations for interns.

From a professional perspective, it is reassuring that more young doctors than ever want to be GPs, and that the colleges are to have a greater role in trainee selection.

I would have liked to have seen a commitment to fund the Pharmacist in General Practice Program in my time as Chair, but the ground work has been laid, and I am confident that in time the common sense of this proposal will prevail.

Of course, there are still challenges ahead, particularly around ensuring policies and funding arrangements that truly support GPs in providing quality preventative, holistic, coordinated and longitudinal care.

In closing, I wish to thank you and the members of the Council of General Practice for all the support. It has been a privilege to serve you. To my successor, I wish you all the best and every success as you lead the profession forward.

Ebola crisis: the world must do better

The reputation of the global system for preventing and responding to infectious disease outbreaks has taken a battering in the wake of the west African Ebola epidemic.

Yet a prestigious Independent Panel believes it is possible to rebuild confidence and prevent future disasters, releasing a roadmap of 10 interrelated recommendations for national governments, the World Health Organisation, non-government organisations and researchers.

The Independent Panel on the Global Response to Ebola, launched jointly by the Harvard Global Health Institute and the London School of Hygiene and Tropical Medicine, spent months reviewing the worldwide response to the outbreak that began in 2013.

“The west African Ebola epidemic … was a human tragedy that exposed a global community altogether unprepared to help some of the world’s poorest countries control a lethal outbreak of infectious disease,” the Panel wrote in The Lancet.

“The outbreak continues … It has infected more than 28,000 people and claimed more than 11,000 lives, brought national health systems to a halt, rolled back hard-won social and economic gains in a region recovering from civil wars, sparked worldwide panic, and cost several billion dollars in short-term control efforts and economic losses.”

The Panel said its goal was to convince high-level political leaders worldwide to make necessary and enduring changes to better prepare for future outbreaks while memories of the human costs of inaction remained vivid and fresh.

It identified four key phases of inaction:

December 2013 to March 2014, when Guinea’s lack of capacity to detect the virus allowed it to spread to neighbouring Liberia and Sierra Leone;
April to July 2014, when intergovernmental and non-government organisations started to respond, health workers struggled to diagnose patients and provide effective care, national authorities played down the scope of the outbreak, and WHO and the US CDC sent expert teams but withdrew them prematurely;
August to October 2014, when global attention and responses grew, but so did panic and misinformation, leading to unnecessary and harmful trade and travel bans; and
October 2014 to September 2015, when cases began to decline, and large-scale global assistance started to arrive, albeit with weak coordination and a lack of accountability for the use of funds.

“This Panel’s overarching conclusion is that the long-delayed and problematic international response to the outbreak resulted in needless suffering and death, social and economic havoc, and a loss of confidence in national and global institutions,” the Panel said.

“Failures of leadership, solidarity and systems came to light in each of the four phases. Recognition of many of these has since spurred proposals for change. We focus on the areas that the Panel identified as needing priority attention and action.”

The Panel made 10 recommendations:

develop a global strategy to invest in, monitor, and sustain national core capacities;
strengthen incentives for early reporting of outbreaks and science-based justifications for trade and travel restrictions;
create a unified WHO Centre for Emergency Preparedness and Response with clear responsibility, adequate capacity, and strong lines of accountability;
broaden responsibility for emergency declarations to a transparent, politically protected Standing Emergency Committee;
institutionalise accountability by creating an independent Accountability Commission for Disease Outbreak Prevention and Response;
develop a framework of rules to enable, govern and ensure access to the benefits of research;
establish a global facility to finance, accelerate, and prioritise research and development;
sustain high-level political attention through a Global Health Committee of the Security Council;
a new deal for a more focused, appropriately financed WHO; and
good governance of WHO through decisive, time-bound reform, and assertive leadership.

“The human catastrophe of the Ebola epidemic that began in 2013 shocked the world’s conscience and created an unprecedented crisis,” the Panel concluded.

“The reputation of WHO has suffered a particularly fierce blow. Ebola brought to the forefront a central question: is major reform of international institutions feasible to restore confidence and prevent future catastrophes? Or should leaders conclude the system is beyond repair and take ad hoc measures when the next major outbreak strikes?

“After difficult and lengthy deliberation, our Panel concluded major reforms are warranted and feasible.”

Maria Hawthorne

[Comment] 10 years of the UK’s National Institute for Health Research

The revolution in molecular medicine and cell biology that occurred in the late 20th century was a magnet for research funding and continues to advance understanding of disease. By the new millennium, however, the scientific capacity to convert this new information into clinical benefit was in danger of being lost, and there was a need to re-establish expertise in clinical and translational science. In the UK, reports urged the Government to consider how strength in this type of research endeavour could be re-established.

