The Australian Medical Association (AMA) has laid out a payment scheme for how it thinks doctors should be compensated for creating a patient's health-record summary.
A health-record summary is a quick fact sheet of a patient's health that their GP will create and keep up to date. The health summary is a key element of the government's personally controlled electronic health record (PCEHR) scheme, which the government is starting from 1 July.
GPs have been concerned about the amount of time it will take to manage the shared e-health summary, and are looking for compensation for the time that they will spend on updating them. At the end of last month, Health Minister Tanya Plibersek said that the government will accede to this wish by providing funds to GPs for managing the records.
For consultations that take less than 20 minutes, GPs will receive a Level B benefit of $35.60. For consultations that are longer, a Level C benefit of $69 would be provided, and, in the case where consultations go for more than 40 minutes, a Level D, $101.55 benefit would be provided, she said.
However, the AMA is concerned that there are no new item numbers specifically for creating an e-health summary, meaning that the creation of the summary would occur during a normal consultation. Doctors charge based on the time and complexity of a session. Both factors need to be considered when thinking about whether to claim Level B, C or D benefits, with documentation to back up their choices. Level B requires the creation of a patient history; C the creation of a detailed patient history; and D the creation of a comprehensive history. This is checked by auditors.
If a consultation went over the 20-minute time purely because of the time taken to create an e-health summary, the doctor wouldn't feel justified in charging the higher rate, according to the AMA, because he or she could be asked difficult questions by auditors.
Plibersek addressed this in her speech, saying, "I want to confirm that the use of the longer consultation items will be seen as appropriate by the Medicare Australia Practitioner Review Process and the Professional Services Review in circumstances where there is clear evidence of patient complexity, and there is documentation of a substantial patient history."
However, the AMA is worried that in cases where a doctor attends to the patient's needs in a consultation, and then creates a basic e-health summary and goes over time, the doctor will be out of pocket, because the document created would not be complex.
"The public announcements from the government suggest that patients will only get a Medicare rebate if the shared health summary is prepared as part of an existing MBS consultation," AMA president Dr Steve Hambleton said in a statement.
"GPs are being asked to do more work in their consultations for no reward."
Given these concerns, the AMA decided to outline and cost separate items specifically for the creation of e-health summaries to "realistically reflect the time, the work and the expertise required to ensure that shared health summaries are thorough, up-to-date and useful across health-care settings".
The AMA's suggested charges are $53 if the doctor spends less than 15 minutes working on an e-health record; $104 if the doctor spends between 15 and 30 minutes; $154 if the doctor spends between 30 and 45 minutes; and $210 if the doctor spends over 45 minutes.
In response to the Medical Observer's queries for clarification on whether doctors could claim longer times for the creation of e-health records without fear of audit consequences, confirmed by ZDNet Australia, the Department of Health and Ageing said that the GP should exercise their judgment.
GPs currently exercise professional judgment about which item to bill, including about the time involved in taking medical histories — and that would apply here, too.
In circumstances where there is clear evidence of patient complexity, and there is documentation of a substantial patient history, GPs using the longer MBS consultation items would be considered appropriate by the Medicare Australia Practitioner Review Process and the Professional Services Review.
It follows that GPs would consider using the higher-level items for longer consultations where there is substantial patient complexity and history.
If GPs don't get on-board with the scheme, the government will have trouble getting it off the ground; the summary will be a key building block of the whole scheme, which sees health professionals able to access and add to a patient's records online.