Wednesday, May 17, 2017

The DoH Really Must Be Desperate To Have GPs Use A System Of Unproven Value.

This appeared a little while ago.

RACGP chief defends budget pact with govt

| 16 May, 2017 |  
The RACGP is denying bungling the numbers as it defends its controversial budget pact with the Federal Government.
Under the “compact”, unveiled on the night of the budget, the RACGP gives the government the green light to wait until July 2018 to lift the freeze on Medicare rebates for GP consultations.
Under the deal, the rebates will rise based on an old indexation formula.
However, the formula, which will lift a level B consult by around 55 cents, has long been criticised by doctor groups for being below the actual rate of CPI (see box below).
Despite this, RACGP president Dr Bastian Seidel has defended the agreement, describing it as a major win and arguing that it represents an “ongoing guarantee of the same funding each year in real terms”.
“While this [guarantee] may seem like a step back to where we were before the big freeze, it’s a clear win for over 85% of Australians who receive preventative health services from their GPs each and every year,” Dr Seidel said in a media statement on Tuesday morning.
“Our agreement with the Australian Government to help strengthen Medicare recognises the essential role of GPs in a system that touches every Australian.”
A college spokesperson said this afternoon that "real terms" meant increases in line with wages and inflation, "not inflation alone which is higher or medical inflation which is higher still".
The AMA made a similar deal with the government, without agreeing to how rebates will be indexed once the freeze is lifted.
But AMA vice president Dr Tony Bartone said: “If funding is less than CPI, then, by definition, it is not in real terms.”
On Monday, former AMA secretary general Dr Bill Cootes warned it would add to the already heavy financial pressures on practices.
Lots more here:
Just amazing that because of  a pittance of an increase in fees the College thinks that they can deliver to a desperate Department of Health more utilization of the myHR (part of the deal is that the College will promote the myHR) that GPs have already largely rejected.
If the system was any good none of this would be needed and we would not need ePIP and the like. Doesn’t the Department realise the myHR is already an obsolete, use-hostile, time wasting dud?
Remember before you can assess and financial benefits from the myHR for the Government you have to deduct all these, apparently endless, incentive costs – which must have been a fair bit by now. Anyone know the figures?
This really just goes round and round with incentives to foster use of a system which I reckon will go back to little use as soon as the payments cease. The lesson from the past has been that GPs only stick with things that help – not things that involve lots of time and effort.
Time will tell I guess! Looking from the outside this myHR is really costing a bundle!
David.

6 comments:

Bernard Robertson-Dunn said...

Under current rules, patients need to create a nominated healthcare provider (usually their GP) who is the only person who can upload a SHS. If a GP tries to upload without being nominated, they will probably be breaking the law.

Unless people buy into this scheme MyHR will just sit there, mostly unused.

GPs will have to spend time explaining MyHR, persuading their patients to let them be their nominated healthcare provider, create a SHS (which has to be accurate and consistent with stuff that might have been uploaded by others mainly clinically useless payment details from MBS and PBS).

Is it likely? Will anyone actually use MyHR. Has anyone ever used MyHR so far?

You can lead a horse to water, you can't make them drink, especially if the water smells off.

Anonymous said...

Bernard thanks yet again for investing your time into providing this level of insight.

Under current rules, patients need to create a nominated healthcare provider (usually their GP) who is the only person who can upload a SHS. If a GP tries to upload without being nominated, they will probably be breaking the law.

So with Opt Out, do I need to go in and create this? And what if I don't create one? Based on the level people in the trails who bothered to access and change privacy controls, one would assume that even if 10 times as many people access their records and nominate a GP, that still exposes a lot of GPS, Hosspitals, Pharmacist, and other professions to innocently breaking the law, especially as uploads will in a lot of cases happen automatically.

I am a little confused how this will work within a legal framework? Still I guess Tim and Ronan are expendable when this gets hot

Bernard Robertson-Dunn said...

In this section of the government's website, aimed at patients

https://myhealthrecord.gov.au/internet/mhr/publishing.nsf/Content/find-out-more?OpenDocument&cat=Managing%20your%20My%20Health%20Record

In the panel labelled "what is a nominated healthcare provider" it says this:

"Your nominated healthcare provider is decided by mutual agreement and has the role of developing and managing your Shared Health Summary. To be a nominated provider, the person must be a medical practitioner, registered nurse, or an Aboriginal and/or Torres Strait Islander health practitioner with a certificate IV in Aboriginal and/or Torres Strait Islander Primary Health Care (Practice). A nominated healthcare provider is not required for you to have a My Health Record."

in "Frequently Asked Questions for Healthcare Providers"
https://myhealthrecord.gov.au/internet/mhr/publishing.nsf/Content/healthcare-providers-faqs?OpenDocument&cat=Using%20My%20Health%20Record

In the panel "how is a Shared Health Summary Created?" it says:

"To create a Shared Health Summary (SHS), the healthcare provider will need to obtain the patient’s agreement that:

The healthcare provider is to be the individual’s nominated healthcare provider
The healthcare provider is to create and upload the SHS for the patient

The document is a good idea for the healthcare provider to have a conversation with the patient about the type of information the provider will include in the SHS. There is no explicit requirement for the patient to review the SHS before it is uploaded to their My Health Record.

When creating the SHS, the nominated healthcare provider needs to ensure that all aspects of it have been completed and verify the accuracy of the information it contains. In assessing its content, the nominated healthcare provider should take into account other relevant information on the patient’s My Health Record.

It is important to note that consent given by the individual is subject to the parts of the Public Health Acts of New South Wales, Queensland and the Australian Capital Territory that prohibit the disclosure of certain sensitive information (such as in connection with AIDS or HIV) without the express consent of the individual."

Which seems to imply that it is the GP who does the nominating but needs to get the patient's agreement.

The answer to your question "So with Opt Out, do I need to go in and create this?" would appear to be Yes, although it might be possible to do it over the phone. The government isn't very clear about all this. The quote below strongly implies that the nominated provider must see the patient face-to-face.

It's almost as though in the nearly 5 years since it went live, they still haven't got their act together.

Bernard Robertson-Dunn said...

A bit more about Healthcare Provider:

Delving into the Concept of Operations, September 2011 Release, and which says "The Concept of Operations will be periodically updated ..." but hasn't, so it is still the only definitive document every released, it says this about the Nominated Provider

The author of a Shared health Summary is referred to as the individual’s
‘nominated provider’.

A nominated provider is an identified healthcare provider involved in the
ongoing care of the individual who has agreed with the individual to create
and manage their Shared Health Summary.

In addition to the meeting general participation criteria for the PCEHR (see
section 3.3), in order to submit a Shared Health Summary, the nominated
provider is required to assert that they:

• Are delivering continuing, coordinated and comprehensive care to the
individual.

• Are a qualified medical practitioner, registered nurse or Aboriginal
Healthcare Worker or other professional group permitted under the
forthcoming PCEHR legislation.

• Have assessed and described all aspects of the Shared Health Summary
and taken reasonable steps to verify the accuracy of information. In
undertaking that assessment, the nominated provider will take into
account other relevant information on the individual’s PCEHR.

• Have reviewed the Shared Health Summary with the individual and both
parties agree that the provider can act as the individual’s nominated
provider.

It is expected that for the majority of Australians, the nominated provider will
be the individual’s regular General Practitioner (GP).

Where a GP who meets the above criteria is not available, another class of
provider who meets the criteria may be engaged as nominated provider.

Nominated providers are not expected to update a Shared Health Summary
outside of a consultation with an individual.

Individuals will have the option of being notified when a new Shared Health
Summary has been posted to their PCEHR (see Section 5.5.2)

A regulatory approach will apply to the management of the above criteria,
including specification of eligible healthcare providers. It is anticipated audit
and other investigations will take place as quality control measures for Shared
Health Summaries.

The Department will continue to work with AHPRA and NEHTA to enhance the
classification of healthcare professions and to investigate if system
mechanisms may be developed over time to assist with enforcement of these
criteria."

Bernard Robertson-Dunn said...

And finally some musings about nominated healthcare providers.

I can't find anything in MyHR that permits you to delete your current GP. My guess is that once you have one, you'll always have one. The only thing you can do is make another GP your nominated provider.

Whoever is your nominated provider can upload whatever they want into your SHS.

If you don't like what they have uploaded in your SHS (e.g. included an even you'd rather keep confidential, you have to persuade them, you can't force them. the MyHR system operator may be able to assist but it is not clear if they can force the GP to comply.

There is no formal dispute resolution process.

You cannot put access controls on your SHS.

Here's a quiz:
The government says this:

"The documents and information stored on My Health Record are completely under your control. You have the ability to hide clinical or Medicare documents and restore hidden documents."

Is this statement completely true?

The quote is from

https://myhealthrecord.gov.au/internet/mhr/publishing.nsf/Content/find-out-more?OpenDocument&cat=Managing%20your%20My%20Health%20Record

In the panel "Can I choose to hide documents or information in MyHR?"

Anonymous said...

Now will the GovHR people simply erase that from history and secretly change legislation etc? Or will they undertaken the same level of engagement that happened in creating these agreements? The then party responsible for privacy and policy at NEHTA is an Executive of the ADHA, just what is her position?