Call to scrap Team Care Plans

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netizens

Team Care Arrangements should be scrapped because they are not doing what they were set up to do and just make more work for GPs, according to an article in the MJA today. According to the authors there is no evidence that team care arrangements are encouraging GPs to shift from episodic care of chronic disease to a more global approach, say GP researchers from Canberra.

http://www.mja.com.au/public/issues/191_02_200709/har11305_fm.html

toeslayer

 

What a load of bollocks it makes more work for the GP's...most of them I know get paid $250 to do a care plan that's just a medical history printed off the computer by their practice nurses. The only reason it makes more work for them is because they insist that patients book in a double appt time to get it done. When pods & physios are regarded as primary contact practitioners, with no need for a referral...why do patients even need to get the GP to do the EPC referral? We should be able to apply directly to Medicare for a patient's eligibility before claiming. They whinge that it's all costing too much money...I think the GP's are getting paid well to do not very much...and they still whinge!

 

Exactly, cut out the middle man - this would free up GPs to see other patients. I wonder if it's the AMA's city members that want to keep control of everything. I'm sure country GPs are overworked & under resourced, they would probably appreciate handing over this role to others. In my area you are lucky to get an appointment the same week with a GP, a good one you have to book a month in advance. (Makes life interesting if you need a doctor's certificate for work!!)
Cheers,
Kara.

 

Totally agree with both the above posts. I have medical practices supplying us with many referrals primarily prepared by the practice nurse (now nurses) of which the GP signs the dotted line. We prepare the full written reports addressed back to them, which are viewed by the nurse & stuck in the file, often the GP doesnt know what is really happening.
Lets hope the health reform has a positive result in allowing allied health direct access to medicare.

 

I agree with Wayne. It is about time the Council approaches the relevant Government Ministers and give all Allied Professionals direct access to Medicare. As far as I know there have been no Pods audited by Medicare. The rules are so strict. You get knocked back if a number is out of place.

Complaint - that the GP dishes out the EPC's to all Allied Health practitioners and if you are the sixth person the patient is seeing you don't get paid!!! I know it is our responsibility to check with medicare, but some time the darlings don't give the paperwork until the end of the session.

Complaint - The GP does not always complete there paperwork

Benefit - We get income overnight from Medicare direct



Don

 

What also annoys me is the need for a review after the 5 visits...GP's getting paid again to do what exactly? To say that a diabetic still has diabetes and still needs their feet attended to? Like that situation changed somehow? They're no longer at risk? The waste of money in unnecessary overbilling by GP's is going to end up with the EPC program getting scrapped and pensioners who can't afford to go private not getting treated because the public system has a 12mth waiting list. It will also affect those of us in private practice with a huge EPC pt database. It always comes down to supposedly saving money that ends up costing far more. I think they will end up scrapping the EPC program until they realise it costs more for hospital admissions and that they haven't got enough beds to deal with the diabetic amputations we could have prevented. Short-sighted bloody moronic politicians and greedy GP's. Phew...rant over...getting off my soapbox..

 

I was actually chatting to a GP at work today. He said that it was ridiculous he gets paid $300 for printing out a piece of paper. He'd rather that money was used for me to see his patients more frequently than get money himself. Now I know that's not the norm, but it's a nice idea.

 

Simple fix...

Don't participate in the EPC system (I don't)!

Frankly it is a little insulting that the GP does stuff-all and gets paid handsomely, and if they don't cross every 'T' and dot every 'I', we are not paid for our efforts. The whole arrangement just plays into the GP's hands, and reiterates the Australian notion of 'health care is free', therefore of little value.


Let the flawed system fall on its backside I say!!

 

Julian,
It would be nice to take the high road and refuse to take part in the flawed system, but I don't think it's entirely practical. I think it would be safe to say that most people using the EPC program are elderly and less likely to have private health insurance as they've always relied on the Medicare system and can't afford otherwise. Many pensioners can't even afford groceries, let alone private practice podiatry fees. The public system has huge waiting lists and turns away anyone who isn't a diabetic - even if they qualify under the chronic condition category. It merely means pensioners get stiffed again and pay to come only once a year, rather than get 5 visits. As a pod in a high pensioner area, I was grateful when the EPC program came into effect; my business tripled. The pensioners deserve to have easy access to pod services. And that includes not having to schlepp off to multiple GP appointments and sit in receptions for hours waiting for the GP to print them off a piece of paper.

 

EPC is and will be a stepping stone to better things. Remember that *podiatry* services are the *largest* group out of all EPC payments! (Beware - audits ARE coming)

The current system is a way of keeping RACGP, AMA and others happy (for a bit longer) that doctors still have "control" over allied health. I predict this wont be for too much longer, and the waste of red tape, GP payments for computerised prinouts, and the like, will decrease.

Midwives and nurse practitioners have and will set the tone for this type of autonomous Medicare funded non-medical practice moving forwards.

The NHHRC final report is out in the next few days. All will be much clearer then and I am hopeful that Roxon will be looking at some real root and branch reform of Medicare and the wider system.

In the meantime, the solution is not to "opt out", IMHO.

