Your SlideShare is downloading. ×
Evan Ackermann - Royal Australian College of General Practitioners National Standing Committee, Quality Care - Medicare Funding of General Practice: Now and in the future
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Saving this for later?

Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime - even offline.

Text the download link to your phone

Standard text messaging rates apply

Evan Ackermann - Royal Australian College of General Practitioners National Standing Committee, Quality Care - Medicare Funding of General Practice: Now and in the future

1,701
views

Published on

Evan Ackermann delivered the presentation at the 2014 Future of Medicare Conference. …

Evan Ackermann delivered the presentation at the 2014 Future of Medicare Conference.

The Future of Medicare Conference was a timely event as the Abbott government debates a full over haul of the Australian healthcare system. This conference presented a chance for government representatives, regulators, health care providers in the public and private sector, educators and private investors to come together and debate the proposed changes to Medicare as well as discuss the best practice methods of implementing new measures and frameworks.

For more information about the event, please visit: http://bit.ly/FutureofMedicare2014

Published in: Business

0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,701
On Slideshare
0
From Embeds
0
Number of Embeds
7
Actions
Shares
0
Downloads
32
Comments
0
Likes
2
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. General Practice Wiser health funding for better health at lower costs Future of Medicare Conference Sydney Harbour Marriott
  • 2. Key Messages • Medicare change won’t help if fundamental health governance problems, waste, poor health financing practices persist. • General Practice is cheap, but not funded to be effective to meet current & future challenges • A reinvestment in General Practice is required to make Australia’s health system more effective and efficient • A medical home and GP population health management as the basis of restructuring GP services and funding can optimise value
  • 3. THE VIEW FROM GENERAL PRACTICE What are the key issues General Practice see contributing health funding problems
  • 4. “The reality is that there isn’t a single point of leadership and accountability for health care in Australia*” “….the structural flaws in governance and financing make it difficult to develop, fund and co-ordinate the primary care, subacute care and specialist care in the community that would be better for people’s care*” …the failure to develop governance structures which promote the identification and resolution of problems according to their importance#. Suboptimal Health Governance in Australia • * Christine Bennett, ‘Are We There Yet? – A journey of health reform in Australia’ (Paper presented at the College of Medicine, Health Leadership Series 2013, The University of Notre Dame Australia, 18 March 2013) • # Jeff RJ Richardson Steering without navigation equipment: the lamentable state of Australian health policy reform Australia and New Zealand Health Policy 2009, 6:27
  • 5. Waste – in all shapes and sizes Government Federal Government Technology savings not realised – Pharmacy – Surgical (cataract) Non-Evidence based health system interventions – Superclinics – After hours telephone services – ? PCEHR State Government Duplication / fragmentation Poor Efficient services (Hospital based primary care services) Not closing redundant hospitals Medical Overdiagnosis & Overtreatment – Disease definitions – Poor clinical guidance (gestational diabetes) – Cancer screening (prostate) – Radiology (++) – Protocol driven pathology Healthcare variation in care “Business of medicine” • Corporate models of health driving expenditure
  • 6. Copayments … the mixed evidence Instituted broadly … • blunt instrument for controlling costs • Unfairly target poor • specifically reduce beneficial preventive care practice • Reduction in appropriate care not just unnecessary services Targeted … • Copayments may work where they are used to reduce demand for irrelevant, unnecessary, and inefficient health care • Reinvestment of savings make the universal healthcare system more effective care
  • 7. Copayments … practical applications • To reduce radiology • To reduce pathology • To reduce use of inefficient activity in Public hospitals • Lifestyle choices – Smokers pay additional costs for vascular procedures – Limits on IVF procedures – Some Cosmetic procedures • To reduce inappropriate “health screening” • To reduce “futile care” – The relentless pursuit of marginal improvement • To reduce “low value” surgery • To optimise choice of medication – eg prefer old diabetes drugs v new – “alternate” medicines
  • 8. Figure 1 ProductivityCommission – Report on Government Services DoHA (Departmentof Health and Ageing) , MBS, PIP, GPII, DGPP and DVA data collections; Where is the Problem ?
  • 9. Health Care is increasingly Hospital Centred • Ambulances go straight to Hospital (even minor conditions) • Increasing A&E Department use – ?health direct hotline – Incentivised by 4 hour rule • Increasing Hospital Admission rates • Inpatient Care – Palliative Care, End of life care, Aged care, Multiple Morbidity • Change in Discharge arrangements • Funding Incentives – IHPA – Ambulatory care payments 2-6 times what they pay through MBS and have lower claims criteria *Australian Instituteof Health and Welfare 2013. Australian hospital statistics2011–12. Health services series no. 50. Cat. no. HSE 134. Canberra: AIHW # NationalEfficientPrice Determination2013-2014 IndependentHospital Pricing Authority Feb 2013
  • 10. IHPA Payment Medicare for GP Medical Consultations Anaesthetics Preanaesthetic assessment and evaluation - Specialist $291 $36 /$72 Preanaesthetic assessment and evaluation - Nurse $293 Obstetrics Specialist Clinic $222 $36 Midwifery and Maternity $255 Alcohol and Other Drugs (Nurse) $156 $36 Sexual Health (Nurse / Allied Health) $185.48 $36 Minor Medical Procedures Venesection (Hospital) $438 $62 Dematology - Cons + Biopsies (skin Cancer) $305 20.33 Wound Management (Nurse - excludes complex wound management) $245 $36 Comparing Hospital and GP payments for same or similar services IPHA – Independent Hospital Pricing Authority
