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Government taskforce doesn’t back sick certificate scare

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The MBS Review Taskforce has sounded a warning on assertions that doctors are blowing out health costs by issuing sick certificates, ordering prescription repeats and writing specialist referrals.

Two-thirds of health professionals responding to an online survey run by the Taskforce called for MBS rules to be reviewed, particularly regarding the use of referrals and restrictions on eligible providers, seemingly lending weight to claims that GPs were wasting much of their time on ‘routine’ tasks like filling out medical certificates and writing referrals.

Related: Review reveals Medicare wastage gripes

Health Minister Sussan Ley seized on the claims, telling ABC radio that “if the Government is paying effectively too much for small appointments that aren’t necessarily adding to a person’s overall health, particularly if they have chronic conditions, then that money does need to be reinvested”.

Extending her attack on primary health care, Ms Ley said a quarter of patients believed they had been recommended tests or treatments that were unnecessary.

The suggestion has fuelled calls, including from the Pharmacy Guild of Australia, for pharmacists, nurses and other allied health professionals to be granted an increased scope of practice to ease the burden on family doctors.

But the Taskforce itself has cast doubt on the extent of the problem, and has instead inferred that its prominence was being driven by health groups like pharmacists and nurses keen to expand their scope of practice.

“Many health professional respondents argued that referrals through GPs were unnecessary, particularly when accessing allied health services,” the Taskforce said in an interim report on its consultation. “It should be noted that the prevalence of this issue may reflect the skew towards allied health providers in the respondent group”.

AMA President Dr Michael Gannon dismissed the claim that valuable health dollars and GP time was being wasted on writing out certificates and referrals.

Dr Gannon said that not only was general practice very cost effective – accounting for just 6 per cent of total health spending – but performing such services was often a valuable opportunity to undertake preventive health care such as performing blood tests and assessing for diabetes and heart disease risk.

Related: Patient charges rising fast

In its discussion of the results of the online survey and stakeholder consultations, the Taskforce notably avoided the issue and turned its focus elsewhere.

It backed proposals for greater transparency on Medicare fees, and endorsed the idea of giving practitioners data on their own Medicare item usage, benchmarked against their peers.

But it flagged a cautious approach to changes to Medicare pay arrangements and MBS items.

In consultations there were calls for the fee-for-service model to be scrapped and replaced with an outcomes-based payment system.

But although expressing interest in pay for performance as a complement to fee-for-service in supporting multidisciplinary care, it was lukewarm on a wholesale change.

“The evidence suggests that clinically-based outcomes linked to payment have mixed success and may not be superior to activity-based payments in driving high-value care,” the Taskforce said. “Indeed, the MBS itself has many examples where incentive payments directed to addressing service deficits have had undesirable outcomes.”

And, while the Government has emphasised the scope for the MBS Review to axe Medicare items, the Taskforce indicated it would be moving with careful deliberation.

It noted that its terms of reference “do not preclude” recommending new items, and was considering “the addition of temporary item numbers to be used specifically for the acquisition of evidence to support the long-term retention or removal of items from the MBS”.

The case to remove items will depend on more than simply how often it is used.

“The Taskforce recognises that low usage of an item is not in itself conclusive evidence of obsolescence,” the Taskforce said.

View the Taskforce interim report here.

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