NSW Health has brought forward work on a web portal that's used to manage payments to visiting medical officers (VMOs) after the NSW auditor-general found glaring issues in how payments are being managed.
NSW's public-hospital system relies on VMOs and other specialist staff who work as contractors. They include surgeons, emergency doctors and psychiatrists, and make up more than half of the 13,000 or so doctors in public hospitals.
The current system involves VMOs submitting claims for payment, the hospital verifying the claims and NSW Health Support Services entering the data into its database and making payment.
The auditor-general found the process to be prone to errors, with all claims for payment made in hard copy, and, in some cases, still being handwritten.
In addition, several hospitals had told the auditor-general that due to tight deadlines, a lack of resources and the difficulty of accessing information to verify claims, they were only conducting minimal checks to determine if a VMO's claims were valid. These issues were exacerbated by some VMOs submitting claims irregularly or late.
One particular VMO had not submitted a claim in over a year, and resulted in the hospital's cash flow being adversely affected by a sudden hit of over $800,000.
VMOs are collectively paid over $500 million each year. Given this large sum, the auditor-general's report said that the financial impact of errors could be significant. It found that hospitals that check claims thoroughly found and fixed errors in 10 to 18 per cent of their claims. The auditor-general saw no reason why this error rate wouldn't be similar in hospitals that didn't have the resources to check as thoroughly.
In addition, the auditor-general found that the number of VMO accounts exceeded the number of VMOs by about 30 per cent. A VMO might have contracts with multiple hospitals, resulting in the need for one VMO to have more than one account, but it also meant that it would be difficult to verify that a VMO had not claimed payment from more than one hospital for the same overlapping services. One such example would be where a VMO would be on call to respond to any one of a number of hospitals, but charge that service to all of them.
The auditor-general stated that electronic claims and the ability to retrieve information from related systems would offer opportunities to automate and speed up verification. In particular, improvements were needed by implementing electronic invoicing with automated cross-checking, and using benchmarks to detect inconsistent VMO claims.
NSW Health had intended to implement a web-based portal as part of its VMoney payment system, which is operated by Health Support Services, to eliminate some of the existing manual processes. Its original plans were to finalise its pilot system by 2014, with the integration of the system with an automated rostering system also by 2014.
Following the auditor-general's recommendations, NSW Health has stated that it will commence a pilot system of the web-based portal in June 2012 and begin integrating it into its existing systems in September 2012. In addition, it will assign unique identifiers to VMOs to reduce the risk that they are overpaid for duplicated services.