GANFYD Syndrome

No surprises in the recent Budget, with a huge deficit and not surprisingly significant cuts to be made across the board. Given the ever-increasing cost in health, some deductions have been announced, including

an increase in the Medicare safety net to $2ooo payable by patients before the Govt provides assistance

– freezing of Medicare rebates to patients, with likely increased charges for patients

One of the common problems in medicine relates not so much to clinical management, but to the potential for cost-shifting; whether from State to Federal funding & vice versa, or from medicare-rebateable services to non-rebateable private fees.

Most days in my role as a primary care provider, I am asked to complete paperwork for third parties

  • Insurance Companies
  • Workcover
  • School or University
  • Employers
  • Centrelink

…and medical exams for activities such as diving, sponsored-parachute jumps, commercial driving activities etc

It seems that there is a constant demand for ‘the Doctor’ to just complete same paperwork for a third party – but that this work should be billed to Medicare.

As I understand it, Medicare is a rebate system for patients to claim back a portion of the Doctor’s private fees. On some occasions the Doctor may choose to accept the Medicare rebate for the service (so-called bulk-billing). However Medicare rebates have fallen by a third over the past decade and are now frozen. Hence there is a widening gap between the Doctor’s fee and the rebate – the ‘gap’ fee.

Of course the tax-payer is funding the Medicare rebate…and this raises the issue of why on earth the taxpayer should, via Medicare, fund the generation of medical reports or letters for non-Medicare compensable conditions.

One of my bugbears is that of GANFYD Syndrome (or “Get A Note From Your Doctor” Syndrome); as suggested above, there are a wide variety of requests for notes from various agencies, often to ‘cover themselves’ – essentially a request to abrogate responsibility for an activity on the basis of a doctor’s assessment.

Such services should be viewed as private services. Moreover, the Doctor may decline to provide them if he/she is asked to provide an assessment out-with their expertise (a diving medical is a classic example, unless the doctor is specifically-trained in dive medicine). Similarly requests for a note that “Is Mr X safe to undertake a parachute jump for charity?” are likely to be declined on the basis that it is inherently unsafe to jump put of a perfectly functioning aircraft, and that this is an activity over which the doctor has no control.

Prof Max Kamien has written on this & reviewed by the ABC “the sick saga of sickness certificates“, commenting on the ridiculous request from employers for sick notes for even a single day of absence from work. Clogging up GP surgeries with people who should be tucked up in bed with their fu-like illness makes no sense – nor does taking up GP appointments for self-limiting illnesses “just for a note” make much sense.

Worse still, the employer is rarely prepared to pay for such a note – either asking for the patient to pay or expecting Medicare to pick up the tab.

I reckon I get 3 requests like this per day. I presume other doctors have similar rates. Multiply this by the number of doctors across Australia and the associated burden on Medicare…and I reckon Mr Wayne Swan could save a few hundred million there alone by either banning sick notes or insisting that the employer pays for this non-Medicare service which, in general, the patient does not want AND FOR WHICH THEY WOULD NOT NORMALLY VISIT THE DOCTOR!

There is a handy GANFYD deflector from the doctors over in the UK – easily adaptable to use in Australia. Copy it into your medical notes software as a macro and deploy it whenever possible – along with a private invoice.

You can download as a Word Doc format or PDF format by clicking.

Mr Swan will be proud of your efforts to reduce Medicare costs…

 

 

7 Comments

  1. Hahaha! Yes, I like it, Tim!
    When you put it that way it does seem unbelievable that the employer doesn’t bear the cost of sick notes in any way. I’d be so tempted to employ this paperwork bedazzlement tactic but in the absence of widespread, large scale behavioural change I think it’d be perceived as one doctor having a bit of a rant. However, would love to see those changes happen!

    Reply
  2. Penny, you will be deluged with this sort of work as time rolls on. No probs with charging medicare for a medical service where patient is sick and requests it – however, the rest is essentially a private medical assessment – and I encourage either the employer to pay or (better still) them to decide they DONT need a GANFYD after all.

    I’ve used the GANFYD deflector a few times – and either get paid a private fee – or else the ‘urgent need for a note’ magically disappears and I can get back to seeing people who DO need to see a doctor, not just ‘get a note…’

    try it.

    Reply
  3. Tim, great post and needed to be said. I had never thought about it this way, about the burden on Medicare for essentially private requirements.

    I have seen so many patients (actually more now that Im closer to the city than out bush) who come in for sick certs and who don’t really want to be there themselves. But work has told them that they ‘have’ to get one. I agree, I think work should pay.

    Don’t get me started on a large national supermarket chain (its 50/50 to guess) that makes you fill out their own workcover type form on top of the state WorkCover form. Stupidity in duplication….

    Keen to see what other people think.

    Gerry

    Reply
  4. Dear Tim

    Most articulate as always!

    I recall writing a letter that went….

    Dear HR manager, I am writing this letter at my patient’s request. He was sent home by his line manager on Friday for an acute illness from which he tells me he has felt better by Saturday. It is now Tuesday. He worked Monday with any problem.

    I cannot understand why he has attended at your request to tell me his story. I do not believe that this letter having my signature on it will have any greater authority than this man’s word.

    Regards……

    Pity I didn’t send a $50 account to the organisation for their lack of common sense.

    Reply
  5. Why don’t the people making up the budget see these kind of things?

    Reply

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