Australian Association of Surgeons ABN: March 2015 NEWSLETTER

Transcription

1 PRESIDENT: John A. Buntine SECRETARY SENIOR VICE- PRESIDENT: Peter Hughes TREASURER: Richard Deveridge JUNIOR VICE-PRESIDENT: Stephen Clifforth Australian Association of Surgeons ABN: March 2015 NEWSLETTER HEALTH FUND MANAGED CARE The AAS has heard of requirements of the following type being put to private hospitals. In addition to presently applying restrictions of health fund rebates to hospitals following re-admission of both medical and surgical patients within seven days, new restrictions are to apply to re-admissions from eight to twenty-eight days. For surgical patients restrictions will apply to re-admission for the same treatment of the original condition (unless left or right). Generally, staged procedures will receive funding for each individual admission only if these admissions are coded to different DRG's. Examples of staged procedures are: - a coronary angiogram for diagnostic purposes and a second admission for angiography and stenting as each admission will be coded to different DRGs. This is funded. - coronary angiography with 2 stents and then another admission within 28 days for additional stents. The second admission will not be funded as both admissions are coded to the same DRG. - deep brain stimulation where a second admission is normally scheduled 8-10 days post discharge following the initial admission. The second admission will not be funded as both admissions are coded to the same DRG. Defined Highly Preventable Adverse Events will not be funded These are:-

2 2 If any of the above occur during an admission, the Hospital will not be funded for the treatment of the condition. The preventative adverse events are based on DRG coding and there is no clinical review. It might be thought reasonable for a health fund not to pay or to pay substantially less for a preventable adverse event in hospital but, irrespective of the care taken, some apparently preventable adverse events will occur, e.g., it can be very difficult to identify that a small part of a disposable instrument has become detached in a body cavity. Actually, in almost every instance, a satisfactory explanation may be found occasionally for the occurrence. Excluding full payment for avoidable events is quite different from monitoring the number of such events and questioning the practice of a surgeon and/or a hospital if the number or proportion of the same type of event seems excessive. These activities have largely followed the sale of Medibank Private. I do not know by how much the funding of preventable adverse events is planned to be reduced. It is stated that the above restrictions are to encourage hospitals to improve quality of patient care but the end result may be to shift non-profitable admissions from private hospitals to public hospitals. Strong opposition has been mounted against these managed care proposals:- proposals which would be very difficult to implement and would entail a great deal of wasted time and effort for everyone concerned the end result would be a lowering of the standard of patient care. MEDIBANK PRIVATE IS SEEKING TO APPOINT A DIRECTOR OF CLINICAL PERFORMANCE The full text of the current advertisement follows. Director - Clinical Performance Job no: Work type: Full-Time Location: All Australia Who we are Medibank is Australia's largest private health insurer. With nearly 4 million members we fund over 1 million surgical procedures a year. To enhance our quality agenda, Medibank are seeking a dynamic individual with a comprehensive knowledge of the Australian health care system and contemporary healthcare practice and trends, as well as a comprehensive understanding of private hospitals and medical specialist practice.

3 3 About the role The Director - Clinical Performance will take the lead in developing clinical quality indicators for hospitals and medical specialists. This will enable Medibank Private to become an informed purchaser of evidence based, cost effective and safe care for our Members. The Director - Clinical Performance will also support clinical operational processes including the assessment of pre-existing conditions and providing clinical determination to support claims and frontline staff. Ideally, the successful applicant will demonstrate the following criteria: Current registration as a Medical Practitioner in Australia; Have completed FRACMA or be an AFRACMA with a clinical specialty; Experience in facilitating clinicians' journey towards evidence based practice Experience in leading organisational change; Extensive experience in high level strategic thinking with the ability to provide leadership in project design and delivery; A high level of analytical and quantitative thinking; An innovative and flexible approach to problem solving and advanced communication skills; and A competitive salary will be offered, commensurate for this key clinical leadership role. The role could be 3 or more days per week if the candidate wants to continue to practice clinically. Better Health starts with our employees. We offer a number of health benefits including subsidized health insurance and advice around diet and nutrition to help you lead a healthier life. So if you have a commitment to Health and Wellness values and are looking for an exciting and challenging role with ongoing career development opportunities then this is the right role for you. Medibank is a proudly Australian organization that values and rewards its' employees. For more information regarding this opportunity please contact Dr David Rankin, Clinical Director, on , or david.rankin@medibank.com.au or, to apply: click on the 'Apply' button below, fill in an online application form and attach your current resume Advertised: 13 Mar :00 AM Aus. Eastern Standard Time Applications close: 03 Apr :55 PM Aus. Eastern Standard Time

