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Referrals to health services such as physiotherapy and podiatry have dropped sharply, coinciding with a Medicare revamp that has made it easier for doctors to offer doctor-only care.
Allied health care was given a boost with the extension of Medicare to cover such services last year. But the steady rise in non-medical services contributing to the care of complex and chronic conditions reversed in July, when the number of services fell by about 20 per cent compared with the previous month.
The decline came in the same month the Government introduced Medicare provisions making it easier for doctors alone to provide care plans for the chronically ill. In the first month of operation, the doctor-only management plans topped 23,500 cases, while care plans involving allied health practitioners fell from 24,700 to fewer than 20,000.
Supporters of allied health care say there are many instances where additions to medical care are more effective and less expensive in combating chronic conditions. These alternatives include physiotherapy for incontinence sufferers, which can avert costly surgery, and foot care administered by podiatrists to diabetics, which can reduce the need for amputation. Other common chronic diseases that can be countered by routine non-medical care include heart disease and respiratory conditions.
The president of the Australian Physiotherapy Association, Cathy Nall, said any decline in Medicare access would be bad news for patients, particularly those without health insurance.
"While it is early days, this is a potentially alarming trend because of the way it is going to reduce access to allied health care," Ms Nall said. "Medicare should facilitate patient access to the care they need when they need it, provided by the health professional with the most appropriate skill set."
Under last year's changes Medicare coverage was expanded to enable general practitioners to refer patients with chronic and complex conditions to a minimum of two allied health care professionals. GP supervision of this multidisciplinary care plan, which includes consulting the two other practitioners about the patient's needs, attracts a Medicare rebate of $206.75. The resulting services provided by the allied health professionals carry a $44.95 rebate but are restricted to a maximum of five services a year. After complaints by the Australian Medical Association that the requirements involved too much red tape, the Government in July introduced a streamlined approach that pays a $120 rebate for a GP to prepare a management plan for a patient with a chronic or terminal condition.
The Health Minister, Tony Abbott, said the changes had nearly doubled the use of care plans overall, and the new GP service was a precursor to another new provision stimulating allied health services. "We are really committed to allied health measures," he said. The problem with the previous arrangements was that GPs were not making enough use of chronic disease management services funded by Medicare, which in their first year had been 60 per cent below budget, he said.
The president of the medical association, Mukesh Haikerwal, said the trend away from allied care did not reflect doctors "creaming" the system.
Previously doctors might have been referring patients for allied health care but this was often a cumbersome process. The new item made it easier for doctors to spend time in providing appropriate chronic care plans that might include their own practice nurses helping patients develop better diet and exercise regimes.
The article does highlight rather nicely one of the potential problems involved when there is a ‘Gate keeper to Health’ system based on fiscal controls. The overall Governmental concern to restrain health care provision can not only restrict public access but constrain provision to the populous. This is a very important matter when it comes to the health of a nation, not to mention the fate of supplementary professions such as podiatry and in this case, physiotherapy. The unthinkable becomes thinkable and under these circumstances if these professions are to continue to serve the public it will be out with the supported health care system. The existing government policies are likely to accelerate this change and professions are left to adapt. In other words podiatry has (already) lost it ability to control its destiny.
One example of this is deconstruction of the service which is already evident in Australia and US and distinctly happening in the UK. Three things are now predictable.
The number of doctors in training will increase and their clinical scope of practice will embrace other disciplines as restricted practice becomes less protected by law.
Foot care will remain buoyant because it is an essential service and will thrive in the private sector when combined with beauty therapy.
Specialist podiatry will initially remain in the public sector but gradually become incorporated into other disciplines as specialist podiatrists are grandparented.
The writing as they say is on the wall and I think there is really very little can be done now (as a profession) other than evolve. Time to bury the hatchet and get on with a new order.
After complaints by the Australian Medical Association that the requirements involved too much red tape, the Government in July introduced a streamlined approach that pays a $120 rebate for a GP to prepare a management plan for a patient with a chronic or terminal condition.
A-ha..the penny drops. I had wondered why I'd seen my first three GP Care Plans this year, when I'd seen none in the previous 10! Someone's paying them to care (plan).
Shouldn't an essential part of every care plan be appropriate referrals to approrpriate professions??
I also get the feeling that GP's who are using there computer systems i.e Medical Director and the like, properly are referring more. This is simply down to ease of creating a careplan from a proforma which must take no more than a minute. I have had one sent that infromed me the patient had type 2 Diabetes. This was news to the patient! The Gp had obviously just selected the wrong proforma or couldn't be bothered changing it.
I don’t believe that referrals to AHP's has dropped at all, but I do agree that the number of VALID referrals has dropped. We receive between 15 and 20 care plans a week and about 15% of theses are invalid.
These newspaper article figures are from the HIC quoting MBS item No's 721 (the doctor-only management plans) and 723 (care plans involving allied health practitioners), these are the 2 numbers that replace the old No 720. Both these numbers need to be claimed by the GP for the referral to be valid.
I thank you will find ,as we have, that during the initial roll out of the new item No's GP's simply didn't know they had to use both No's to enable a valid referral, hence lots more 721's and not as many 723's !
Doctors drop allied care option
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