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
- School or University
…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.
Mr Swan will be proud of your efforts to reduce Medicare costs…