PSR re-set and operational
The AMA has always been a strong supporter of the Professional Services Review (PSR) scheme. We know that the Medicare and Pharmaceutical Benefits Schemes assist Australians to gain access to affordable medical services and medicines, and it is important that there are sound audit and peer review arrangements to ensure that benefits are paid appropriately.
Peer review is fundamental to the AMA’s support of the PSR scheme, and it is why we engaged with the Health Department and went into bat for it.
It is critical that decisions about the clinical relevance of a service that has attracted a Medicare rebate or a prescription that has attracted a pharmaceutical subsidy are made by medical practitioners, based on medical facts.
Members will recall that, during 2011, the PSR scheme was under significant threat. The AMA heard members’ concerns about the transparency of PSR processes and procedural fairness. There were even calls for the peer review scheme to be replaced with a legal process.
At the same time, problems with the internal operations of the agency required an independent review, and a Federal Court case forced the annulment of the PSR panel.
Compounding this, a high degree of media attention implied that the matters handled by the PSR were more widespread than they actually were, which had a negative effect on the public perception of the whole profession.
And then there was a Senate Committee inquiry into the scheme.
During this time, the AMA did what it does best.
Our current Chair of Council Dr Iain Dunlop, our current Chair of the Council of General Practice Dr Brian Morton, and I, worked closely with senior leaders within the Department of Health, the PSR, and the Department of Human Services – under the auspices of the PSR Advisory Committee (PSRAC) – to re-set the PSR Scheme.
The AMA did not want to lose the PSR scheme to the lawyers. Lawyers are good with the law and administrative facts, but only doctors are good with medical facts.
We saw it was important for the whole profession to know that we acknowledge and support accountability within the system. It is equally important for those people who are reviewed under the scheme to have a complete understanding of how the scheme works, and what they can expect at each stage – and that they will be treated fairly.
All persons under review deserve procedural fairness and natural justice. Justice needs to be done, and seen to be done.
Under the guidance of the PSRAC, we now have:
· a Memorandum of Understanding between the Minister and the AMA, setting out the roles and responsibilities of the Department of Health, the PSR agency and the AMA in relation to the scheme, and the various operational aspects of the scheme;
· a document – Your Guide to the PSR Process – that explains in detail the PSR process. This allows people under review to understand each stage and what is expected of them, and their rights;
· guidelines that set out in detail the arrangements for the Director’s investigation and the processes for people under review negotiating a Section 92 Agreement;
· a newly-constituted PSR panel and Deputy Directors, and operational guidelines for them to follow when they are reviewing a peer; and
· documented arrangements for the Director convening PSR Committees.
The staff at the PSR agency are all trained and skilled for their roles. The PSR Deputy Directors have received training to ensure that persons under review receive procedural fairness, a full explanation of the outcomes of their review, and the reasons for Committee decisions.
I am confident that all of these activities have set the PSR scheme back on track.
I am confident that people who are reviewed under the scheme will be afforded procedural fairness and natural justice by their peers.
The profession can again have confidence in the PSR scheme.