“I think GPs are rightly concerned that this is going to be the thin edge of the wedge, and before we know it in 5 or 10 years’ time, if you’re not part of MyMedicare, your ability to bulkbill even standard things is going to be impaired, your ability to access care plans is going to be impaired…” said Dr Aniello Iannuzzi, a GP and chair of the Australian Doctors Federation.
Healthed’s latest survey showed high levels of cynicism from GPs regarding the government’s freshly launched MyMedicare/voluntary patient enrolment initiative— and advocates including Dr Iannuzzi say if history is anything to go by, the scepticism is justified.
“If we look at what’s happened with things like accreditation and the PIP (Practice Incentive Program), this is the way things start. They start with innocent benign programs with little strings, perhaps little benefits, everyone starts to sign up to them and then a few years later what happens is more and more strings are attached, more and more conditions, and all of a sudden, we’ll have a system where, if you’re not part of it, you’re gonna be punished financially,” Dr Iannuzzi said.
At the moment, there’s little benefit for most patients, unless they happen to need long telehealth consultations, or are in a nursing home, he added.
“The item numbers and rebates related to nursing home patients are nowhere what’s needed for financial viability, and so one needs those bonus payments that come through MyMedicare in order to make nursing home visits viable,” he explained.
“This is an unfunded enrolment process, so the burden is all upon the practices and there is very little in it for practices who do not do nursing homes or long telehealth,” Dr Iannuzzi said.
“It’s yet another burden, yet another complexity, yet another compliance piece, and practices’ are really under a lot of strain when it comes to all this red tape. Instead of reducing red tape and making practice easier, this is yet another example of making practice harder.”
Australian Society of General Practice president Dr Chris Irwin also believes doctors are right to be cynical.
“Every single piece of Medicare change needs to be seen through the lens of cost cutting, data mining and increased bureaucratic control. MyMedicare is aimed to tick all three boxes,” Dr Irwin said.
He says the government has designed a ‘pointless’ system on purpose.
“They have done this so that it initially appears inoffensive, in the hope that the majority of practices and doctors blindly follow RACGP and AMA endorsements. They then hope to slowly place the noose on general practice and hope no one really notices or minds, or continue to be blindly supportive of blended payment models despite the lack of detail,” Dr Irwin contends.
“The recent quid pro quo situation of funding the level E consultations by cutting level B consults –$250 million saving annually— show the government’s true intentions,” Dr Irwin said.
“As the government looks to capitate general practice it will try to do so by reigning in spending from other places within general practice – and by cutting fee for service funding – or rather making sure the funding for fee for service never keeps up with inflation—which of course is just a cut by stealth.”
“All MyMedicare will mean is reduced funding in real terms for fee for service consultations, and increased paperwork to satisfy meaningless bureaucratic hoops to get the capitated funding. I often joke that any doctor can pretend to be capitated without having to wait for full MyMedicare implementation – simply spend an hour every day doing pointless paperwork before shredding it and don’t charge 25% of your patients.”
AMA President Professor Stephen Robson said MyMedicare “has the potential to improve patient care by cementing long term doctor-patient relationships.”
Professor Robson said the AMA is working to ensure it provides a platform for positive reforms that strengthen general practice, “with the Government already announcing some early initiatives including expanded access to telehealth, support for GP services to aged care and support for patients who are frequent hospital users.”
“The AMA will continue working with the federal government to ensure programs attached to MyMedicare improve access to care for patients and that these expand over time, while also ensuring that this does not lead to a flawed capitated model used in the UK.”
The RACGP has declined to comment on Healthed’s survey results, but is on the record supporting the policy. Following teething issues when practices struggled to register as the program launched, College President Dr Nicole Higgins said better communication and support for GPs was needed, but remained broadly supportive of the initiative.
But Healthed’s survey results reflect that many GPs share similar concerns to Dr Iannuzzi and Dr Irwin.
The survey showed that:
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