Campaigns
Allied Health Services
The AACP is having ongoing discussion with the Department of Health and Ageing in relation to the anomaly whereby patients are not eligible for MBS reimbursement for allied health services following attendance for consultation or review under MBS Items 132 and 133 (although patients are eligible for benefits after MBS Items 110 and 116).
Geriatric Assessment Items
There has been further correspondence with the Department of Health and Ageing about expanded access to the geriatric assessment items for those consultant physicians who provided the assessment services, particularly for rural patients. Consideration of these matters continues.
Medical Climate Change
The release of the National Health and Hospitals Reform Commission's and National Primary Health Care Strategy's reports have indicated there are changes expected in the Australian health care scene.
However, there has been little mention of the role of consultant physicians and paediatricians. Scant reference in the review reports to public health issues, geriatric patients and palliative care services does not provide recognition of the role of consultant physicians and paediatricians in Australian health care – either in hospitals or ambulatory care medicine.
The role of general practitioners in preventative and primary health care is the focus of the current papers. However, with the increasing complexity of patient care and the management of patients with chronic diseases, together with the ageing of the population, there is a continuing need to emphasise the role and importance of collaborative care with specialist paediatricians and consultant physicians.
The AACP will continue to represent the interest of our members during the consultative processes undertaken by the Prime Minister, and the Minister for Health and Ageing.
Medicare items for longer initial and review consultations
Currently there is provision for longer consultations for both geriatric and psychiatric assessment. However, there are other situations where patients require significantly longer consultations than currently available under items 132 and 133. The AACP is reviewing a proposal in relation to introducing new items for prolonged consultation and review consultations for complex patients with chronic diseases requiring coordination and management.
Practice Nurses
The AACP has been having discussions to seek support for practice nurses in consultant physician and paediatrician practices. Practice nurses already play a valuable role in many consultant physician and paediatrician practices, but there may also be a role in relation to expanded e-health capacity.
Telehealth
The AACP has been looking at possibilities for e-consultation items for consultant physicians and paediatricians and has had discussions with the Department about how they might be implemented. This is particularly relevant now that the Government has released its discussion paper Connecting Health Services with the Future: Modernising Medicare by Providing Rebates for Online Consultations.
The AACP's approach will be acknowledgement of what it sees as the two "boundaries" of telehealth, namely the case conference and the e-consultation. There are a number of issues to be addressed in relation to the organisation of e-consultations, not the least of which is whether the patient must always be present. However, at the same time, there is still a legislative requirement for the patient to be present in order for a rebate to be payable. (The AACP recognises that there are also some situations where face-to-face consultations would preferably not involve the patient; however, this is being raised separately.)
A committee has also been established (Telehealth Advisory Group [TAG]) to provide input to the Department on telehealth and new e-consultations. The President, Dr Bill Heddle, is representing the AACP, together with the AACP's Executive Officer.
It is recognised that there needs to be financial support or incentives to encourage uptake of telehealth services. The AACP has supported both an initial one-off payment to assist in set up and also ongoing payments linked to the services provided. There is also recognition of the need for training to assist providers to take up telehealth practice. The DoHA is looking at appropriate ways to do this.