The interim report of the Medicare Review Taskforce is just that: an interim report that describes the taskforce’s methods, and the areas for further exploration that have been flagged by the Taskforce’s initial round of research and consultation.
Coming up with final recommendations that include second guessing all the possible outcomes of any proposed changes will be a mammoth task – one which the Taskforce and its Clinical Committees are beginning to flesh out.
In the post below, CEO of the Consumers Health Forum of Australia, Leanne Wells, says consumers hold different views to providers when it comes to some important aspects of Medicare, and points to the importance of including a diverse range of perspectives in the ongoing review process.
Leanne Wells writes:
The interim report of the Medicare Review Taskforce should warm the hearts of Australians who have a keen interest in Medicare and its future.
It supports many things the Consumers Health Forum has called for: greater medical fee transparency, an emphasis on outcomes rather than activities, and multidisciplinary care.
It also challenges stakeholders – clinicians, consumers, policy makers and the research community – to commence a mature discussion on what constitutes ‘low’ and ‘high’ value care.
Consumers and the Medicare review
Consumer participation and engagement in the decision making process is as important as clinical stewardship, in the conversation about waste and value in our public health insurance arrangements.
The detail and complexity of this long overdue exercise led by Chairman Professor Bruce Robinson presents a variety of complex challenges.
The scope of the review makes it imperative that the consumer interest has a central place. Professor Robinson has made it clear he wants to hear the consumer voice.
It is the firm position of the Consumers Health Forum that there should be more training and support for informed consumers to participate in the review’s various clinical committees to ensure the best outcome.
Consumers have knowledge, perspectives and experiences that are unique and that add depth and integrity to essential evidence being taken into account as recommendations for change are framed.
This not only assures that public, rather than provider, interests are at the forefront, but also facilitates legitimacy, transparency and credibility to decision-making, and ensures that the diverse needs of consumers are understood.
While the stated aim early on was to encourage consumer input, the belated release of the interim report (it was apparently delivered to the government in January by not released publically until September 6) prompts our concern that the review process itself has been moving ahead without the promised level and depth of consumer input.
Based on consumer consultation and a review of the literature, CHF earlier recommended strategies including clear information about the review and how the public can participate; a dedicated website to support public involvement and fit-for-purpose training and support for consumer advisers to the review and its various committees.
Divergent perspectives
The submissions to the Taskforce so far indicate the divergent perspectives of consumers and health professionals (Interim report, Appendix B), highlighting the need for a diverse range of consumer representatives with confidence and skills to constructively contribute their knowledge and expertise.
Health professionals when asked where MBS rules should be reviewed were most likely to mention range of eligible provider issues such as nurses and allied health professionals seeking to perform more MBS services. Consumers however were more likely to be concerned about limits on Medicare coverage, especially for mental health services.
While health professionals said better guides were needed to improve consumer information, consumers were more likely to put priority on information about procedure costs.
The genesis of the review was to reduce waste and modernise Medicare but, perversely perhaps, it is also hearing about areas of high patient out of pocket costs, leading to a comment in the report that Clinical Committees would “consider revising fees where there is evidence that current pricing is distorting the provision of healthcare”. This could, in some cases, result in additional MBS expenditure.
Understanding value
Actually weeding out genuinely ‘low value’ procedures and practices, dozens of which have already been identified by the taskforce, may be easier said than done.
The ten most commonly cited types of ‘low value’ items in the report included ‘administrative’ GP consults for doctors’ certificates and repeat scripts.
At first blush, it seems feasible to contemplate that these services might be paid for in other ways and are not a good use of a GP’s time. But then there’s the value of opportunistic GP care and the prospect of a pattern of behaviour – such as extended periods of work absenteeism – being symptomatic of some more serious health issue and being overlooked. Therein lies the complexity of the task.
Others areas identified for scrutiny included unnecessary diagnostic imaging, pathology tests, orthopaedic procedures – especially arthroscopy – obstetrics and gynaecology procedures, gastroenterology and ENT procedures; unnecessary or ineffective surgery and inefficient provision of psychological services.
The review’s first tranche of clinical committees is probing a range of procedures seen as ‘potentially obsolete’, in specialist areas including diagnostic imaging, ear, nose and throat surgery, gastroenterology, obstetrics and thoracic medicine.
More widely, the review identifies a plethora of issues across the Medicare landscape: MBS rules that limit access to healthcare (such as GP referrals to see specialists), inadequate information made available to consumers on Medicare item subsidies, (such as cost information), and wide-reaching concerns about the structure and administration of the MBS and the types of care it incentivises.
The interim report states that the root cause of most commonly raised issues afflicting Medicare is the level of MBS fees, rules around eligible providers and their scope of practice, and concerns in relation to legal liability.
Some review respondents identified the level of MBS fees as disincentives for the use of some items, others pointed to the GP item structure as spurring shorter GP consultations and failing to provide enough remuneration for high-value care by encouraging “six-minute medicine” wherein high volume GPs can “cream the system”.
Getting the best from Medicare
There will be many who will agree that we need to reshape general practice to make primary care more effective. We know that the best performing health systems in the world are those where there is investment in accessible, multidisciplinary, coordinated primary health care. This is a direction the MBS Review and its recommendations must reinforce.
The development of Health Care Homes, sufficiently funded, provides an ideal opportunity for a consumer-supported reform of primary care that could reduce waste and improve outcomes.
*Leanne Wells is CEO of the Consumers Health Forum of Australia.