4 4 MEETING WITH SUSSAN LEY, NEW HEALTH MINISTER SINCE Via COPS, Stephen Milgate organized a meeting of Gary Speck (Australian Orthopaedic Society), Michael Steiner (Australian Society of Ophthalmologists), Guy Christie-Taylor (Australian Society of Anaesthetists) and John Buntine (Australian Association of Surgeons) on the 26 th February 2015 at which the following questions were asked:- 1. Is the Minister aware of concerns within the medical profession of health fund ambitions to implement managed care practices designed to shape clinical treatment and restrict medical and clinical decision making? (i.e. intervene in the doctor patient relationship.) 2. Will the government support or introduce legislation or regulations which will facilitate/coerce doctors to sign health fund dictated contracts? (i.e. establish preferred provider networks similar to that used in Defence Force Health (Medibank Health Solutions) established by the previous government.) 3. What is the Minister s and the government s attitude to centrally determined role substitution in clinical care? (i.e. proposals that traditional scopes of practice be altered by regulation to create new roles under the banner of 21st century health care.) 4. Is the Minister aware that the current structure of national boards introduced by the previous governments has no hierarchy of clinical decision making despite this being a central principle of risk management? Furthermore, that under this model, important clinical safety issues are being determined in (or on the steps of) the Supreme Court? Does the Minister support this approach? 5. Given budget constraints in the foreseeable future, what does the Minister believe will be the likely impact on health in general and procedural specialties in particular? The above matters were discussed forcefully. It was a positive meeting. Clearly, the new Health Minister intends to communicate with doctor s groups and has been encouraged to do so. I pointed out that, on the basis of my personal experience as having been at one time a Board Member of a health fund (the AMA Health Fund), a Board Member of a private hospital group (Health and Life Care) and having had a number of involvements with surgical bodies, I have observed over a considerable number of years that governments ordinarily listen first to health funds, then to hospitals and last of all to doctors. I was convinced that the undesirable aspects of this prioritization were appreciated by the Minister.

5 5 A short meeting followed with the Minister s Senior Advisor, James McAdam. As an example of waste, I said that a fixed obsessional attitude to safety causes much inefficiency in hospital services, e.g., the large number of staff required in a day surgery theatre while quite minor procedures are taking place and Michael Steiner pointed out that rigid requirements for eye drops to be discarded after twenty-eight days have persisted despite modern packaging which would allow safe storage for a longer period. There was further discussion concerning the inefficiency of AHPRA due to a lessened input from doctors and concerning the inefficiency of staff substitution which directs services to less highly trained health care providers. Problems relating to the complaint system were also touched upon. COMMENTS ON A RECENTLY DISCUSSED MATTER The Australian Association of Surgeons forwarded the following to the Royal Australasian College of Surgeons:- The proposed information sheet for patients relating to surgeons fees is a good initiative. I do, however, feel some caution to be desirable with respect to the following. Charges by other clinicians It is not always possible to suggest the size of the fees which will be charged by other clinicians, which importantly includes anaesthetists with whom a surgeon does not regularly work. Some anaesthetists provide sheets explaining their fees all should be encouraged to do so. Some anaesthetists ask patients to telephone their offices to enquire about their fees which is satisfactory although cumbersome for patients. With respect to some other services, the costs of individual services might be known but not the number of services. The amount of information provided should be consistent with each particular patient s desire to be informed. Sometimes just a suggestion of the possible greatest amount of the overall cost is all that is desired. The gap A number of surgical groups do not like the term the gap believing that discussions are best couched in terms of charges and rebates from Medicare and health funds. Also, the rebates provided to surgeons are not usually influenced by the level of a patient s private health insurance, the main exception being the Doctors Health Fund which includes the option of a rebate up to the level of the AMA recommended fee. However, some surgeons and anaesthetists accept special arrangements with particular health funds by which the health fund pays a higher amount than ordinarily but this is not influenced by the size of the

6 6 patient s contribution to the fund. Importantly, some no gap arrangements are rightly seen as a step towards managed care by health funds which is again a particular concern at the present time. Second opinions If there is a close relationship between the patient and the referring practitioner, it is reasonable to accept that the referral has been made to the surgeon likely to provide the most appropriate service in all respects, including financial respects. It would therefore be appropriate to express some caution about interfering with such a trusting relationship when advising people to request second opinions from others because a close working relationship between patient, referring doctor and surgeon provides the highest possible standard of care and the greatest likelihood of satisfaction and unnecessary second opinions can cause unnecessary concern. However, when referrals are made by doctors who do not know the surgeon or the patient, a second opinion is more appropriate. Specific advice to patients Depending upon the way the information sheet is phrased, the College might later regret having promoted the role of giving specific advice to individual patients which could take up a great deal of time and effort and would entail the potential of causing significant problems for all parties without doing much good. Advice to fellows It would seem reasonable to continue to periodically remind fellows to avoid excessive fees and I would add to use Medicare item numbers carefully. TASK SUBSTITUTION The following are extracts from an extra-ordinarily biased article Calls to reform racket by adding to nurse duties by Sarah Martin in the weekend Australian January (page 4 The Nation). Health savings can be found by ending the protectionist racket of the medical industry, with experts advocating that nurses, pharmacists and paramedics be allowed to take on more responsibilities. Grattan Insitute health program director Stephen Duckett told The Weekend Australian the government should consider expanding a successful Queensland physician assistant program to deliver significant health savings.

7 7 I think that the AMA does a pretty good job of sitting on its old fashioned turf from the last century, she said.... particularly in areas outside of metropolitan areas, then we should be looking at community health workers. Aboriginal health workers, nurse practitioners and practice nurses. Adjunct lecturer in public health at Monash University Michael Keane, who has labelled the AMA the Australian Mafia Association, said some doctors were engaged in sausage-factory practice, and the system was not rewarding diligent general practice. It would not be completely reasonable to be critical of governments and planning groups for not getting the projected requirements for numbers of health care providers correct as everyone who attempts this gets it wrong! However, there is presently a shortage of nurses and it is generally believed that considerable recent increases in medical student numbers will result in more doctors than are required: why make this imbalance worse by arranging for nurses to perform roles doctors are trained to undertake? Workers compensation authorities have realized that arranging for lower paid health workers to become involved in making decisions about the treatment of individual workers is not a sure way of reducing costs because the increased number of services ends up being more rather than less expensive. It would be interesting to see what would happen if a term similar to the Australian Mafia Association were employed with respect to any well unionized organization of health care providers. John A Buntine President