Hospitals, doctors in gun sights

The AMA has joined international calls for combatants to respect the neutrality of health workers and medical facilities amid widespread outrage at an attack on a Syrian hospital that has reportedly left at least 55 dead and 60 injured.

AMA Vice President Dr Stephen Parnis said it was “unacceptable” that health professionals and facilities were being targeted in armed conflicts in many parts of the world, most recently in Syria.

“It is unacceptable that health personnel and facilities are ever regarded as legitimate targets,” Dr Parnis said. “It is the duty of the international health community to speak out and protect the non-discriminatory provision of health care to all those in need.”

The AMA Vice President was commenting following a recent spate of deadly attacks on hospitals and clinics in strife-torn parts of the world, including Syria and Afghanistan, in which hundreds of patients, doctors, nurses and other health workers have been killed and injured.

In one of the most recent incidents, Syrian Government forces were blamed for killing at least 55 people and injuring 60 late last month after launching an air strike on the al-Quds Hospital in Aleppo.

Several doctors and nurses were among those killed in the attack on the hospital, including one of the city’s few remaining paediatricians, Dr Mohammed Wassim Maaz.

A spokeswoman for Medicins Sans Frontieres (MSF) which, along with the International Committee of the Red Cross (ICRC), has been supporting the hospital, told The Guardian that 95 per cent of doctors from opposition-held parts of Aleppo had fled or been killed, leaving fewer than 80 doctors to care for around 250,000 still living in the war-torn city.

The al-Quds Hospital is the latest in a string of attacks on medical facilities. According to media reports at least seven MSF-supported hospitals and clinics have been bombed since the beginning of the year, and the US Government has punished 16 military officers over a deadly airstrike on a MSF hospital in the Afghan city of Kunduz last year in which 42 people, including 13 doctors, nurses and other health workers, were killed.

In a report on the incident released late last month, the Pentagon blamed a chain of human errors and failures of procedures and equipment for the attack, but rejected accusations from MSF that it amounted to a war crime.

MSF is furious that the hospital was bombed despite the fact all combatants had been notified of its location, and that the attack continued despite repeated calls from the medical charity to the US military alerting it to the fact it was bombing a medical facility.

The military personnel involved, including a general, will not face criminal charges and will instead receive a range of “administrative actions” including suspension, letters of reprimand and removal from command.

The ICRC, the World Health Organisation and the World Medical Association have in recent years been sounding increasingly loud warnings about the incidence of attacks on health workers and medical facilities.

Late last year they issued a joint call for governments and non-state combatants to adhere to international laws regarding the neutrality of medical staff and health facilities, and ensuring this commitment is reflected in armed forces training and rules of engagement.

The ICRC, through its Health Care in Danger project, recorded 2398 attacks on health workers, facilities and ambulances in just 11 countries between January 2012 and the end of 2014.

Disturbingly, while many incidents involved health workers and facilities caught in cross-fire or being hit in indiscriminate attacks, the ICRC has also identified numerous incidents where they have been deliberately targeted.

Governments attending the 32^nd International Conference of the Red Cross and Red Crescent last December reaffirmed their commitment to international humanitarian law and a prohibition on attacks on the wounded and sick as well as health care workers, hospitals and ambulances, and the ICRC is also working with non-state combatant groups to raise awareness of laws and conventions around the protection of patients, health workers and medical facilities.

Adrian Rollins

Rural internet as useful as a blunt chainsaw

As a long time rural internet user, I was shocked when going online in Hong Kong last December.

No time was wasted watching an arrow endlessly circling, nor were there long pauses where one is forced to consider taking up smoking or knitting to pass the time while switching between screens. Just click, and the next screen is there faster than one can blink.

The internet is a big part of our lives, and essential to our provision of health care. It enables us to learn from the most current resources, explore treatment options, watch demonstrations of procedures and attend live discussions with experts. It permits our patients to receive specialist care online, and is the backbone for the My Health Record.

Soon, it will lessen the burden of obtaining authority prescription – online authorisation is around the corner after much AMA lobbying to minimise the time currently wasted.

While I never expect those of us outside the big cities to be provided with a service matching speeds provided to inner city residents, we should at least get a half decent service and costs per gigabyte similar to city users – not 20 times more expensive, as recently outlined in The Land.

I have a mate who gets up at 2am to post his online billing to NSW Health. Their system is one from the Dark Ages, designed to save their accounting department time and money with no realisation that with tortoise speed rural internet it is a pain in the derrière for all those using it.

Assumptions are made that we have oodles of time to waste in rural Australia, when the reverse is true.

We want to spend more time on fun and families, not online with clunky unfriendly software battling to overcome a very slow internet system.

Having to get up at 2am to get a speedy connection is just cruelty.

