From the President
Dr Hamish Meldrum, MBChB, DRANZCOG, FRACGP
Reaction to health-related measures in the budget has been swift and insightful. A selection of formal responses to the budget as it relates to health is provided below for your information, and also this excellent summary from The Conversation.
Disappointingly, Tuesday’s budget didn’t restore any faith that government intends to adequately resource and recompense GPs, with an extension to the MBS freeze to 2019-20. There is a distinct sense that GPs, an important gateway to the healthcare system, will continue to be financially squeezed – directly contributing some part of the $900 million in projected savings out of their own pockets in lost potential for more appropriate levels of reimbursement. Given the critical importance of Primary Care to the health of the nation, this can only appear shortsighted, and at the coal face feels like systematic gouging of the profession, regardless of the obvious pressures on the healthcare purse that are being addressed by extending this measure.
Bipartisan support for increasing the tobacco excise, irrespective of the alleged ‘hole’ in the Labour estimates, is largely a no-brainer despite that it will financially impact most those who can least afford it, it is an evidence-based way to reduce smoking rates. Even a 1% reduction in the national smoking rate results in health care savings in the tens of billions over a decade, let alone the reduction in human suffering it would bring. However, we strongly concur with Prof Rob Moodie’s concern that “so little of this money is invested back into preventive health programs”. Ideally, tobacco taxes would directly fund the cost to the nation of smoking, rather than find their way into consolidated revenue, which health professionals could find offensive in light of some of that money making its way to fund human rights abuses through indefinite detention of asylum seekers, or to subsidies for environmentally damaging power generation methods.
A reasonable person would expect unprecedented funding of new and innovative programs, along with preventive measures already known to be effective in the face of an as yet unrestrained chronic disease pandemic. Yet we have seen preventive health funding reduced under this government. The only light being a cautious trial of the Health Care Home concept, which we support in principle, but with an important proviso, already touched on in my editorial on the PHCAG recommendations here.
A renewed opportunity for the Shared Medical Appointment model
In that editorial, I expressed concern at any Health Care Home funding model that “fails to address the systemic and financial pressures already on GPs”, and similarly, that fails to adequately incentivise and resource the proposed Health Care Homes to achieve regular patient engagement, to provide patient education programs and innovative clinical consulting initiatives like Shared Medical Appointments, in order to achieve improved patient outcomes, and ultimately, to keep their practice patient cohort largely healthy.
Unfortunately, after a nearly three year long process, I’m disappointed to advise that ASLM has not been successful in our application to Medicare for an MBS item number for Shared Medical Appointments, which despite having obvious application to a wide range of chronic conditions, was only being sought by ASLM in respect of managing Type 2 Diabetes and pre‐diabetes, based on our view that a conservative application limited to one condition area would be more likely to be successful initially. MSAC’s sub-committee evaluation of our application, while appreciating the potential in the SMA model, seemed to flounder on a lack of guaranteed savings to the public purse, uncertainty as to privacy and related considerations of the group medical appointment format, and general lack of understanding or practical experience of the model itself.
To be clear, there are numerous studies into the Shared Medical Appointment/Group Medical Visit model around the world, consistently pointing to improved patient outcomes, increased practitioner and patient satisfaction, and overall cost and resource effectiveness. While acknowledging that it is extremely difficult to quantify the long term savings to the health system of empowering patients to be healthier and happier, there are already a handful of medical practices in Australia successfully applying the model under ASLM supervision of the protocol, despite the lack of clarity as to how to bill Medicare for the consultation.
Once again for clarity, the lack of an MBS item number which specifically recognises the SMA is the only thing standing in the way of national uptake of the model. Given that the SMA is, by definition, “A series of consecutive individual medical consultations in a supportive group setting where all can listen, interact, and learn” (more information here), use of an Item 23 to bill this service remains unclear and ASLM will continue it’s efforts to achieve a determination on this from Medicare, while continuing to support and train GPs and SMA facilitators (who are commonly allied health professionals) in the correct use of the model.
We firmly believe that without funding for innovative chronic disease management and patient education programs, practice systems and capabilities in the Health Care Home trial, specifically including funding and/or MBS item number clarification for the Shared Medical Appointment, the Health Care Home will be little more than a small boost to the traditional central role of the primary care practitioner in the face of increasing health consumer disillusionment with the system due to the systemic pressures already mentioned, resulting in ‘shopping around’ for solutions to their health concerns.
Keep listening for more announcements from ASLM as we ramp up our efforts to deliver Shared Medical Appointments into primary care, and other settings for which they are ideally suited. We will shortly be announcing new SMA Facilitator training programs at which the ASLM SMA protocol is explained, taught and practised. Certification is available from ASLM and we will support and assist practitioners and practices delivering SMAs according to the ASLM protocol.
Further reading:
Budget commentary:
Some official responses:
