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Podiatry assistants in QLD

Discussion in 'Practice Management' started by toughspiders, Nov 21, 2013.

  1. toughspiders

    toughspiders Active Member


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    Hi,

    Is anyone using assistants in QLD. If so, what type of patient do they see. Are they able to see EPC and DVA patients? Also private patients are we legally able to bill a health fund is a Pod Asst has seen a patient.

    I have asked for guidance from the association but the answer was not very committal.

    Thanks

    Be
     
  2. Tuckersm

    Tuckersm Well-Known Member

    Bel,

    If you look at Medicare, and Consultants and registrars there is a need for the consultant to have provided "professional attention", to be able to bill for the consultation provided by the registrar. Which means the Consultant must have an interaction with the patient and agree with the care provided by the registrar.

    If you examine the podiatry item numbers for EPC on

    http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/Medicare-Benefits-Schedule-MBS-1

    that should better indicate when you can legally bill.
    DVA I think requires that the service is provided by a podiatrist, but this may be similar to professional attention, and the private funds will all have different options.
     
  3. toughspiders

    toughspiders Active Member

    Thanks Stephen
     
  4. APodC

    APodC Active Member

    Hi Bel,

    We (the APodC) produced a policy defining a podiatry consultation which also addressed the use of assistants in private practice. This was provided to all health funds nationally for reference and I've not had any negative responses. We've sought clarification from the department on assistants under Medicare as we feel there's some contradictions in federal policy and the use of assistants is currently part of a submission being considered by the repatriation commission (DVA). We've reported this work in the magazine so members get to see what's happening.

    Members can speak to the APodA who has access to our policy work in the area - maybe there were crossed wires. I can say while sitting here in Parliament House Canberra, we thank APodA members for supporting all the hard work on the issue.

    Regards,
    Damian.
     
  5. toughspiders

    toughspiders Active Member

    Thank you, Darren

    My understanding is

    1. Claiming on a health fund may vary between health funds , so i am assuming that that is a non starter until we are provided with a list of funds that would accept claims of treatment that aren't provided by the Podiatrists. I would be very concerned that i could be committing an offence by obtaining funds by deception.

    2. I am advised that "A Podiatry Assistant cannot claim medicare rebates. It makes no difference to pod’s whether they mention assistants in their claims or not. (Does this makes sense?)" - nope i am not sure i get this one? Has medicare issued any documents which support the use of claiming for a Pod Asst?

    3. DVA wont accept claims for Pod assistants but this is work in progress.

    Is this right Darren or am i misinterpreting things?

    Many thanks
     
  6. Paul Bowles

    Paul Bowles Well-Known Member

    Considering the Dental model has had oral hygienists in place for years under private health I am surprised that we don't have a clear and concise Podiatry model on this yet.
     
  7. APodC

    APodC Active Member

    Thanks Paul,

    Recent comments from the president of the Dental Hygienists Association that:

    "dental hygienists, dental therapists and oral health therapists are autonomous professionals who work collaboratively when required" and pointing out that this "needs to be made clear, both to dental practitioners and the public"

    highlights why the dental model might cause difficulties in a small profession like podiatry. As we believe that podiatry rebates must be for podiatry and not other ancillary work, we've chosen not to pursue a policy where assistants are considered autonomous professionals.

    It'd be fair to say that there's been much debate around this over recent years and the model we've chosen to implement is one where rebates only go to treatments performed by podiatrists. However, assistants can legitimately do part of the work. As long as the podiatrist provides a service that meets our definition of a podiatry consultation, they have met the standards for a rebate.

    The issue with DVA and Medicare definitions affects all of allied health, which is why we're asking for clarification / amendment.

    Cheers,
    Damian.
     
  8. Paul Bowles

    Paul Bowles Well-Known Member

    Thanks Damian for the reference. But relatively autonomy changes very little in the grand scheme of things. Just because "we" have chosen a model that does not rely on autonomy I can't see how this effects the outcome - if anything it should appease the private health funds and medicare/DVA somewhat ensuring Podiatry consultation is being performed as the Podiatrist must be present.

    I am trying to think of places where oral hygienists work autonomously? Every situation I can foresee it is in a dental clinic overseen by the dentist. Maybe someone can help out here.....

    So let me pose a hypothetical - lets say I owned a Podiatry Clinic and as a Podiatrist I wanted to employ an "assistant" who would take of tasks such as nail cutting, callous reduction, casting/scanning, assisting in minor procedures and general practice duties. What would stop me employing a person such as an EN or RN, providing adequate training and then coming in to every patient during the consultation and checking everything. Correct me if I am wrong, but this would constitute a Podiatry treatment or service would it not? In fact they wouldn't even have to be an RN or EN would they? By law they don;t even have to have a Cert IV do they?

    Sort of opens up the playing field a little. What is AHPRA's official position on this? Do they even have one?

    "Our" definition do you mean that of APodC? Largely that wouldn't matter would it - shouldn't it be the definition provided by AHPRA? Who probably don't have a formal statement on it....

    I honestly think this is a massive storm in a very small tea cup. There should be absolutely no issues or resistance from private health funds or medicare/DVA in generating a new Podiatry Item number which is able to be used when the consultation is performed by a Podiatry Assistant and a Podiatrist. There could be a clear and concise definition, approved by AHPRA and implemented for nationwide use. The issue of autonomy really has no place here - a person can open up a "Foot Clinic" anywhere and provide footcare/services as long as they don't call themselves Podiatrists in any case - the fact APodC have chosen the no autonomy path is arguably an even better outcome for Private Health funds and Medicare/DVA.

    This debate has been ongoing for 10+ yrs - and honestly are we any better off for it? I doubt it.
     
  9. APodC

    APodC Active Member

    Hi Paul, you've touched on a number of areas over which there isn't consensus. Thus the debate rages on.

    What we (the APodC) have done is to create a policy that we've discussed individually with key health insurers and with the health insurance industry more broadly that provides confidence for practitioners to be able to use assistants in a way that is acceptable under fund rules. Ultimately, practitioners have three options.
    1. They can choose not to use assistants.
    2. They can wing it and see if they get a letter from a health fund investigating fraud.
    3. They can apply the APodC policy which has been discussed with the private health insurance industry and over which we've had general acceptance.

    The Podiatry Board's role (to which AHPRA provide administration services), is to protect the public. The board doesn't have a role to play in negotiating rebates or setting standards where they aren't related to protection of the public. AHPRA does have a policy that assistants must be supervised - to protect the public. The APodC therefore has an important role to play in creating and negotiating the acceptance of policies and standards in these areas - as a national voice of podiatry, we provide confidence so podiatrists can get on with the job.

    The upshot is that if a podiatrist has provided the core components of a service set out in our policy, health funds will accept the service is a podiatry consultation even when part of the intervention was provided by an assistant under delegation. Thus a podiatry rebate can be paid (at the full rate rather than a reduced assistant rate). Re the hypothetical, our view is that if a podiatrist didn't play a significant role, it's not podiatry and there should be no health fund rebate provided from the podiatry pool. If health funds introduce a new or expanded pool for foot health, then we would have a meaningful discussion with health funds about how that could be applied.

    You're right that anyone can open a foot clinic however I expect podiatrists would want us to fight tooth and nail to prevent health funds paying a rebate from the podiatry pool toward assistants running independent foot clinics. Just as I think they'd object to rebates going to nail bars.

    We know that there are critics out there that don't want any podiatry assistants and there are others that would prefer a free market model of assistants. Our approach delivered something practical that we can all live with - even if it's not perfect. Thanks also for the discussion as it's a good one to have openly debated.

    Cheers,
    Damian.
     
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