Are you letting go of your nursing staff?

BREAKING NEWS 20th October 2014 – Medicare reverses its decision

New Double Dipping Ban is on from 1st November 2014!! If this happens then the read the rest of this article about what you need to think about. For some practices either redeploy your staff or start doing things differently. Let us know what you think!

http://www.australiandoctor.com.au/news/latest-news/double-dipping-ban-to-hit-on-1-November

BREAKING NEWS 2nd July 2014 – Medicare reverses its decision

We are so glad we have kept the original Medicare Press release below on the 30th June 2014. They have now amended the link after howls of protests by nurses, practices, organisations and you. Congratulations to everyone. Publicly complaining still rules.

Below is the original blog we published on 30th June 2014. We kept the original Medicare advice before they amended it on the 2nd July 2014 which appears on the link below.

For further information see:

http://hpnews.medicareaustralia.gov.au/2014/06/record-keeping-requirement-for-a-health-assessment-mbs-items-701-715/

Our 30th June 20th 2014 Blog

This is the latest Medicare Healthcare Assessment of nursing item numbers advice.

In a nutshell, many practices have claimed separately nursing and doctors time to these healthcare assessments. This is no longer according to these new rules/interpretation.

Medicare has “corrected” rules that may expose practices to claims of over claiming doctor item numbers. Many practices use nursing staff to claim rebates and a medical practitioner is not present for the whole nursing consult. It is not clear whether the practice (if theynurse%20get%20fired_jpg have charged a service fee against this item number) and or if the practitioner/ must pay back this money.

The matter is so serious we have recently received reports that practices are making nursing staff redundant nursing in response to the latest Medicare bulletin.

The Medicare bulletin states:

“Record keeping requirement for a health assessment (MBS items 701–715)

We have recently reviewed Medicare Benefits Schedule (MBS) Health Assessment items 701 to 707 and the legal requirements to claim those items.

Previously we advised that the time spent by nurses contributing to health assessments could be included with the medical practitioner’s time when choosing the time-based item to bill. This was incorrect.

While a practice nurse may spend time with the patient in helping to prepare a health assessment, it is only the time that the billing medical practitioner spends with the patient that determines the choice of item number.

For example, if a practice nurse spends 30 minutes with a patient to assist with a health assessment, and the medical practitioner then spends 40 minutes with the patient for the health assessment, the correct MBS item number to be billed is MBS item 703, standard health assessment lasting more than 30 minutes but less than 45 minutes.

Note: this information supersedes any contrary MBS itemisation advice that may have been provided to you by the Department of Human Services prior to this notification.”

An interesting view we have received is worthy of discussion.

Mr Jonathan Lee (NSW) former lawyer and current practice manager and consultant in general practice writes:

In my opinion, it is not a correct interpretation.

From the Schedule:

  1. “Medical practitioners may select one of the MBS health assessment items to provide a health assessment service to a member of any of the target groups listed in the table below.   The health assessment item that is selected will depend on the time taken to complete the health assessment service.  This is determined by the complexity of the patient’s presentation and the specific requirements that have been established for each target group eligible for health assessments.”
  2. “MBS health assessment items 701, 703, 705, 707 must be provided by a medical practitioner personally attending upon a patient. Suitably qualified health professionals, such as practice nurses or Aboriginal and Torres Strait Islander health practitioners, employed and/or otherwise engaged by a general practice or health service, may assist medical practitioners in performing health assessments.

My interpretation:

  1. The health assessment service is one continuous service provided by the doctor with the assistance of a “suitably qualified health professional” (where available).
  2. The item number will reflect the time taken to complete this continuous service, in which the nurse will be “collecting information” and providing “recommended interventions at the direction of the practitioner”.
  3. The time taken to complete is determined by the complexity of the presentation and specific requirements of each target group (eg. healthy kids, refugees etc.).
  4. Assistance is provided in accordance with acceptable practice and under supervision by the practitioner.
  5. Thus, to consider the nurse’s time and practitioner’s time separately seems to go against the spirit of what this section of the schedule is trying to achieve (ie. collaboration between nurses and doctors to manage complex presentations for specific target groups).”