Just bill your normal fee and don't bulk bill. That leaves it to be a problem between Medicare, the patient and the GP is someone messes up the paperwork (providing you fulfil your own obligations).

Podiatry patients have been the greatest beneficiaries of EPC since its inception, so lets keep pushing the politicians to improve the system further.

Write to your MP and point out the stupidity of the current system now, before the government begins implementing the NHHRC reforms.

LL

 

Hi Nat,

Honestly I think its great that the new(ish) EPC system has increased business for you as well as assisting the many pensioners who would otherwise be without Podiatric services.

I 'toyed' with the system in the early phases and whilst passing on the dubious task of retrieving funds from Medicare to the unfortunate patient, if said patients GP missed the slightest detail from the referral/GP paperwork, they were denied payment. Invariably the abuse for the 'high treason' of being denied finds from Medicare, because of a GP oversight, was passed onto my Secretary (Bless her!).

You know the schpeel...."oh my GP is just wonderful, I am sure THEY wouldn't screw up the forms....He/She 'promised' this wouldn't cost a penny...what did YOU do wrong!!!". The 'dear-sweet pensioner' is just wonderful until Medicare denies/delays payment....then the colorful language follows :dizzy: The same is true of the GP's secretary that's my best friend when trying to refer an EPC patient....then after hearing I do not accept those referrals, mention nasty things about my Mother!!!

Whilst I agree that access to the public purse for our important services is a great step-forward, the system in place is just too burdensome, hierarchical and skewed in favor of the medical establishment. If 'everyone' wrote their MP, or 'everyone' (Pod's) opted out, then change would occur by necessity. Since neither has occurred some years into the scheme, the status quo will no doubt continue....we mere Pod's are the 'serfs' begging for scraps at the edge of the table while our 'masters' print out a form and merrily collect >$250. (perhaps I am need of a vacation?!)

I am most blessed in not having to rely on it, but am probably in the minority.

LL's advice to write my MP is sound, not for personal reasons, but rather to support the profession.

Cheers...

 

Completely agree. I've just finished an analysis of the EPC podiatry consultations using the MBS database, and between 2004 and 2008, there were 1,338,044 services provided by podiatrists, second only to physiotherapy (1,388,460). Nat Smith is also correct about elderly people being the greatest beneficiaries, as those aged over 65 accounted for 75% of all services provided.

While there are certainly some flaws in the system, the EPC program does represent a substantial funding commitment to podiatry by the Commonwealth (approx $63m between 2004 and 2008), and there are some promising signs that the system will improve over time.

 

Dr. M, what are those promising signs?

 

They will carry out their audits and find that the Allied Health Professionals are doing the right thing with the treatment of the patients and not over servicing (there is no way we can) . The Care plan must be in place from the GP, although I had to contact Medicare today as I had an electronic payment declined. The operator then said to input the data but leave out the GP's provider number. The payment went through. The operator then said they would chase up the GP as they had not completed their paperwork properly.

Don

 

Great stats Hylton - I am sure APodC will be keen to get their hands on that ASAP.

Its interesting to see what "the other half" of the equation thinks about us though...The site "6 minutes" is a type of GP Podiatry Arena - they have a very interesting discussion about this exact issue here. Recommended reading to see what THEY think of US!

LL

 

I just visited the link...most illuminating...thanks LL
'

 

When my receptionist was checking on the validity of a referral earlier this year, she was informed by Medicare that if the GP has not completed their details correctly that our payment would be processed and the GP would be contacted for the correct paper work (as long as we had the EPC voucher for audit purposes). She was informed that this came into place in January.

I suspect this was a response to allied health practices contacting Medicare prior to the patients appointment to check on there current referral status and this was inferred by the medicare staff.

Another issue with the current system is that a lot of GPs do not know how the system works. We have a couple of practices in our area that insist on sending out care arrangements to two service providers and receiving their response before issuing the EPC voucher. As a result I have one patient who is still waiting for EPC voucher 3 months after we received her team care arrangement as the other podiatrist has not responded. Not to mention the pile of team care arrangements we have where their patient has gone to another provider.

On the whole though, the program is well supported by GPs in our area, has provided podiatry services to many who otherwise would miss out and has certainly helped our business grow.

On a side note, how do people deal with patients that have been referred through the EPC program and don't have chronic health problems/ fit the criteria for the program?

Mark

 

Interesting point...

I have had varied opinions from GPs about what constitutes a 'chronic health problem'. Thankfully the government has chosen not to define this too readily.

Leaving aside rheumatoid and diabetic foot issues, in terms of podiatric pathology, which of these is not a 'chronic health problem'?

• long standing painful ingrown toenails
• recurrent corns
• osteoarthritis (eg painful hallux limitus)
• plantar fasciitis > 3/12 duration
• neuroma > 3 months duration
• long standing undiagnosed foot pain
• recurrent tinea pedis
• recurrent onychomycosis
• plantar plate tear
• painful flat foot/cavus foot

In my humble experience there are more conditions that we take care of that could be considered a chronic health problem, rather than an acute condition. I am sure the physiotherapy referral criteria could be equally problematic.

I think I have had referrals under EPC for many of the above, but there might be some conjecture about if they fit the governments' decription of a chronic health problem...?

LL