The Murder of Medicare in Australia

Labor’s Medicare Locals integrated health care scheme ceased operations on 30 June 2015 when the Abbott Government replaced it with the Primary Health Networks scheme.

The Abbott and Turnbull governments’ grand plan for further ‘reforming’ Medicare service delivery swam into view on News.com.au and other media platforms on 30 March 2016:

SEVEN MILLION people in the country with chronic diseases like diabetes, heart disease and cancer will have to enrol with a single medical practice under a revolution in GP care to be announced by the Prime Minister today.

Patients will get to choose the GP practice that will co-ordinate all of the medical, allied health and out-of-hospital services they need.

And those with multiple chronic illnesses will get a care plan individually tailored to meet their needs.

Instead of paying their doctor a fee for service every time they receive treatment for their chronic illness, the government will give doctors a quarterly lump sum payment to care for the patient.

A fee for service will still be paid when the patient sees the doctor for other illnesses such as the flu or broken bones or other acute illnesses.

And the performance of doctors will be checked by the government via a new information bank that will measure patient outcomes at a local level and highlight areas for improvement.

Malcolm Turnbull says enrolling patients in a single medical home will help keep people with chronic diseases out of hospital by giving them evidence-based treatment.

This it turns out was merely announcing stage one in the introduction of the Health Care Homes model, which in October 2016 saw Prime Minister Turnbull and Health Minister Ley officially announcing the selected regions, based on Primary Health Network boundaries, for Stage One implementation of Health Care Homes. These include: Perth North, Adelaide, Country South Australia, South Eastern Melbourne, Western Sydney, Tasmania, Nepean Blue Mountains, Northern Territory, Brisbane North, as well as Hunter, New England and Central Coast in New South Wales.

The Hunter New England and Central Coast Primary Health Network includes, but is not limited to, the following locations: Armidale ,Bulahdelah, Cessnock, Forster, Glen Innes, Gosford, Gunnedah, Inverell, Moree, Muswellbrook, Narrabri, Nelson Bay, Newcastle, Quirindi, Tamworth, Taree and Tenterfield.

Therefore in NSW the scheme will be initially implemented in three primary health care networks which stretch from western Sydney through to the NSW-Qld border.

By 4 November 2016 this scheme had quietly morphed in right-wing political backrooms into this according to the Herald Sun:

THE nation’s sickest cancer patients and people with diabetes and other chronic illnesses will get a maximum of $1795 worth of GP care a year funded by Medicare under a revolution in the way doctors are paid.

And Medicare will fund just five extra visits to the doctor if these people need medical attention for issues aside from their chronic illness under the Turnbull Government’s Health Care Homes model.

Doctors were expressing deep concern about the adequacy of the payment levels that were released without consultation with medical groups on November 4.

“The modelling is concerning and potentially leaves the whole program at risk of falling over because of being underfunded from the beginning,” AMA vice president Dr Tony Bartone said.

The Health Care Homes policy is a signature government policy which it claims will solve the woes of the Medicare system by providing comprehensive care for one in five Australians who have a chronic illness, keep them out of hospital and save the health system money.

Patients will have to enrol with a single GP practice to get a new form of wrap around health care under the model but Doctors are worried they’ll get less money than they receive now to care for the sickest patients.

Currently doctors are paid on a fee for service model and get paid $37 by Medicare every time they see a patient for a standard 20 minute visit, they get paid more for longer visits.

There are no limits on how many times a patient can see a doctor and get a Medicare rebate.

Under the new model patients with the least complex chronic conditions will get $591 a year worth of GP care, those with a slightly higher level of complexity will get $1,267 worth of GP care and the most complex patients will receive $1795 worth of care.

The sickest 12 per cent of patients account for 40 per cent of Medicare benefits and on average they receive 51 services a year, Dr Seidel said.

The maximum funding under the government’s health care homes model is only enough to cover 48 GP visits a year, or less than one per week.

Dr Seidel says a patient with diabetes and an infected leg would need to visit the GP at least three times per week to get it dressed.

