Tuesday, March 01, 2011

Medicare Locals: I Really Wish Someone One Would Explain What They Are and How They Will Work.

The following appeared last week.

Are you interested in becoming a Medicare Local?

22 Feb 2011

Approximately 15 Medicare Locals will commence in July 2011. A further 15 will commence in January 2012, with the remainder starting in July 2012.

The first group of Medicare Locals will be drawn from high performing Divisions of General Practice, preferably working in consortia with other high performing organisations with the advanced capacity needed to lead primary health care reforms in their catchment, and who have the capacity to take on the roles and functions expected under the new arrangements.

The subsequent groups of Medicare Locals will build on the expertise and capacity of existing primary care organisations, particularly Divisions of General Practice as well as other primary health care organisations and service providers.

Applications for Medicare Locals to commence in July 2011 close on 5 April 2011.

Applications for Medicare Locals to commence in 2012 close on 19 July 2011.

Medicare Local Guidelines and Information for Applicants

These guidelines have been provided for general information; anyone wishing to apply should visit the Department’s tenders and grants webpage where you will be required to enter your contact information. This is necessary to ensure you are notified in the event of any additional information becoming available during the Invitation to Apply process.

I have browsed the document mentioned above and am still not all that clear what is going on.

There are a whole lot of ‘buzzwords’ but very little clarity.

Here is the big picture:

“The Commonwealth Government is establishing Medicare Locals to drive improvements in primary health care and ensure that primary health care services are better tailored to meet the needs to local communities. Medicare Locals will be primary health care organisations, established to coordinate primary health care delivery to address local health care needs and service gaps.” Page 3

This seems to be the problem to be addressed:

Existing arrangements involving Divisions of General Practice, as well as Commonwealth, state and territory health programs and initiatives have had some impact on reducing the fragmentation of the primary health care service delivery system. However, their effect has been limited by a lack of overarching coordination between services offered by providers and the needs of patients and consumers. This shortcoming has often led to complexity within the service system resulting in delays and inefficiency, for example, patient attendance at a hospital Emergency Department for conditions that could be more appropriately treated in a primary health care setting.

Accordingly, the Commonwealth has announced the implementation of Medicare Locals, primary health care organisations, to improve coordination and integration of primary health

care in local communities, address service gaps, and make it easier for patients to navigate their local health care system. Medicare Locals will reflect their local communities and health care services in their governance, including consumers, doctors, nurses, allied health and State-funded community health providers.

Medicare Locals will be expected to engage with a wide range of health professionals; identify community primary health care needs; and work to fill the gaps in primary health care in their area. To meet these complex challenges many existing primary health care organisations that plan to apply to operate as Medicare Locals will need to increase their capacity or expertise on a number of fronts to progress the health sector reforms. To adapt to the new reforms many organisations may need to increase their size, scope of program delivery, performance, achievement of outcomes, change management capacity, influence and engagement with the broader community and the primary health care sector. Medicare Locals will also be expected to report against an accountability and performance framework. They will be supported in all the above areas at a national level.

The obvious question to ask is how?

Page 5 attempts to tell us:

The role of Medicare Locals

As critical elements in the Government’s health reforms, Medicare Locals are expected to be closely involved with other reform initiatives to help drive and strengthen the primary health care system, including:

- establishing effective collaborations between Medicare Locals, Local Hospital Networks and local Lead Clinician Groups once established to deliver more coordinated, integrated, locally responsive and flexible health services so that patients transition smoothly in and out of hospital and receive the right care, in the right place, at the right time;

- supporting the development of e-health and health information, including shared electronic health records, data provision to drive health system performance, service planning, monitoring and evaluation;

-improving the planning of primary health care services to respond to local needs;

-supporting the ongoing development of primary health care infrastructure, including GP Super Clinics;

- initiatives to increase and enhance the primary health care workforce to meet local

community needs; and

- initiatives in general practice and primary health care designed to improve disease prevention and management and improve access to services. These include the Australian Government’s reform measures to improve access to after-hours primary care, telehealth and access to primary health care services for older Australians.

There is about half a billion dollars over 4 years to set these up and $171M per annum for ongoing operations. (If there are about 60 of these Medicare Locals finally that is only 3 million per annum with each covering say 400,000 people. Back of the envelope that is $7.50 per person per year. ).

Do some other calculations yourself like this means 20 or so people to address these issues for 400,000 souls! Remember these replace GP Divisions which are being defunded, as far as I can tell, so how much new money who knows?

Here we see it:

“All existing program funding to Divisions of General Practice will be directed through the Medicare Local and over time this will be absorbed into a single funding agreement.”

