Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Sunday, August 13, 2006

Mr Howard Announces Electronic Medicare Claiming – A Good Thing?

Today the following press release appeared on the Prime Ministers Web Site.

ELECTRONIC MEDICARE CLAIMING

I am pleased to announce that the Australian Government will be introducing new arrangements to make it easier for people to claim their Medicare rebate.

We will be formally engaging the private sector to manage the introduction of a system for patients to directly claim a Medicare rebate into their bank account with the swipe of a Medicare card at their doctor’s surgery.

This streamlined claiming process demonstrates the Coalition Government’s commitment to Medicare. It will be a huge benefit for families, avoiding the queue at a Medicare office, filling in forms or waiting for cheques.

Through these arrangements, patients will pay for a doctor’s visit and then swipe their Medicare card and EFTPOS card to receive their rebate back directly into their bank account. It is expected the new claiming system, via the EFTPOS network, will be available in the second half of next year.

The new claiming process will not affect bulk billed patients, although it will mean their doctor will receive payment from Medicare more quickly for providing the bulk billed service. This will be a major improvement in the way we pay doctors for bulk billed services.

Each day 80,000 people queue at a Medicare office to claim their rebate. Access Economics estimates that the average cost in time and resources to make that claim is $10.
The private sector has indicated it can provide this technology simply and quickly and the Australian Medical Association has given its support for the proposal.

It will provide real time checking for Medicare and concession status.

Medicare offices, easy-claim booths and other current claiming processes will remain in place while the new system is introduced.

13 August 2006”

On the face of it this all seems to be a great idea. Mr Howard is to be commended in trying to reduce the frustration felt by those queuing at Medicare offices in their lunch time as well as speeding up the payment of claims by practitioners.

The devil, however, is in the detail (again) and there are certainly a number of issues raised by this release.

Before discussing these I guess it is pretty clear the motivation for such a system can be seen in the figures provided by the costs of the Medicare queues. $800,000 per day is a large cost when multiplied by the 260 working days of each year ($208 Million p.a.). Sadly it will be impossible, except in the broadest community sense, to recover that possible benefit as it is largely to be found in the time spent by individuals who could be doing more productive things than queuing with their time. Savings will largely only come as Medicare offices are shrunk and closed - to the disadvantage of all those not fully enrolled in the electronic world. Depending on how much the banks charge for their services there may also be some reduction in the $3.50 spent on processing each transaction.

The larger issues from my perspective include the following:

Firstly this system is obviously designed to be a co-payment collection system for doctors who do not bulk bill. Those who are bulk billed are explicitly not affected according to the release. The impact of the prompt return of the Medicare rebate, and electronic payment of the residual via EFTPOS, will make it easier for doctors to raise their co-payment level and avoid the customer “sticker shock”.

Rather than strengthening Medicare this looks like another piece of sleight of hand to make it easier to reduce the role Medicare plays in paying for GP services.

Secondly, one is forced to wonder just how secure and fraud free a payment system based on the use of the Medicare Card will be. It is well known these cards are widely forged and that the number on issue exceeds by a considerable margin the number of eligible families and individuals – hence the enthusiasm from Mr Abbott (the health minister) to replace them with a smartcard, a much more robust system, as announced a year or so ago (Jul, 2004).

The HealthConnect web site makes the importance of accurate identification clear.

Health Identifiers

Another significant issue for HealthConnect is the need for a foolproof system of identification to prevent people receiving incorrect treatments. It is vital to have such a system in the transfer of clinical information. Without it, health care providers cannot be certain that the information held in HealthConnect belongs to the individual being treated.

As in every hospital in Australia, HealthConnect local level patient health identifiers are being used in HealthConnect trials to ensure a consumer's medical information is unambiguously linked to that person. Identification arrangements for the whole of state implementation of HealthConnect are still being investigated, but could include a health smartcard.

Longer-term identification arrangements for HealthConnect will need to take into consideration work underway through the National Health Information Group to investigate options for a national health identifier together with appropriate and robust privacy safeguards.” Current as of 23/02/2006 (It should be noted I am pretty sure the NHIG does not know it is doing this! I can’t check as the AHIC Web Site is currently down!)

The policy confusion regarding patient identification issues just continues to deteriorate. We are now planning, it seems, to introduce a payment system based on the Medicare card by the end of 2007. At the same time the Government plans to introduce its Access Card from 2008 on! (This is not mentioned in the PM’s press release – one wonders why - as presumably the Medicare Card is to be replaced by the Access Card!) Of course we also have NEHTA developing its own Individual Health Identifier for patients to also be available in 2008 or so! We can only wonder will this be used as a basis for payments too!

Next there are some real privacy issues that will inevitably emerge unless there is very clear regulation (and possibly legislation) to ensure all the claims information handled by the bank network is kept totally separate from other banking details. For example, would the payment show the doctor providing the service and the date of service? At first glance it will need to have some information of this type. If it does the person’s bank statement may contain information the patient does not wish to appear on their statement (consider the issue of joint accounts, children operating on parent’s accounts and so on).

Further the press release says the AMA and the banks are in favour. Of course they are. For very little additional cost it means, for the AMA easier access to higher co-payments, and for the banks incremental revenue from transaction fees.

Lastly, it seems that as the electronic payments become the norm, the Medicare office is certain to be wound back to realise additional savings. Who will be inconvenienced? Those without an EFTPOS card and those older and typically more infirm who have not mastered the electronic world and still write a cheque or pay cash for things. Again Medicare is hardly being strengthened.

Before concluding it should also be noted there will be a range of practicalities around implementation of this plan that will need very careful planning. How many practices have EFTPOS terminals? What paper trails are required to avoid and detect possible fraud? What will be the impact on current practice workflows? What information will be required to be held by the practice to identify that an EFT refund has been requested and what will be the costs of providing such interfaces into GP computers? A moment of reflection, I am sure, will identify many more issues to be resolved.

I fear what we have here is a proposal which may very well weaken Medicare, increase fraud, violate at least some people’s privacy, disadvantage the old and be very complex to actually implement. It is also curious why this was announced by the PM rather than by the Health and Human Services Ministers given they have been talking about fixing this problem for a good while now.

I will look forward to understanding how the implementation of this proposal will avoid all these apparent risks. It is not clear to this observer that all the un-intended consequences have been properly analysed.

David.

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