The RACGP had asked the government to provide doctors with an extra $300 per patient per year on top of existing funding to make the new Medicare model work.

The current funding suggests doctors will be receiving less than they currently get.

Dr Bartone said the Health Care Homes model was based on a long standing method of paying GPs for caring for war veterans.

So now we all have a slightly clearer picture of how multi-millionaire Malcolm Bligh Turnbull and his fellow travellers intend to further pervert Medicare’s aim of providing universal health care.

Those with a chronic or complex medical condition will be tied to one general practitioner or medical practice and be restricted as to how many times a year they can see their doctor. Bulk billing is not guaranteed if that is not the policy of the medical practice/GP with which they are enrolled and, if they require more than 48 standard GP visits a year they may possibly be forced to pay the full cost of any additional ‘chronic illness’ visits . As for any other type of illness or injury they might experience – only five extra GP visits a year will be covered by a Medicare rebate [See update below].

At the moment participation on the patient’s part is allegedly voluntary, however if they agree to enter the Health Care Homes scheme they are forced deeper into the Abbott and Turnbull Governments’ insecure national database and ongoing government data retention scheme.

According to the Australian Dept. of Health, enrolment of up to 65,000 patients begins in 2017 and implementation of services delivery begins on 1 July that same year and continues through to the end of stage one on 30 June 2019. During this initial stage, Health Care Homes services will be limited to Medicare-eligible patients with two or more complex or chronic conditions.

Ongoing evaluation and refinement of Health Care Homes is also promised which probably means that, like e-Health aka My Health, the scheme will cease to be opt-in and become opt-out - or possibly even mandatory.

The Turnbull Government intends to fund Stage One of Health Care Homes by redirecting $93 million in MBS funding between 2017-18 and 2018-19 and providing an additional $21.3 million over the next three years to establish the design principles, IT systems and provide the training needed to assist health care providers to transition to the new system.

Thus far, this new scheme appears to offer no enhanced or additional health services to the chronically ill or those with complex medical conditions - it presents as nothing more than another federal government cost-cutting measure wrapped up in a public relation bow.

Stay tuned for the next instalment in the ongoing saga, “The Murder of Medicare”.

UPDATE

Turnbull Government backs down on capping number of extra GP visits for illness or injury not related to patient's chronic or complex medical condition. However, all other Medicare 
limits impacting on health services delivery to chronically ill patients appear to remain.

News.com.au, 9:35pm 8 November 2016:

The cap on doctor’s visits was revealed on Friday when the government announced details of its keystone Health Care Homes trial.

The trial will see 65,000 chronically ill patients in 200 GP practices enrol with a single GP practice for all their health care.

The Health Department revealed doctors would be given an annual budget of between $591 and $1795 a year to care for these patients, a budget doctors say amounts to a pay cut.

And in a fact sheet the Department of Health said:

“Enrolled patients can still access fee-for-service billing for a small number (up to five) of episodes of care not related to a patient’s chronic conditions”.

On Monday, in a tweet, Health Minister Sussan Ley denied there was a cap of five visits.

“No limit to Medicare fee for service under health care homes. 5 appts departmental guide only. Opt in not capitation. Co-designed with docs!”

Mysteriously, and without a new press statement, wording of the department’s fact sheet on Health Care Homes was changed on Monday to remove the five visit rule:

“Enrolled patients can still access fee-for service episodes of care not related to a patient’s chronic condition”.

Yesterday Ms Ley tweeted “Capped visits were never on the table”.

In response to an inquiry a spokesman for Health Minister Sussan Ley said the Department of Health said it had “changed its fact sheet on payment information”.

“The Department amended it to make it clear that there is no hard cap or limit on the capability of GPs to bill MBS services not related to an enrolled patient’s chronic conditions. The Department says it had nominated five as a notional number for planning purposes for these services and that it was based on clinical advice. The number of fee-for-service episodes of care will not be capped or restricted and will be monitored during stage one of Health Care Homes,” he said.