But towards to end of the document we do see some e-Health information.

Under The Section on Important Notices to Applicants we find the following (Page 21):

vii. Information Management and Information Technology (IM/IT)

The introduction of a personally controlled electronic health record (PCEHR) is an important element of the Government’s broader reforms to improve the Australian health system. The Commonwealth and state and territory governments are working to put in place national standards and infrastructure to support the secure management and communication of health information. As such, the Commonwealth requires each Medicare Local to make an appropriate investment to ensure IM/IT arrangements are secure and properly address community expectations on privacy and security, and to provide advice and assistance to primary health care providers to meet required standards. Applicants can obtain more information at the website addresses provided below.

Applicants should note the purposes for which Medicare Local funding can be applied (see Section 1.3 above). Medicare Locals that are responsible for the delivery of healthcare services will address the requirements below. Medicare Locals responsible for the provision of support to organisations that deliver healthcare services will assist them with the implementation of the requirements below.

- Implementation of systems that adhere to National E-Health Transition Authority (NEHTA) specifications and frameworks and Standards Australia's Health Informatics Standards, within 24 months of publication.

- Compliance with all relevant state, territory and Commonwealth government requirements for collecting and reporting information, e.g. for data fields and connectivity.

- The Commonwealth intends to introduce a personally controlled electronic health record (PCEHR) to be available to Australians who wish to have one. Within 24 months of a Commonwealth approved PCEHR System becoming operational or being enhanced; ensure that primary health care providers use the PCEHR System for consumers who have given consent to do so.

- Noting that Privacy Impact Assessments (PIAs) represent best practice for the evaluation of arrangements for management of patient health information, ensure that a PIA is conducted in accordance with the Australian Privacy Commissioner’s Privacy Impact assessment Guide Office of Privacy Commissioner, http://www.privacy.gov.au/ Privacy Impact Assessment Guide Revised May 2010.

- When implementing IM/IT systems, undertake a Security Threat Risk Assessment that is in line with recognised Australian standards. (ISO 31000 Risk management - Principles and guidelines, ISO/IEC 27001 Information technology - Security techniques - Information security management systems - Requirements). Ensure that this assessment considers the provisions in Health and Privacy legislation that require the protection of health and other personal information such as the protection of Medicare numbers.

- The Information Management Maturity Framework (IMMF) has been designed specifically to build capacity in information management and enhance service delivery outcomes. Consideration of the framework and its associated toolkit elements should be incorporated into standard IM/IT. The IMMF can be found at: http://www.agpn.com.au/programs/ehealth-and-information-management/agpn-ehealth-program/information-management-maturity-framework

----- End Extract.

Now I have seen some open-ended ambit claims in my time but this is a lulu. Who knows just what NEHTA / DoHA might come up with and just why would anyone sign up without some assurances of practicality and common-sense - things NEHTA at least hardly has a reputation for!

I leave it as an exercise for the reader to work out just where the IMMF fits!

One really does wonder just what difference the $171M on Medicare Locals will make in an overall health spend of close to $100 Billion per annum. Given this document I am still not at all clear just what the money will actually be spent doing - other than some apparent enforcement activities focussed on wayward GPs. It feels a bit like just an extra layer of bureaucracy to me and note that are not integrated into the planned Local Hospital Networks. We shall see I guess!


1 comment:

Bruce Farnell said...

Interesting post David.

I worked for a Division of GP for around 9 years and observed a wide variation between them in terms of what they actually did and member attitudes to their local DGP. Having said that, the strength of the local DGP was its relationship with its membership in terms of the services it provided and what it stood for. However, there was always a tension between what the members desired vs what the DGP could reasonably provide given their funding guidelines and other priorities.

From my perspective,the move to Medicare Local's and the associated governance changes risks the loss of this core DGP strength - the potential for a strong local DGP-GP relationship. Another issue is that of fund-holding for other primary care services while still providing primary care services. A potential conflict of interest for sure.

Also, as an aside, the concept of 'high performing' Divisions and how this is defined is interesting. Does anyone remember the scrapped points system of years ago? I assume that the 'wrong' Divisions were accumulating too many points. Perhaps the process is less subjective now?

For those DGP's managing to transform themselves to Medicare Local's - I do wish them well. Hopefully they can retain a positive relationship with their local GP community.

As for the IMMF. When it was first promoted some years ago my I was initially sceptical. However, after making an honest attempt to use it properly I found that it was a valuable tool. It does provide a useful quality framework for assessing IM within the business and identifying areas where action is required. I only hope that DoHA don't use the IMMF output as a means of assessing 'high performance' otherwise the potential benefits of using the tool properly will be lost.