2. Report on performance
Outcome and output structure
PSR contributes to the Health and Ageing portfolio outcomes.
The PSR Scheme is funded to ensure that requests by Medicare Australia to investigate suspected cases of inappropriate practice are reviewed and, if necessary, examined by a committee of the practitioner’s peers.
The PSR outcome specified in the Portfolio Budget Statement 2008–09 was:
Australians are protected from meeting the cost and associated risks of inappropriate practices of health service providers.
The key performance information specified for PSR in the Portfolio Budget Statement 2008–09 was:
| Indicator | Reference point or target |
|---|---|
| Increased awareness and understanding of PSR’s process within health care professions. | Targeted qualitative evaluation of stakeholder awareness to be conducted annually. |
| Improved efficiency and cost effectiveness of PSR’s internal processes. | Timeframes reduced, internal processes streamlined and cost per case reduced. |
| Reduction in the number of practitioners referred to PSR more than once. | Annual percentage of re-referred practitioners is lower than total percentage of re-referred practitioners. |
| Resourcing: $5.891 million | |
Increased awareness and understanding
During the year PSR implemented its first Communication, Education and Media Strategy. The strategy’s three main aims are to:
- ensure information about PSR’s processes is easily available to those that need or want it
- reinforce Medicare Australia’s efforts to promote appropriate use of Medicare and the PBS, and awareness of the PSR Scheme
- deter health care practitioners from inappropriate practice.
The Director spoke about PSR’s work and findings at several conferences and seminars during the year. These events were mainly for general practitioner audiences, but also included legal representatives and medical defence organisations.
The Director used regular opportunities to respond to media interest in issues relevant to PSR activities. In 2008–09 these issues included the proportion of general practitioners to specialists who were the subject of PSR investigations, Level C and D consultations, enhanced primary care items and the quality of clinical records.
PSR issued its fourth annual Report to the Professions. As in previous years, the report has effectively served the dual purposes of educating the professions about the PSR Scheme and PSR’s activities, and acting as a deterrent to those who might see elements of their own practice reflected in the cases described. To strengthen its educational value, this year the report included commentary from two expert consultants on issues that had been raised in a number of PSR cases during the year; namely, the inappropriate use of antibiotics and prescribing psychoactive drugs.
The 2007–08 Report to the Professions was distributed to over 49,000 practitioners and attracted significant attention from the medical media.
With the mailout of the 2007–08 Report to the Professions, PSR included an invitation to practitioners to participate in a survey through PSR’s website. The survey asked practitioners what they knew about PSR, what they needed to know, and how PSR could assist. While the response to the survey was disappointingly small, those who did respond indicated a reasonable level of knowledge about the PSR Scheme, and a preference for receiving information about the Scheme and PSR processes either through the PSR website or through professional journals and newsletters. PSR will use this information to further refine its Communication, Education and Media Strategy in 2009–10.
Improved efficiency and cost effectiveness
In 2008–09 PSR finished implementing its new organisational structure. The new structure better supports start-to-finish management of cases, and in turn provides staff with more control and autonomy in their work. The structure provides for a greater emphasis on assuring the quality of outcomes in all PSR’s processes.
PSR’s new organisational structure also facilitated staff involvement in identifying opportunities for productivity improvements and efficiencies. Initiatives included significant reductions in freight costs through use of revised procedures and sourcing more cost effective services, reduced travel costs through increased use of video conferencing, and savings in paper, printing and freight costs through providing PSR Committee documentation electronically.
Evidence of the improved efficiencies achieved this year can be seen in Table 2, which shows that some processes were completed more quickly than in 2007–08, even though a significantly greater workload was received.
Reduction in the number of practitioners referred more than once
PSR is yet to achieve its target of reducing the annual percentage of re-referred practitioners to less than the total percentage of practitioners who have been to PSR more than once.
In the period since the PSR Scheme commenced in 1994 to 30 June 2008, Medicare Australia has asked PSR to review 445 practitioners. Of these, 72 (16.18%) had been referred more than once. In 2008–09, 24 of the 136 practitioners referred by Medicare Australia had been previously referred (that is, 17.65%).
A number of factors influence this result, including the attitude of practitioners to the views of their peers, Medicare Australia’s processes, the severity of sanctions applied, and practitioners’ perceptions of the PSR Scheme. In 2009–10 PSR will analyse the cases of practitioners who have been referred to PSR more than once to identify any trends or indicators that may reveal opportunities to strengthen the deterrent effect of the Scheme for these practitioners.