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The nation’s sickest patients could be at risk after a massive Medicare shake-up

THE nation’s sickest cancer patients and people with diabetes and other chronic illnesses will get a maximum of $1795 worth of GP care a year funded by Medicare under a revolution in the way doctors are paid.

And Medicare will fund just five extra visits to the doctor if these people need medical attention for issues aside from their chronic illness under the Turnbull Government’s Health Care Homes model. Doctors were expressing deep concern about the adequacy of the payment levels that were released without consultation with medical groups on November 4.

“The modelling is concerning and potentially leaves the whole program at risk of falling over because of being underfunded from the beginning,” AMA vice president Dr. Tony Bartone said. The Health Care Homes policy is a signature government policy which it claims will solve the woes of the Medicare system by providing comprehensive care for one in five Australians who have a chronic illness, keep them out of a hospital and save the health system money.

Patients will have to enrol with a single GP practice to get a new form of wrap-around health care under the model, but Doctors are worried they’ll get less money than they receive now to care for the sickest patients. Currently, doctors are paid on a fee for service model and get paid $37 by Medicare every time they see a patient for a standard 20-minute visit, they get paid more for longer visits.

There are no limits on how many times a patient can see a doctor and get a Medicare rebate. Under the new model patients with the least complex, chronic conditions will get $591 a year worth of GP care, those with a slightly higher level of complexity will get $1,267 worth of GP care and the most complex patients will receive $1795 worth of care. The government released the payment details of the controversial program late Friday, and doctor’s groups said they had not been consulted on the details of the model.

Royal Australian College of General Practitioners president Dr. Bastian Seidel was suspicious about the timing of the announcement. Governments traditionally use that time to “take out the trash” and announce unpopular policy details. The sickest 12 percent of patients account for 40 percent of Medicare benefits and on average they receive 51 services a year, Dr. Seidel said.

The maximum funding under the government’s health care homes model is only enough to cover 48 GP visits a year, or less than one per week. Dr. Seidel says a patient with diabetes and an infected leg would need to visit the GP at least three times per week to get it dressed. The RACGP had asked the government to provide doctors with an extra $300 per patient per year on top of existing funding to make the new Medicare model work. The current funding suggests doctors will be receiving less than they currently get.

Dr. Bartone said the Health Care Homes model was based on a long-standing method of paying GPs for caring for war veterans. However, he said doctors were paid around 30 percent more to care for veterans than they would be paid to care for patients under the Health Care Homes model.

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