Sunday, August 26, 2012

What I Want To See Is The Modelling On The Costs Of Paying GPs For NEHRS Activities. There Will Be Unintended Consequences I Suspect.

A couple of days ago the AMA responded to the offer from the Government to provide certainty as to the payment that were available to GPs with regard to the NEHRS.

Government delivers PCEHR incentives for doctors

Health Minister Tanya Plibersek tonight provided important policy clarity and greater incentives for GPs to become fully engaged more quickly with the Personally Controlled Electronic Health Record (PCEHR).
The AMA is a strong supporter of a quality workable shared health summary and has been in discussions with the Minister and the Department of Health and Ageing for some time seeking further clarification on how GPs could confidently provide PCEHR services for patients under existing Medicare Benefits Scheme (MBS) arrangements.
AMA President, Dr Steve Hambleton, said that the Government has listened to the AMA’s concerns and delivered an outcome that will encourage doctors to become actively involved in the implementation of the PCEHR.
“The Government has clarified that additional time spent by a GP on a shared health summary or an event summary during a consultation will count towards the total consultation time, and that the relevant time-based GP item can be billed accordingly,” Dr Hambleton said.
“The Minister has tonight fully explained how doctors can now safely and confidently provide new PCEHR clinical services such as a shared health summary under current MBS items.
“The Minister has also delayed the PCEHR e-health practice incentive payment (PIP) capability requirements until May2013.
“The AMA strongly welcomes both announcements.
The full release is found here:
Here is one of the better pieces of press coverage which includes a link to the Medicare rules.


23 August, 2012 Megan Reynolds
The AMA has welcomed the government's announcement that doctors will be paid for transferring patients to the PCEHR scheme.
Full details of the new arrangements can be seen on the Medicare website here.
According to the site:
The time spent by a medical practitioner on the following activities may be counted towards the total consultation time:·
Reviewing a patient's clinical history, in the patient's file and/or the PCEHR, and preparing or updating a Shared Health Summary where it involves the exercise of clinical judgement about what aspects of the clinical history are relevant to inform ongoing management of the patient's care by other providers; or
Preparing an Event Summary for the episode of care.
Preparing or updating a Shared Health Summary and preparing an Event Summary are clinically relevant activities.  When either of these activities are undertaken with any form of patient history taking and/or the other clinically relevant activities that can form part of a consultation, the item that can be billed is the one with the time period that matches the total consultation time.
MBS rebates are not available for creating or updating a Shared Health Summary as a stand alone service.
More here:
Parenthetically this was clearly big news - with even coverage in the Cowra Community News!

GPs to be paid for e-health work

THE federal Government has relented to a demand by doctors that they be paid for helping to set up patients’ electronic health records.
Health Minister Tanya Plibersek announced yesterday (Wednesday) that GPs will be able to receive Medicare payments for preparing shared health summaries and event summaries as part of a consultation.
“In deciding which item to bill, GPs will only have to consider the reasonable time it would take – not the complexity of the consultation,” Ms Plibersek says in a statement.
Lots more here:
What seems to have escaped people is just what all this might cost in terms of actual costs for Government and time available for servicing community needs. Additionally there is also the issue of just what the cost benefit outcomes of all this might be.
Let’s think about the implications. First on costs. If we assume say 20% of the population eventually are using a NEHRS which is updated twice a year with an average bill of $50 for that service.
Doing the maths that is 4.4 million people by $100 per annum. That comes to $440 million per annum.
Second on available time for GPs. What this is suggesting is that (at 15 mins average - the AMA figure) we are losing 8.8 million patient encounters. If we assume a GP sees 6 patients per hour for 8 hours per day  for 5 days a week. we are having a GP service 11520 encounters per year (48 week work year).
That works out at a need for 760 or so additional GPs unless filling in NEHRS records actually reduces patient attendances, which is just possible.
From here we can see there are presently about 25,000 GPs. 760/25000 means a loss of 3% of the effective GP workforce or more than were added in the whole last year.
So the bottom line is that this is a pretty real impact on the availability of GP services and we don’t have a single word about the assumptions underpinning this investment and just how cost effective and beneficial it will be.
Why do I get the feeling this is just one of those times where the Government has decided to ‘kick the can down the road’ and try to stave off the ultimate fate of the NEHRS by throwing money at the problem - with no real evidence of cost and impact.
Proper modelling of these announcement should have been done and it should be public.


Paul Fitzgerald said...

so $400M to get doctors to put patients onto a $700M that probably, given current course and speed, will not provide any benefits? Am I the only one who has a problem with this?

Paul Fitzgerald said...

that should read $700M System :-)

Anonymous said...

You are thinking about this all wrong. You keep thinking logically about value for the taxpayer, utility of the system and benefit for the patients. You need to start looking at it from big consulting profits and public service careers!

No doubt this is just the first of a series of money grabs as they slush more into the trough!

It is a classic response to a departmental stuff up. Good money after bad.

You can imagine the conversation went something like.....

I know we don't have any patients in the system so far but don't worry Minister we can fix it, we just need $$$$$ms for the GPs and we can get them populating it and make it look like a success.

Yes Minister!

Anonymous said...

Sir Humphrey is alive and well in the halls of DOHA.

Anonymous said...

If the system provides no useful purpose to doctors because the design is fundamentally flawed then the overall outcome will be a lot more money wasted by overzealously promoting the system to the public with the end result that pubic disillusionment in the system will be increased beyond redemption.

Anonymous said...

Redemption - great choice of word. ..... Redemption - efforts amongst a person or people within a particular faith to overcome their problems and short comings, and go on to achieve the moral positions that are exemplified within their faith.

The Government, bureaucrats and NeHTA are looking for a way to be saved whilst adopting the moral high ground. The doctors and eHealth vendors know that faith will not save them.

Anonymous said...

6 patients per hour? Is that a misprint? How do patients get the care they need in that time?

Dr David More MB PhD FACHI said...

I was being conservative on the impact.