Director's report
Tony Webber, Director
An increasing public demand for assurance that medical services are delivered safely and at a high standard has placed new demands on healthcareregulators worldwide. A criminal case in the United Kingdom (Dr Harold Shipman) and and inquiry in Queensland (Dr Jayant Patel) have forced medical authorities to make radical changes to health administration. The Professional Services Review (PSR) has always had the dual role of protecting federal revenue and protecting the public from the adverse health effects of inappropriate practice. An emphasis, by PSR committees, on the quality of the service delivered by a practitioner under review is appropriate.
This year the Department of Health and Ageing (the Department) initiated a long anticipated review of the Professional Services Review Scheme. The purpose of the review was to assess the effectiveness of the 1999 and 2002 legislative changes to Part VAA of the Health Insurance Act 1973, and to make recommendations on areas for improvements to the scheme. The review will report to the Minister for Health and Ageing in the fourth quarter of 2006. The steering committee, with representation from the Australian Medical Association (AMA), Medicare Australia, and the Department (with PSR as a co-opted member), was able to closely examine the scheme. Medicare Australia's role in initial identification and investigation of a practitioner to the whole Professional Services Review process through to a final determination, has been subjected to detailed scrutiny. The lessons learnt from legal challenges and consultations with the many stakeholder groups were incorporated into the steering committee's deliberations. I have been pleased with the thoroughness and willingness of the steering committee to examine all aspects of the scheme. I am confident that the review recommendations will result in a more robust, comprehensive and fairer process for practitioners.
Since becoming Director I have held the view that, to have an optimal deterrent effect, the Professional Services Review Scheme, has to have greater visibility and transparency amongst the professions. This year, PSR published the Report to the Professions that explained the scheme in detail and published the outcomes of cases finalised during the previous 12 months. The publication included the names of practitioners, the extent of their inappropriate conduct and the sanctions imposed by the Determining Authority. These details were already available on the public record having been tabled in Parliament in last year's Annual Report.
The Report to the Professions created considerable media interest, in both the medical and lay press. The feedback PSR received directly was overwhelmingly positive. Many practitioners expressed strong disapproval of their colleague's conduct and supported PSR's publication. An independent survey of doctors' attitudes to the Report to the Professions found a majority of those surveyed approved of the publication. Significantly, 25 per cent of respondents said they were now more aware of the implications of misusing Medicare. I intend to publish a similar report following tabling of this Annual Report.
Many of the same aspects of inappropriate practice reappear every year. Practitioners are still not making adequate or contemporaneous clinical notes. This is a too often neglected aspect of providing a quality professional service to Australian healthcare consumers. This is not confined to general practice; many consultant physicians' and specialists' clinical notes fail to meet minimal standards, as determined by their peers. Good records are an integral part of a health professional's duty of care.
General practice Medicare Benefits Schedule (MBS) items have undergone considerable changes in the last few years. During the last 12 months PSR committees have examined Care Plans, Health Assessments and other Extended Primary Care items. Many appear to have been initiated for trivial conditions and amount to no more than a highly paid referral. Practitioners should be aware that their behaviour, when using these items, will be judged by their peers as to acceptability to the general body of practitioners, not solely that they fulfil the item descriptor. The clinical content and relevance of a service is also a significant aspect of a committee's deliberation.
Vocationally Registered general practitioners have been found to consistently misunderstand the content requirement of the higher valued consultation items (Group A1 MBS items). Practitioners should be reminded that if a consultation does not meet the content requirement for Group A1 it should be billed at a lower rate for time based items (Group A2).
There has been a trend in recent years for PSR to make more referrals to state medical boards because the conduct of a practitioner was, or could be, a significant threat to a person's life or health. PSR committees have viewed this as part of their role in protecting the public from harm associated with inappropriate practice. I expect this practice will increase in the future. Amendment to the regulations now enables referral to appropriate professional bodies in relation to a practitioner's failure to comply with professional standards.
In April I attended the European Forum on Quality Improvement in Health Care, in Prague. While in Europe I met with health care regulators in France, Germany and Denmark. Although the European and Australian healthcare systems are different we share enough in common to encounter similar problems of financial abuse and inappropriate practice.
It was encouraging to find that Australia's regulatory systems appear more rigorous and effective than many of those in Europe.
A successful training weekend was held for new Panel members in October. The inquisitorial nature of a PSR committee's work requires skills not normally used in medical practice. A well-trained Panel member is able to bring an understanding of procedural fairness to a committee hearing to the benefit of the process and the practitioner under review. A conference for Deputy Directors was also held in March.
Dr Morris Williams', a general practitioner from Brisbane, appointment to the Determining Authority ended after a five-year term. I would like to acknowledge the dedication and wisdom Dr Williams displayed during his term when called upon to make judgements on his colleagues. Dr Bill Meagher, a general practitioner from Young, has very ably stepped forward to fill the vacancy.
During the year there were a number of Federal Court actions that are detailed later in this Report. The most significant of these has been a constitutional challenge to the validity of the scheme. While this has yet to be heard by the High Court, many of the other litigants have also added this ground to their cases. This will have the effect of delaying finalisation of these cases until the High Court case is decided.
Seven new requests were received from Medicare Australia this year. Discussions during the review process focused on this issue. I am confident that changes planned will see the rate of requests from Medicare Australia increasing over the next 12 months.
We have forged closer working relationships with Medicare Australia's Program Review Division and Department of Health and Ageing staff. I have confidence that this will improve our efficiency in the future.
I would like to thank my own team in Canberra and the PSR Panel members throughout Australia. Their dedication and skill has contributed in large measure to a successful and rewarding year.
Tony Webber
Director