This appeared last week.
More than 1000 GP practices denied PIP payment after 'data-matching' crackdown
Health Department officials are using new legal powers to access GP data
3rd May 2021
More than 1000 practices have missed out on quarterly eHealth Practice Incentive Program (e-PIP) payments following a compliance crackdown using the Department of Health's latest “data-matching” powers.
Laws introduced in 2019 allow the department to cross-reference a GP's MBS and PBS claims with data from AHPRA, Border Force, private health insurers and the Australian Digital Health Agency.
This was previously forbidden under privacy legislation but the health department claimed the changes were necessary to identify Medicare rorts.
It has now revealed it has used the powers to check if practices have been uploading sufficient numbers of shared health summaries to My Health Record to quality for the e-PIP.
To get the payments, worth up to $50,000 a year, at least 0.5% of patients need to have an updated shared health summary uploaded to the system per quarter.
Typically practices declare they have met the requirements and that have the appropriate records if subject to an audit.
But in this case, the digital upload records for individual GPs working in the practices were handed over by the Australian Digital Health Agency, which manages the My Health Record system.
No patient data was handed over, just information on the number of shared health summary uploads made by the GP, the department stressed.
Officials then matched the records to the practice's PIP claims.
Some 1106 practices were subsequently denied the PIP payment after data-matching showed they had not met the requirements, a spokesperson for the Department of Health said.
More here:
The word ‘sprung’ leaps to mind!
Additional coverage here:
New DoH data matching powers deny 20% of practices ePIP
If having to upload shared health summaries and the My Health Record seems an annoying waste of your time, you’re practice manager probably won’t agree anymore
1106 practices which were paid ePiP last quarter have been denied the payment this quarter after DoH data matched records with the Australian Digital Health Agency (ADHA) and found that these practices had “not met the shared health summary upload requirements for a payment quarter under the Practice Incentives Program eHealth Incentive (ePIP).”
According to the DoH, all practices were sent an initial compliance letter, outlining an exemption process, and so far the department has granted 80 exemptions.
If we assume 1000 practices don’t end up exempt, then you can do some back of envelope calculations here to arrive at an average amount those 1,000 practices may have lost in revenue. We get $6250 per practice for that quarter . Of course that is going to be lower and higher depending on FTE numbers in each practice, but, ouch.
The department has provided quite a bit of information for those practices which have missed out this quarter on what to do to make sure they get in line for next quarter, so the problem is likely to go away over time for those practices affected. If you’re interested you can start HERE.
We have put some further questions to the department asking it to detail some of the reasons practices had not met “the requirements”.
It doesn’t seem to be that they failed to upload the minimum number of summaries required as the system rejects a practice straight away if the required number of the summaries aren’t uploaded.
It seems like it is something the department has managed to audit within the summary data itself, which it isn’t right. It should be interesting to find out what constitutes some of the fails. Are some of the summaries dummy summaries or automated summaries which aren’t loading real or meaningful data?
We’ll get back to you if and when we find out.
Probably the more important message for practice managers in this episode is that Big Brother has officially arrived in the form of genuine data matching to reveal inconsistencies in practice management, claiming and funding.
The legislation to clear the way for such sophisticated and automated prying was passed nearly two years ago, with not a great deal of fuss, at that time.
The even bigger warning in terms of data matching starting up is probably for individual GPs because the more sophisticated the department gets in matching data between the various arms of government in health – MBS, PBS, ADHA et al – the more they don’t need to rely on random and small scale auditing. Even Robodebt type guessing via analytics, which they’ve used a bit in the past to generate nudge letters, will be surpassed in accuracy and performance.
More here:
https://medicalrepublic.com.au/new-doh-data-matching-powers-deny-20-of-practices-epip/44927
While it is amusing to see how many people were not keen to upload clinical summaries – when they presumably thought they would not get caught – the more sinister thing to me is just how intrusive the monitoring of clinical can be and what that means, in the broad, for autonomy in clinical practice.
I don’t think this sort of monitoring and level of intrusion was part of the deal when Medicare was kicked off all those years ago!
This sort of trend needs better monitoring and discussion.
David.
6 comments:
I do hope the ADHA reflects this in its claims of overwhelming adopting and the ‘never meet anyone who wants to turn it off’.
The Government wants uploads? Then upload , just send a blank document, I am not sure it even needs to be CDA these days.
Are we sure the ADHA is able to without doubt determine if a GP has or has not uploaded? It was not long ago that there was evidence the system was rejecting documents without the sender being notified. There is no evidence that was resolved.
Well pretty clear the purpose of the MyHR now, in case there are still those who think it a clinical tool.
It is how the collective APS and politicians think. Just like Aged Care, lots of money thrown at the wrong things to attack issues that are insignificant and detract from the more important issues. Where in this latest budget will we see the called for landmark Australian social policy reform, which would ensure well trained, well paid staff overseen by an independent auditor and with complete transparency for the billions of dollars in taxpayer funds given to the industry each year?
Agree, monitor and control everything except their own questionable ethics and behaviour. We see what happen when even the faintest light is shone on them.
If a system gets used little, then attention wanes, lack of attention presents risk, the system become vulnerable and ends up exploited. If a system within a set of trusted systems is exploited and known is there to notice - was it really exploited? yes and places every other data store it is trusted by at extreme risk.
The cyber security centre should step in and shut it down.
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