Tuesday, August 12, 2014

It Is Looking Like Any Introduction Of A Medicare Co-Payment Will Be A Technical Nightmare!

I am starting to see information from DoH on just how they are hoping the still uncertain Medicare Co-Payment will work.
An article appeared on the topic here a month or so ago:

GP co-payment IT system 'a big ask'

Deputy Editor, Technology
TAXPAYERS will have to pay hundreds of millions of dollars to build a centralised database for 25 million people that would update in real time to cater for the Abbott government’s proposed $7 medical co-payment scheme, IT experts say.
The government has proposed that people pay $7 each time they visit a GP, get an X-ray or a blood test from July next year. A patient who visits a doctor and needs a pathology test and an X-ray will be slugged with $21 in upfront fees.
The $7 fee is applicable to everyone except concession card holders and children under 16 who will pay for the first 10 services combined.
The controversial plan has drawn the ire of consumers and many in the healthcare fraternity who say it marks the demise of universal access to healthcare in Australia.
One of the biggest challenges with the proposal is there is no way to determine — in real time — the number of times a patient has made a co-payment.
The federal Department of Human Services, which runs Medicare, declined to say how long it would take to develop ­special software or a portal to provide the real-time information and how much it would cost.
Jorn Bettin of IT consultancy IBRS, said given the fragmented nature of health IT systems and the multitude of different healthcare providers, it would be ­“extremely hard to develop a system that reliably tracks all visits of healthcare service providers”.
“In terms of costs, the underlying platform will cost several hundred million dollars to develop and roll out. Adding a feature that tracks $7 payments is the easy part,” Mr Bettin said.
“Given recent news about government budgets and NEHTA (National E-health Transition Authority), it is questionable to what extent it is realistic to assume that such a platform will be available in a timely manner for the payment proposal to be implementable,” Mr Bettin said.
When asked how GPs, patients and the respective labs would be able to identify the number of co-paid services in real time, a DHS spokeswoman said the department was “designing the technical solution for the implementation of co-payment policy as outlined in the federal budget”.
Lots more here:
That the delay is likely to be a problem is confirmed by this from DoH.
“It is foreseeable that there may be some delay between the date of service, the lodgement and processing of the Medicare claim. This may result in the DHS system, at a particular point in time, only recognising that 10 or less patient contributions have been charged when in fact the patient has been charged 11 or more in a calendar year (with a number of claims yet to be submitted to DHS or processed by DHS). To mitigate this situation, the claiming channels will also be enhanced so that providers have the option to declare that the provider has obtained information that provides a reasonable belief that the patient has been charged at least 10 patient contributions in the calendar year.”
The other obvious issue is just how the practice management billing systems are going to need to be modified, how much this will cost the software providers and just how much it will be given to them to fund the change.
Of course all this will be made more complicated if there are to be changes in the core Medicare and PBS systems following the EOI we noted a few days ago.
I think you can expect a lot more discussion of the potential issues.
Surely it would be simpler for all if the Senate just rejects the co-pay plan and thinks of other ways to fund the health system?
Some fundamental reform of the health system would seem to be a much better, but much harder way to proceed.


Anonymous said...

Maybe centralised technology is not the answer? We could have coffee shop - style cards. 10 stamps and the next one is free.
I think there is already an app that could be adapted for that…

Anonymous said...

Hundreds of millions of dollars to send a standardised outbound message from the GP/path lab to a central system which then other systems can interface with? Two acronyms: HL7, PCEHR.

DHS/Medicare don't need a new system or a new portal to handle this, they should use the existing infrastructure they have. Sounds like they need some advice, not yet another system.

Anonymous said...

The bureaucrats want a new system. The Minister has been well sold on the message that the current system is broken and can't be fixed. So a new system we must have - oh, and in the process it will ensure we all keep our jobs while the new system is invented.