An
almost three-fold increase in the number of doctors investigated for
over-servicing or inappropriate practice has been reported by the Professional
Services Review this year.
The
PSR investigated 136 health professionals, mostly GPs, for inappropriate
behavior such as overuse of long consultations, overprescribing of benzodiazepines
and ordering of too many CT scans.
In
its annual report, PSR director Dr Tony Webber many cases investigated by the
PSR last year involved GPs being pressured to ‘get the paperwork done’ for Team
Care Arrangements (MBS item 723) for allied health services, when the patient’s
condition did not warrant the use of the item.
He
says he was also concerned about the ongoing overprescribing of benzodiazepines
such as alprazolam by some practitioners, given their potential for diversion
and abuse.
“Tighter
restrictions on and surveillance of these drugs may be needed,” he writes.
It
was also cause for concern that some GPs appeared to be using CT scans as a
screening tool for patients with back pain, which was of concern because of the
radiationrisks, especially foryounger women of reprodutive age.
In
its report, the PSR also warns GPs that it is cracking down on the
practitioners who use Medicare consultations to provide quack remedies.
Last
year the PSR investigated 136 practitioners, up from 50 in 2007-8, and 119 of
them were GPs. The PSR took action in 61 cases, including one case in which a
GP working for a heart check clinic had to repay almost $180,000 for
inappropriate ordering ofinvestigations.
Medicare requires a GP to claim the TCA item number as well as that for a GPMP whenever a patient with complex care needs seek Medicare subsidy of allied health care or dental care. If Medicare is concerned that too much money is being spent on TCA or if inappropriate practice is occurring to a significant degree, the simple solution is to scrap the TCA & allow the subsidy on the basis of the GPMP alone.
Posted by Kevin Farrell GP, Nambour, QLD 5/11/2009 3:56:19 PM
Medicare introduces these EPC TCA and dental items, then seems surprised that so many patients want to access these (sometimes free)services. Demand continues to escalate.So the poor old GP gets blamed and accused of overservicing yet again.I am always being hassled by patients who are not eligible, and demand EPC, and are disappointed when I refuse.
Posted by Mimika 5/11/2009 6:49:03 PM
I don't condone overservicing or fraud anymore than I condone governments who are more interested in penalising doctors when their own systems are not perfect and more importantly when they do not explain the Medicare rules and/or their own Medicare advisers do not understand them nor can they explain them consistently in writing. My case in point is the administrative position statement program see http://www.medicare.gov.au/provider/business/aps/index.jsp which is supposed to clarify the Medicare rules (primary concerns), how many of these rules are about clarifying major Medicare's position. You will note very few if any. They are not serious about overservicing this is yet another revenue grab. Millions are spent on promoting team healthcare plans no wonder GPs are confused and the government programs are not as effective as they hoped for. How about prevention before cure isn’t this what you are telling GPs? Some government leadership on this issue would be great. I do oppose the current Health Care Bill which if passed would prevent doctors going back to their patients to claim back their consulting fee up to two years if Medicare found their service was inappropriate regardless of whether this service was provided on good faith or not. In the real world this would never happen. More importantly you cant run a business with this uncertainty. What is in appropriate is Medicares lack of early warning detection and education schemes so our poor doctors don’t fear this level of scrutiny and the big tail penalties. Fair Go PSR if you know the rules tell the rest of us! How much does Medicare Australia spend on MBS face to face education to new graduate doctors/practice managers and also when new rules are introduced. Once again I rest my relatively very little when you consider the amount of resources they spend on promoting the very healthcare plans they are prosecuting. The PSR has a lot to answer for before any doctor has. Im sorry I don't like bullies when the good guys are trying to do the right thing and Medicare Australia wont help.
Posted by David Dahm 5/11/2009 7:04:35 PM
The instigators of the pressure for inappropriate practices - Allied Health Services - Why are they not investigated & prosecuted??
Latest Comments
Posted by Kevin Farrell GP, Nambour, QLD 5/11/2009 3:56:19 PM
Posted by Mimika 5/11/2009 6:49:03 PM
Posted by David Dahm 5/11/2009 7:04:35 PM
Posted by JohnC 6/11/2009 4:10:33 PM
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