Mark Butler has called it a ‘red letter day’. GPs and Australia’s elderly hope the changes live up to the hype.
Late on 31 December 1999 I was huddled in a newsroom staring at a blinking green cursor on a clunky computer screen waiting for planes to start falling from the sky.
The chances were greater that the computer itself would crash, but our IT gurus had promised us that the six months and buckets of money they had spent preparing us for this moment would guarantee we’d stay up and running.
That didn’t stop the sweat beading on their foreheads, however.
I suspect there are people at the Department of Health, Disability and Ageing, Mark Butler’s and Sam Rae’s offices, and Services Australia who are feeling a bit like that right now.
On Thursday, during Question Time, Mr Butler called today – 1 November – a “red letter day”.
A lot changes today – bulk billing, telehealth guidelines, the women’s health package, mental health treatment plans – check out my colleague Holly Payne’s wrap over at The Medical Republic.
Aged care
The big one, of course, is the new aged care system.
For people receiving aged care there’s a new statement of rights and more legal protections if you make a complaint. Support at Home will replace Home Care Packages and Short-Term Restorative Care programs. There are new fee arrangements for both residential care and in-home care, including means-testing. And there’s a “no worse off” principle for people already in residential care.
For providers of care, there are changes to workforce planning, criteria for star ratings will actually start to have teeth, a new funding system will replace provider reports and care activity claims with independent assessments, and providers must clearly explain fees and payment arrangements to residents.
I suspect the real “plane-dropping-from-the-sky” moment will come at the end of November when providers try to get paid and start to upload data and reports to the DoHDA in earnest.
Is Services Australia ready for the influx of claims and invoices coming its way?
All those digital systems out there – providers trying to upgrade and upskill their hardware, software and staff, and the DoHDA systems they’re trying to connect to – has the work been done? Has the testing been sufficient? Have the bugs been found and eliminated?
Reality suggests that the answer is no and that the next couple of months, at least, will be rocky and painful at the very least.
Bulk billing
It’s been very interesting to watch the narrative leading up to today’s introduction of the Bulk Billing Practice Incentive Payment.
The politicians don’t really want to talk about it. They’d much rather talk about the changes to bulk-billing incentives for patients which also happen today, expanding the applicable cohort to all Australians and not just children under 16, people with a Pensioner Concession Card, Health Care Card holders and people with a Commonwealth Seniors Health Card.
Talking about that allows Mr Butler to do what he also did in Question Time yesterday, taking out his Medicare card and waving it around while shouting “this beautiful little green card”.
The BBPIP is another kettle of fish, of course.
In exchange for bulk billing, participating GP clinics will receive quarterly payments equal to 12.5% of their bulk-billing income, which includes the additional money made from the expanded bulk-billing incentive.
The payments will be split 50/50 between practices and GPs.
There are other strings attached, too; participating clinics must display certain signage and register on Healthdirect as a universal bulk biller.
Mr Butler’s big words have been all about his plan to get 90% of GP practices bulk billing by the end of the decade.
Everything we hear at HSD and our sister publication for GPs, The Medical Republic, tells us that’s not going to happen. GPs do not believe they can remain financially viable via bulk billing alone, particularly if they are serving a patient demographic that is more complex, comorbid, and economically disadvantaged.
Take the example of Melbourne community care hub, Cohealth. We’ve been writing about it all week – here, here, here, and most especially, here.
Related
The federal government’s attitude to Cohealth is baffling, to say the least, and frankly shows how out of touch with the reality on the street they actually are.
Mr Butler has been all over the media this week talking about intervening in tough markets like the ACT – Canberra, essentially, one of the richest cities in the country – where bulk billing is almost non-existent.
On ABC Afternoon Briefing on Wednesday, he said this:
“We’re going to intervene in the market. We’re going to fund new practices that come into the ACT, set up here on the basis of being fully bulk billing.
“I’m not just going to sit by and let some markets really prohibit members in their community from being able to access bulk-billed visits.
“I just want to be clear with doctors’ groups, we’re determined to do this. We think the settings we have right now are going to do it, but if there are particular markets in the country like Canberra where we’re just not getting that increase that we need to see, then we’ll look at taking action.
“We’ll support new practices coming into the market on the basis they’re going to be fully bulk billing.”
Yet when it comes to supporting clinics like those provided by Cohealth for society’s most vulnerable patients, Mr Butler’s government shows no interest.
In fact, worse than that, this week they have just fallen short of blaming Cohealth for the situation it finds itself in.
Here’s the DoHDA’s response to our questions on Wednesday:
“The decision by Cohealth to close its GP clinics is deeply disappointing,” they said.
“We have requested the board reconsider its position. Since the announcement, the DoHDA, Victorian Department for Health and the local PHN have continued to meet with Cohealth, with the next meeting scheduled for 6 November.
“The Department expects Cohealth to provide detailed data and information to support discussion. Commonwealth officials have been in regular contact with Cohealth management on a near-daily basis since the announcement.”
Social Services minister Senator Jenny McAllister was at it again in Parliament on Thursday, repeating the “deeply disappointed” line and suggesting that the Cohealth board needed to “reconsider its position”, as if there’s a choice.
Maybe there is. Maybe GPs should just stop caring for the most vulnerable patients and let them go to public hospital emergency departments.
Because that’s working so well.
By the way, for the under 25s out there, the Y2K bug didn’t amount to much in the end. Maybe we prepared exceptionally well for it, and maybe it was never really a thing to begin with.
Let’s hope the 1N25 bug will be just as forgettable in 25 years’ time.