So we have a double whammy – poor internet speeds that waste our time, and higher costs per GB for the lousy service we get.

Currently, consumer protection laws give some protection for fixed line phone users. But there is none for mobile and internet users in rural locations.

The Government has admitted change is needed, and is seeking the Productivity Commission’s direction on reforms. This cannot come too soon.

So, next time you find poor connectivity is annoying the hell out of you don’t waste the moment. Get online to your local Federal Member and express your frustrations.

Just as a blunt chainsaw wastes fuel and time, lousy internet connectivity at high cost lessens our output as rural doctors.

Pathologists happy with new deal but it’s ‘another blow for GPs’

GPs have expressed concerns over the Coalition’s announcement that it will cap rent on pathology collection centres.

The deal would take place under a returned Turnbull Coalition Government and will help reduce regulatory cost pressures on pathology providers to help them provide affordable services and maintain current bulk billing rates.

It’s a move that is supported by the Royal College of Pathologists of Australasia:

“The Coalition’s new proposed plans will see a delay in the changes to the bulk billing incentive, as well as a solution to the high cost of rents being paid for pathology collection centres. In addition there will be a moratorium for the next 3 years on any further changes to Pathology Services Table without agreement from the profession. The RCPA believes this will result in the profession maintaining the current billing practices and high quality services and efficiencies offered,” Dr Michael Harrison, President of the RCPA said.

However the Royal Australian College of General Practitioners says the changes are another blow to GPs, on top of the ongoing Medical Benefits Freeze.

“The RACGP has always supported universal access to healthcare services and therefore welcomes the announcement of continued bulk-billing arrangements for pathology services,” RACGP President Dr Frank Jones said.

“However, the proposed changes effectively create an anti-competitive environment, where multi-national corporations who make hundreds of millions of profit each year are propped up, while GPs running small businesses lose funding.”

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.

He also said there is no guarantee that the pathologists will not abandon bulk billing.

When he spoke to Pathology Australia, they admitted they don’t have the ability to make that guarantee.

“It will be up to the individual pathology companies to actually make that decision over time,” he said.

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Freeze a white-hot election issue

The Medicare rebate freeze is set to become a top issue in the Federal Election following the launch of a nationwide AMA campaign targeting Coalition MPs and candidates over the issue.

In a blow for Malcolm Turnbull as he seeks to win his first election as Prime Minister, the nation’s peak medical organisation is mobilising doctors and patients, accusing the Government of cutting Medicare and trying to sneak through a tax that would hit every Australian household.

AMA President Professor Brian Owler said that ever since Budget night the AMA has been flooded with complaints from medical practitioners and members of the public outraged by the Government’s decision.

“The Medicare freeze is not just a co-payment by stealth – it is a sneaky tax that punishes every Australian family,” Professor Owler said. “It will hit working families with kids really hard. It will hit people with chronic illness, and it will hit the elderly.”

The Budget decision to extend the Medicare rebate freeze through to 2020, at a saving of almost $1 billion over four years, has undermined Government attempts to neutralise health as an issue in the Federal Election.

Prime Minister Malcolm Turnbull acted to get public hospital funding out of the headlines by giving the states and territories an extra $2.9 billion at a Council of Australian Governments meeting last month, and Health Minister Sussan Ley has been accused of trying to deflect public attention by mounting attacks on the professionalism and integrity of doctors and other health workers.

But the Government, which has previously been forced to back down on plans to introduce patient co-payments in the face of widespread doctor and patient fury, faces a similar outcry over the extended Medicare freeze.

Professor Owler said the decision placed GPs and other specialists under enormous financial strain and left them no choice but pass their increased costs onto their patients.

“The costs of running a medical practice – rents, staff, technology and equipment, indemnity insurance, accreditation – continue to rise year-on-year,” the AMA President said. “Many doctors have absorbed the impact of the freeze until now, but the two-year extension has pushed them over the edge. Their businesses are now struggling to remain viable.”

Professor Owler has warned that for practices that have traditionally bulk billed their patients, moving to a model in which they begin to charge some will be expensive.

To recoup the outlay and cover associated costs, patients faced being charged up to $30 or more a visit, he said.

Combined with the Government’s decision to axe bulk billing incentives for pathology and diagnostic imaging services, it meant that patients would “face higher costs for their health every step of their health care journey – every GP visit, every specialist visit, every blood test, every x-ray”.

Posters supporting the #nomedicarefreeze campaign are being distributed to 30,000 GPs and other medical specialists around the country, and doctors and patients are being provided with the contact details of MPs and candidates in every electorate.

Professor Owler said the medical profession was united in its efforts to put an end to the Medicare freeze, and the AMA campaign would complement those of other medical organisations.

For information and to download campaign materials, visit: ama.com.au/nomedicarefreeze

Adrian Rollins

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