What difference will the new MyMedicare scheme make for patients, communities, hospitals and general practices?
These are some of the questions raised in the article below by Professor Anthony Scott, from the Centre for Health Economics, Monash Business School.
Croakey will also be watching for any unintended consequences and perverse incentives that may emerge.
Anthony Scott writes:
MyMedicare is a new voluntary scheme that allows patients to register with their usual GP, in an attempt to improve continuity of care and health outcomes.
From October 1, the scheme will give registered patients access to longer telehealth consultations. Then, from next year, GP clinics with patients who are frequently admitted to hospital or are aged care residents will be able to access additional “blended” funding, which sits outside Medicare’s usual fee-for-service.
MyMedicare was announced in the May budget, with A$19.7 million of funding over four years, alongside a range of other health reforms, including funding for practice nurses to improve team-based care, as well as new incentives to increase bulk billing rates.
We’re still waiting on a lot of detail about how the scheme will function. But here’s what we know so far – and what it might mean for patients and GPs.
What do we know about MyMedicare?
The scheme is voluntary for GPs and patients. In addition to patients opting in, GPs will also need to sign up, and have been able to do so since the start of July. There will be a gradual roll out and it will take three years to cover all of Australia.
Though details are yet to be confirmed, from mid-2024 individual GPs will receive “capitation” payments for patients who have more than ten hospital admissions per year. These patients are likely to have complex needs and multiple conditions and, for various reasons, may not be able to access a GP as much as they should.
Though not yet confirmed, GPs are likely to receive $2,000 per patient per year, plus a $500 bonus for keeping patients out of hospital. The funding provides incentives for the GP to coordinate their care and provide the patient with access to nursing and allied health if required. It’s hoped this will stop patients going to hospital as often.
There will also be similar payments for providing regular visits to patients in residential aged care facilities.
Will MyMedicare make a difference to patients?
Let’s consider four key areas patients are concerned about:
1) Continuity of care
Research shows greater continuity of care – developing a relationship with and seeing the same provider or team for your care – improves patient outcomes and reduces costs to the health system. People who use MyMedicare to get a regular GP may see some of these benefits.
But many patients already see the same GP or visit the same practice, especially those with chronic conditions. So registration with a practice may not make much difference for this group of patients. What are the other benefits of registration?
2) Reducing hospital admissions
Avoiding hospitals can be beneficial – in hospitals, there are no home comforts, they are inconvenient for you and relatives, there is little privacy, and they can be costly. Patients with ten or more hospital admissions in a year have been targeted as they have more complex chronic conditions and may be from vulnerable populations.
Better access to a GP could prevent patients visiting the emergency department or prevent overnight hospital admissions. Research shows financial incentives for GPs to better manage chronic disease can reduce hospital admissions.
However, hospital admissions could also increase if the scheme identifies significant levels of previous unmet need.
3) Reducing barriers to care
MyMedicare does not directly address many of the barriers to accessing GP services. If GPs are getting paid more and still getting fee for service payments, will MyMedicare patients be guaranteed to be bulk billed? This has not yet been mentioned, but could be an important part of the scheme to attract patients.
People with chronic disease have two to three times higher out-of-pocket costs than those who do not, and 30 percent of patients with chronic disease would find it difficult to pay for care if they became seriously ill.
Unfortunately MyMedicare will not directly reduce out-of-pocket costs, which may be the real reason why people use “free” emergency department care.
4) Making it clear and easy to sign up
It is also unclear how the process of registration will work for patients. Will patients be offered a choice of alternative GPs? If chosen, will GPs be obliged to take them?
At the moment, there are no public data about out-of-pocket costs and quality of care provided by different GPs, and so it will be impossible for patients to make an informed choice. Information to inform choice on a website would be useful, as is the case for specialists.
It’s also unclear if patients who chose to register will find it harder to move GPs or continue to see other GPs if they wish to. The advantages to patients of MyMedicare need to be made clear to encourage them to register and be supported to exercise informed choice if they wish.
Will it make a difference for GPs?
Patient registration can mean a more secure and predictable stream of future income for some patients and also less competition (in terms of “losing” patients to other GPs) and more continuity of care.
Moving away from fee for service towards a blended payment model is widely recognised to support higher value healthcare.
Yet GPs are wary of moving from fee for service to capitation payment. Capitation payments are fixed, so GPs take on more financial risk if they have more complex patients who are more costly to treat and manage in terms of time and effort. Whether the $2,000, plus $500 bonus, plus normal fee for service payments are sufficient to cover the costs of treating very complex patients is unclear.
Overall, GPs will get more money, and along with the other announcements in the budget, will receive a significant investment of resources invested in primary care.
Our previous research has shown a five percent increase in earnings for GPs is predicted to reduce the total number of GPs by up to one percent (equivalent to around 310 GPs in 2021) at a time of significant GP shortages. If they get paid more, they would prefer to work less.
But this could also be offset because the increase in funding will hopefully make general practice more attractive as a career and so there will be more postgraduate doctors choosing to be a GP.
Voluntary patient registration under MyMedicare has potential to strengthen the relationship between patients and their GP, and focuses on keeping patients out of hospital and properly cared for in residential aged care.
But the devil is in the detail and we will need a proper evaluation to determine the impacts on health outcomes, costs and access to healthcare.
• Anthony Scott is a Professor in the Centre for Health Economics, Monash Business School. Previously, he led health economics research at the Melbourne Institute: Applied Economic and Social Research at the University of Melbourne. He is an elected Fellow of the Academy of the Social Sciences in Australia, immediate Past President of the Australian Health Economics Society, and was a Board Director of the International Health Economics Association.
This article was first published at the Conversation, under the headline, ‘Should you register with a GP? What is MyMedicare and how might it change the care you get?’
Previously at Croakey
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