Director’s report
This was a watershed year for Professional Services Review (PSR). During 2007–08 we established the environment in which we will be working in the future, and devised systems and methods to equip us to deal with an increased and varied workload.
In 2007–08 Medicare Australia asked PSR to review the behaviour of 50 practitioners, up from 27 the previous year. They included general practitioners, medical specialists and three optometrists and encompassed a variety of concerns. There was a notable increase in Medicare Australia’s requests to review prescribing by general practitioners, particularly the inappropriate use of antibiotics, anti-arthritic medications and of more concern the inappropriate use of narcotics and benzodiazepine drugs. One doctor from Victoria, who was disqualified from Medicare for three years, was found to have supplied narcotic and benzodiazepine drugs to known addicts in large quantities. The doctor was also referred to the Medical Board of Victoria.
A common concern in Medicare Australia’s requests was the initiation of pathology by general practitioners working in narrow areas of practice, including women’s health, nutritional medicine and life style and risk factor management. Practitioners are expected to initiate expensive investigations in a thoughtful manner where there is a sound clinical reason. Many of the practitioners under review were found to be ordering expensive tests with no regard to their clinical relevance. Practitioners who have been found to have practised inappropriately in this way are required to repay the pathology benefits to the Commonwealth.
Long consultations by general practitioners have always been an issue PSR investigates. Comments I made in the 2006–07 Report to the Professions about the correct use of level C and D GP items sparked a lively debate in the medical media. The debate highlighted the degree of confusion that existed in the GP community on the correct use of these items. Discussions with the Department of Health and Ageing have confirmed the policy intent that these items are to be used for care requiring complex clinical input by practitioners.
The proportion of requests from Medicare Australia that are subsequently dismissed under section 91 of the Health Insurance Act 1973 following a PSR review is less than 15 per cent. Of more concern is the increasing numbers of second and subsequent requests PSR has received recently. The adequacy of sanctions the Determining Authority imposes to deter future inappropriate behaviour is an aspect of the PSR Scheme that the PSR Advisory Committee is to examine. (The PSR Advisory Committee is chaired by the Department of Health and Ageing and has representatives from Medicare Australia, the Australian Medical Association and PSR. The Committee was established following the 2006 Review of the PSR Scheme to continually assess and review the effectiveness of the Scheme.)
As a consequence of PSR’s increased workload, staffing levels have increased to 25 full- and part-time staff. PSR reviewed its internal structure and systems during the year and, as a result, a more streamlined process has accelerated the pace at which a case progresses. Practitioners find the PSR process stressful and it is my aim to reduce to a minimum the total time a practitioner is involved.
PSR has begun reviewing its corporate policies and guidelines, including human resources, risk management, financial management and governance. The reporting and compliance requirements for a small agency put considerable pressure on key staff. My Executive Officer, Chief Finance Officer and Human Resources Manager have worked assiduously to ensure PSR meets the necessary compliance models of an Australian Public Service agency.
PSR values its relationship with our key stakeholders – the Department of Health and Ageing, Medicare Australia, the Australian Medical Association, and the professions more widely. This year we embarked on a series of educational evenings around the country. PSR has a role to investigate individual behaviour, and also to complement Medicare Australia’s role to educate practitioners about their compliance obligations. I intend to expand the educational role in 2008–09. Over the last three years the medical media has displayed an increasing interest in the work of PSR and I would expect this to continue.
No challenges have been made in the Federal Court to decisions involving cases referred to PSR in the last four years. However, a number of older cases are still progressing through the courts. Most significantly, 15 cases are tied to a constitutional challenge currently before the High Court of Australia. This challenge has delayed finalisation of several cases the Health Insurance Commission initially referred to PSR over eight years ago.
In September 2007 I travelled, with my Executive Officer, to the United Kingdom to examine the changes to medical regulation following several high profile cases of inappropriate practice. While the United Kingdom National Health Service is vastly different from Australia’s health system, many of the same problems in regulating aberrant behaviour by health professionals exist. As a result of our visit, the United Kingdom now provides information about adverse determinations about doctors by the General Medical Council directly to PSR.
I pay tribute to my own staff for the hard work they have cheerfully undertaken this year. I also thank the staff of the Department of Health and Ageing and Medicare Australia for their continued support and advice. As head of a peer review organisation, I am extremely grateful for the dedication by members of the PSR Panel, including my Deputy Directors, who forego their time in practice to participate in PSR Committees. The members of the Determining Authority also deserve my thanks and praise for the difficult work they undertake. In particular I would like to thank Ms Jane Phelan who recently retired as the lay member of the Determining Authority.
Tony Webber
Director