EPC & Medicare.... :(

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Ahh there has been a lot of discussion over medicare and EPC plans lately...

It was in the papers today and even on 7 Sunrise (briefly yes) but it is worrying....

I have a feeling that the life of EPC is nearing the end.... I really think the Government is trying to save money atm and cutting EPC plan stuff is on their agenda

I dont want the EPC to go cos I will struggle 100% to practice... but it is worry...

Your thoughts

 

In todays Age
Medicare rorts 'cost $3bn'

http://www.theage.com.au/national/medicare-rorts-cost-3bn-20120115-1q1fy.html

 

When i worked in Sydney we had 2 practices.

One in an affluent middle class professional suburb and the other in the wetsern suburbs.

needless to say there was a marked disparity in the numbers on EPC plans.

The affluent suburb was only advanced vascular neurological and diabetes also R/A etc etc. Plus about 10-15 % of pts in practice.

The western suburbs well it was every man and his dog. So practice contacted Medicare about abuse of the epc plans. Well was it warmly greeted. NOPE.

Told that if GP refers pt under medicare then t/t. This was about 45-50% of practice. Many suffered from only bones in the legs. No relevant pathology that would make them eligible for t/t under EPC plans.

There was nothing the practice could do, even when it tried to prevent Fraudulent misuse of the EPC system.:butcher:

So the outcome seems to be abandoning the system due to abuse .:deadhorse:

Ho Hum

As an aside here in the UK it was reported in the newspapers today that there is to be a massive investment in Private health clinics as the Govt considers using the resources of private medicine.

What was interesting was the Person who is showing a lot of interest in opening approx 50 of these.

Who do you think the papers mentioned?????

None other than the Great Socialist and Wife of a Former Labour Prime Minister Mrs Cheris Blair.

HHHMMMMMMM.


David:drinks

 

An article in Medical Journal of Australia - What is wrong with Medicare?

http://www.mja.com.au/public/issues/196_01_160112/web11431_fm.html

 

Bloody EPC Plans! Where do I start: 1./I have GP's referring clients under EPC that do not have chronic disease issues, its just the patient has winged loudly that they cannot afford the fee to see a private podiatrist (ironically they are happy to pay $65 to get a pedicure though!). 2./ GP's don't seem to understand that HACC or Community funded podiatrists cannot participate in EPC Plans, as it is double dipping from the funding bucket. I wrote numerous letters to GP's when the EPC bonanza kicked in explaining this, to no avail. Until they were audited - then they understood. Now they send them under Care Plans - and I spend all my time writing reports, which is funny, given the often "lacking" medical history & information I feel GP's provide us in return. 3/ FInal Gripe: GP's have taken to getting their clinical nurses to do high risk wound care, often using cheap inappropriate dressings (melonin on exudating wounds). Then forward them after lack of healing some 3 yrs down the track. Anyone else out there going through these problems?

 

Anyone else out there going through these problems?

Yep, I think we all are!!

 

Are Team Care Arrangements (TCAs have been the medicare speak for EPCs for a few years) a pain...well kind of...well actually yes. They are confusing for Doctors, Allied Health Professionals and patients. that said they allow access to care for those who could not otherwise do so.
I have set up two clinics in Chronic Disease hot spots which unsurpisingly enough in low socioeconomic areas that were not just under-seviced they were not serviced at all. besides patients using Private health Insurance are still taxpayer subsidized at either 30-40% when they role up for their monthly clip and chip. No doubt some referrals are shall we say more worthy than others but I get doctors venting about other pods who push the scheme to patients a process Gps call "reverse referrals". The patients then go to the doctors demanding a TCA. Finally what doctor Webbers article omits is that many doctors would be happy to write out a simple referral like the DVA d904 rather than billing the 721 and 723 items to medicare for a care plan and team care arrangement but without doing so there is no medicare rebate for the patient.

 

Medicare and EPC Problem!!!!

One major problem with Medicare and EPC is lack of ID when using a system like this. The lack of photo ID either with documents and Medicare card allows visitors to Australia and illegals to use family member cards to get treatment for free. Come to Australia for a holiday and get free treatment either EPC or other medicare T/t's. Heck stay long enough and go a bulk billing clinic and get full surgery for complaints, as long as the family whos card the person is using has not had this before. Chances of getting caught almost nione. The system neeeds tighter control in all ways, central system for files ie medical history, so all GP and hospital clinics can tap into. Also with photo ID or even finger print retinal scans to provide proper ID to identify the patient in front of the GP. Another cheap alt would be a super medicare card with photo ID and a chip with all previous medical info embedded in it. Paying $ for a tighter system now allows reduced abuse $ later and thus a continuation of a otherwise good system, and people who need it do not suffer.

 

Dentists are having problems too:

 

The EPC plans are a good idea, porvide a service for clients who have chronic conditions and lets face it would not acess services iof they had to pay for treatment.
would rather wait months or years to access a public health service or community service.

it EPC Scheme is no longer in favor with the powers that be. i can see a significant increase in referrals to hospitals and community services, which they will not be able to meet.

so a over all decline in services to the community i guess

 

l think the GP's are the ones that have a lot to answer for, not the clients.

l was seen by my GP awhile ago for chest pain, she offered to sign me up for an EPC for Physio, Dental and Pod... all happen to be operating out of the same facility.

l asked what did any of that have to do with my chest pain, "Nothing but its there and you should use it".

Here lays your problem IMO.

 

As with DVA Podiatry tops the list of claimed allied health visits under the scheme.
For a poorly controlled newly diagnosed diabetic 5 TCA Medicare rebated visits per calendar year shared between an educator, dietitian and podiatrist is unlikely to be adequate. But this early primary care intervention represents excellent value as far as health care expenditure goes. The TCA allied heath item numbers reward output not outcomes. The $51.95 rebate applies only to the interval of time (20 minutes or longer) not to the quality or procedure of the consultation. So palpate a couple of pulses or undertake a doppler an ABI the payment is the same.
Rather than increase the number of generic claimable visits under TCA's it would be better to allow item numbers such F104 doppler ultrasound as supplementary interventions.
I concede it sounds like some GPs might be doing the wrong thing but others are not undertaking plans for fear of Audit to their patients detriment.
Also let the health profession without sin cast the first stone. The prevelence of custom kinetic orthotics amongst DVA gold card holders seems a lot higher than that in similar aged people in the rest of the community. As for the powers that be they would like to see more salaried allied health and that is in part what medicare locals are all about.

 

from MBS Online

So the definition of a "Chronic Disease" is very broad, given that onychomycosis could be considerd a medical condition that would be present for more than six months!