Perverse, if not outright perverted, incentives (Australian Doctor 3 February 2012)

February 3, 2012 § Leave a comment

Tony Webber is a former Director of the Professional Services Review. He’s also a clueless bureaucrat. At least, I thought that a few years ago while he was flailing around to avoid defining long consultations under Medicare.

I wrote at the time that, regardless of the PSR’s views, I would keep billing a long consult item for any professional attendance that hurt my brain and lasted more that 20 minutes. This included consults using phone interpreters for Kirundi-speaking refugees who turned out to have simple viral URTIs.

My opinion of the man has changed. AMA hacks are whining that Dr Webber is a doctor-basher but I liked his article ‘What is wrong with Medicare?’ in the latest Medical Journal of Australia.

Most of Dr Webber’s points were cogent and cautious. Comments like, “Australians are fortunate that, in the main, we do have a motivated and ethical health workforce”, shouldn’t generate much rancour — but if a buck is involved, emotions rise.

Most GPs have experienced the cases in which they are unable to write a care plan and organise referrals because the relevant Medicare items have already been claimed. Popping into a corporate surgery out-of-hours with a minor illness can, for some reason, lead to the use of Extended Primary Care items. Actually, the reason is obvious. It’s the payment of $250 for fifteen minutes’ work.

Why not allow everyone the occasional bulk-billed visit to allied health professionals without bizarre bureaucratic hoops and the perverse, if not outright perverted, temptation of a large rebate?

I often refer homeless youth to psychologists at a youth service. Many patients are incredulous to learn that a mental health care plan (MHCP) has been claimed by another doctor before they come to see me. They often have no idea of who did it. I’d hoped the recent slashing of the rebate would completely stop this but it hasn’t yet.

I often find myself thinking: “WTF? Why did some idiot claim a MHCP? Don’t they know the rebate isn’t $160 anymore?” But an immediate psychology referral for a very distressed patient still gets stymied as a result.

The only problem I had with Dr Webber’s piece was his failure to recognise that utterly stupid General Practice Management Plans and Team Care Arrangements are now often essential to the management and arrangement of a normal GP’s income. In one of my workplaces, they’re also essential to employing much-needed nursing staff.

It seems to be a law of human activity that the most useful work is the lowest paid. Garbage collectors are more important to the community’s health than health professionals but they get paid less. GPs are more important to community wellbeing than sub-specialists but they get paid less. And don’t get me started on why large companies pay millions to employ psychopaths as CEOs.

I’d like to see garbos paid more. Bulk-billing GPs’ incomes should also be supported. Pushing the oncoming flood of medical students into private sub-specialty practice because primary care is the poor doctor’s option won’t help the health budget or the community.

Politicians might one day realise this. Just don’t hold your breath.

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