AMA VICDOC Autumn 2024 - Magazine - Page 45
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It’s completely understandable, therefore,
that when allegations of $8 billion being wasted
in fraud are made, national attention is swift
and condemnation fierce.
If only it were true.
The suggestion that $8 billion (around 30
percent) of the spend on Medicare is being
defrauded has been shown to be based on
anecdotes, simplistic analysis and opinion, rather
than any rigorous data or comprehensive statistical
analysis. This goes someway to explaining the
utter puzzlement of the medical profession, and
the federal government (as the holder of Medicare
data) for that matter, at the suggestion.
But it’s completely understandable that
Australian’s responded this way, when presented
with these figures as “facts”.
We’ve seen Medicare used as a political football
before — through five years of a Medicare freeze
as a savings measure — pushing costs away from
government and onto patients.
And we’re seeing pressures on general practice
like never before, with increasing out-of-pocket
costs as the Medicare patient rebate falls further
and further behind.
Clearly change is needed. Doctors and the
community know this.
From the AMA’s perspective, to achieve this
change it’s critical we do three things.
Firstly, we do need to increase the funding to
Medicare. At the beginning of the year the patient’s
rebate for a regular GP consult was $39.10. After
indexing it in July, it is now $39.75. That’s not going
to do much in an inflation environment of around
7 per cent. Something is broken here.
Secondly, we need to continue to stamp out
any fraud, mistakes, and wastage — something
the AMA (with the wider profession) has dedicated
a significant amount of its resources to over
many years.
Over 700 clinicians gave up their time to be part
of a five-year effort to review the entire Medicare
system, through the MBS Review. You don’t do that
if you’re not interested in protecting the system
from misuse.
In recent years we have backed legislative
reforms to increase Medicare audit and compliance
powers, making it easier for Government to tackle
allegations of Medicare fraud. The specific cases
being quoted in the media are largely those that
have been detected under the current compliance
and audit regime, showing the system is working.
We’ve been regularly consulted on the Department
of Health’s education program — helping to shape
letters to practitioners on Medicare by using the
Department’s advanced data analytics to support
practitioners who genuinely struggle to understand
often complex Medicare rules.
Where issues of fraud appear, we’ve worked
with the government’s compliance and risk
program, alerting them to issues, and supporting
efforts to quickly address any inappropriate and
unethical use — including where necessary through
referral to the Professional Services Review.
The AMA always has, and always will, have a strong
stand on our role as stewards of the system.
It’s also why we implored health ministers to
ditch a plan that would have seen cosmetic
surgeons able to use patient testimonials on
social media. We need tighter controls on
cosmetic surgery, not a TikTok free for all.
Thirdly, much of the recent debate has centred
on how complicated, confusing and convoluted the
system is. We’d agree. It’s why the AMA is running
a campaign called “Modernise Medicare”, focussed
on reforming the system to fund co-ordinated,
multi-disciplinary care under one roof.
You shouldn’t have to bounce around the health
system to see a doctor, a nurse, an allied health
specialist. It’s a travesty those with chronic wounds
can’t afford bandages to take to the GP, because
we don’t fund it as a nation. We don’t fund GPs to
make it sustainable to be open after hours, while
also expecting them to devote huge of amounts
of their time to completely unfunded healthcare
delivery, because the ‘system’ hasn’t kept up with
Australian’s healthcare needs.
It’s no surprise Australian’s needing healthcare
miss out, become sicker and end up caught in the
hospital logjam.
One of the very few areas of the recent media
coverage we do agree with is that there is more
work to be done.
Doctors go to work every day with the express
purpose of caring for other people, healing them
and making them well. Recently in theatre I worked
to save the life of a woman who had lost 12 litres of
blood — more than twice her blood volume. This is
the job doctors quietly go to work and do every day.
That’s what doctors want to focus on.
It’s no surprise then that hundreds if not
thousands of hard-working dedicated doctors have
been dismayed by recent media stories.
There are important issues to be debated
relating to the health system, including the
pressures placed on that system by an ageing
society, rising chronic disease rates and the long
tail of COVID-19 in the community. I can only hope
we have the political will to invest in Medicare as
it is needed, and the opportunity to have a truthful
public debate about these issues.
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