  • 11. Comparing Hospital and GP payments for same or similar services (a) Independent Evaluation of the ACT Nurse-led Walk-in Centre 30th June 2011 b)Productivity Commission Report on Government Services Section E – Health Table 11.A2 & 11A.10 2103 Nurse Walk in Centre - Canberra Average cost per Service Av Cost for All GP Services $196 (a) $49.58 (b)
  • 12. Code Description Weight $ per patient service event (IPHA) Allied Health (MBS) 40.01Aboriginal and Torres Strait Islander Health Clinic 0.0506 $249.61 $ 52.95 40.09Physiotherapy 0.0376 $185.48 $ 52.95 40.18Speech Pathology 0.0434 $214.09 $ 52.95 40.23Nutrition/Dietetics 0.0261 $128.75 $ 52.95 40.25Podiatry 0.0713 $351.72 $ 52.95 40.29Psychology 0.0577 $284.63 $ 52.95 Comparing Hospital and Allied Health payments for same or similar services IPHA – Independent Hospital Pricing Authority
  • 13. The view from General Practice The problems of medicare are not going to resolve if critical flaws (other than finance models) are not addressed Similar funding arrangements to public sector • have an honest cῸnversation about health expenditure without political gaming Determine what is an Australian version of a high performance health system and GP Role
  • 14. MEDICARE AND GENERAL PRACTICE What's right and wrong now?
  • 15. GENERAL PRACTICE HAS A BLENDED FUNDING MODEL General Practices - Practice Incentive Programme Per Capita (SWPE) • Infrastructure eg (IT) / Nurses • Performance / Quality Incentive eg Diabetes Cx Screens • Services population ie ATSI General Practices and General Practitioners - Fee for Service • Medicare Benefits • DVA • Workcover • Private General Practitioners • Practice Incentive Programme • Skills (Rural -Anaesthetics, obstetrics, Surgery) • Aged care access • Other • Rural Incentive • Service Incentive Payments
  • 16. Medicare - Australian Government real expenditure on GPs (2012-2013 dollars) per person *Fee for Service = $286 per year for every woman , transgender , man, and child $0.78 per day * ProductivityCommission – Report on GovernmentService DoHA (Departmentof Health and Ageing) , MBS, PIP, GPII, DGPP and DVA data collections; Chapter 11 Primaryand Community Care table 11A,2 GP Costs
  • 17. Medicare - Australian Government real expenditure on GPs (2012-2013 dollars) per person *Add Radiology= $58.60 per year for every woman , transgender , man, and child $0.17 per day * ProductivityCommission – Report on GovernmentService table 11A.65 GP Costs Fees $0.78
  • 18. Medicare - Australian Government real expenditure on GPs (2012-2013 dollars) per person *Add Pathology= $58.60 per year for every woman , transgender , man, and child $0.16 per day * ProductivityCommission – Report on GovernmentService table 11A.63 GP Costs Fees $0.78 Radiology $0.17
  • 19. Medicare - Australian Government real expenditure on GPs (2012-2013 dollars) per person Total GP Costs per day per person to medicare $1.13 per day * ProductivityCommission – Report on GovernmentService table 11A.63 GP Costs Fees $0.78 Radiology $0.17 Pathology $0.16
  • 20. How cheap is GP Care ... Daily GP Costs Packet of Chips $1.13 per day $1.45 per pkt
  • 21. “Largely delivered by private practitioners, …. the many community based services that could help keep people well and out of hospital or provide a better and more cost effective care in a non-hospital environment are underdeveloped, underfunded and poorly co-ordinated.”* We argue strongly that strengthened primary health care services in the community should be the ‘first contact’ for providing care for most health needs of Australian people.. This builds upon the vital role of general practice. How effective is General Practice for today’s health care problems? * Christine Bennett, ‘Are We There Yet? – A journey of health reform in Australia’ (Paper presented at the College of Medicine, Health Leadership Series 2013, The University of Notre Dame Australia, 18 March 2013)
  • 22. THE FUTURE FOR GENERAL PRACTICE If we want a high performance health system, what roles and functions of General Practice should be Medicare funded?
  • 23. The fundamental paradox of primary care: ‘…a paradoxical situation: the tension between the relative weakness and unattractiveness of this level care versus the intention to assign critical strategic functions to it.’ From: Primary Care In the Driver’s Seat? Saltman, Rico and Boerma (eds) 2006
  • 24. Palliative Care Complex Patient Care Active Chronic Disease Management Chronic Disease – Self Care At high risk for Chronic Disease Well Population
  • 25. GENERAL PRACTICE HAS A BLENDED FUNDING MODEL General Practices - Practice Incentive Programme CHANGE General Practices and General Practitioners - Fee for Service • Medicare Benefits • DVA • MAINTAIN General Practitioners • CHANGE
  • 26. Practice Incentive Programme for General Practices New Rationale - : To encourage General Practices to organise the infrastructure for appropriate and comprehensive primary care delivery that adds value to their local communities and the health sector
  • 27. Traditional GP Practice “Niche” GP Practice Corporate GP Practice “Models” of General Practice are changing
  • 28. 1Implement the Medical Home Registration with 1 Doctor & 1 Practice Delineates site/role of primary care Patient Registration will facilitate population Health activities
  • 29. * Delineate new roles for General Practices – then support them New General Practice Characteristics Advanced Multidisciplinary health care teams Comprehensiveness of services to match local need Clinical governance Population management (Hospital avoidance) Health Service integration (?financed by states) Quality Management
  • 30. Key Messages • Medicare change won’t help if fundamental health governance problems, waste, poor health financing practices persist. • General Practice is cheap, but not funded to be effective to meet current & future challenges • A reinvestment in General Practice is required to make Australia’s health system more effective and efficient • A medical home and GP population health management as the basis of restructuring GP services and funding can optimise value