This comment may have merit that is worthy of your consideration.

What do you think?

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1st July 2014 new Award pay rise or freeze and more?!

CHILD-SUPPORT-MONEY-BABYThe budget has a number of overwhelming changes that could seriously impact your practice. Here we cover the two most important ones, and provide a practice solution for your organisation.

On the 1st July 2014 wage rates should be increased by 3% p.a. For practices that predominantly receive the Medicare Benefit Schedule rebate, the rebate has been frozen in 2013 and will be frozen in 2014. Recently there have also been increases and changes in superannuation, tax and industrial laws including the 2013 General Practice Registrar arrangements.

This is an important opportunity to engage positively with recruitment and retention of your staff. This includes improving the sustainability of your practice. Our newly revised employment kit will allow practices to offer a better employment package to key staff in the short and long-term that provides a solid career structure which includes employer paid training.

1. Employees and employers must give each other 13 weeks notice if they want to end their employment arrangement!

ending_employment-TEXTDid you know under the recently amended Awards all new employees from December 2013 who do not have a legally valid employment agreement and/or the employer are required to provide at least13 weeks notice! This is rather expensive and inconvenient and can harm staff morale. This is quite amazing, given most employers and employees are more than happy to offer two weeks notice to avoid an awkward work environment. People should be allowed to leave a lot earlier if they are not happy. Our latest employment kit addresses this problem as well as the new Award and employer super increases.

2. New national wage increase 3% p.a. and Employer Super to increase from 9.25% to 9.5% p.a. from 1st July 2014.

wageincreaseRegardless of the budget, it is more than likely a four year freeze on increasing the Medicare rebate for General and medical practices will continue; see the Greedy Doctor  article about the impact of the Medicare freezes. This increase can be absorbed into over award payments, if you have documented your employment arrangements correctly. Clients who have correctly implemented our latest “Employment Kit” update (see below) released last month should have this option available.

These are the latest Awards commencing 1st July 2014

1. Medical Practitioners Award 2010

http://www.fwc.gov.au/documents/documents/modern_awards/pdf/MA000031.pdf

2. Nurses Award 2010

https://www.fwc.gov.au/documents/documents/modern_awards/pdf/MA000034.pdf

3. Health Professionals and Support Services  Award 2010

http://www.fwc.gov.au/documents/documents/modern_awards/pdf/MA000027.pdf

If you subscribe below you should receive automatic notification of any material updates we are aware of.

The main changes include:

  1. Fair Work penalties have increased to a maximum of $51,000 per breach from $33,000.
  2. 3% new Award rates for the Medical, Nursing and Health Support Staff Awards effective from 1st July 2014;
  3. 0.25% increase in employer super to 9.5%;
  4. New default 13 week notice period should you need to let go a staff member for staff commencing employment from December 2013;
  5. Requirement to confirm employment terms to ensure your employment agreements are legally binding, regardless of whether you have a signed employment contract. This is important if you wish to avoid an underpayment of wages claim.

Do you have legally binding and sustainable employment arrangements?

contract-1024x682If you do not have signed and up to date employment contracts, your staff may be entitled, from 1st July 2014, to a 3% p.a. national wage and a 9.5% super guarantee increase. Practices should have updated their payroll software programs to reflect and pay these changes.
Currently wages represent 60% of a practice’s total overheads so it is a significant investment. Freezing staff wages can significantly hurt morale, however any significant cost increases will have to be met by either reducing quality or increasing patient fees.  Share this article with your staff and patients see http://wp.me/p4FHeU-4

Good staff employment contracts are good for staff morale.

Generally staff prefer to work with practices that are open and transparent. This can only build trust and prevent any further feelings that they have been taken advantage of in these unprecedented and changing times.

Baby-Sitting-Holding-Money-Shocked

3. The new and revised 2014/15 Health and Life Employment Template Kit

There are quite a number of significant and sensitive changes, that can become quite complex to implement.

At Health and Life we have developed since the new Federal industrial laws in 2010 and  an employment kit to help you meet these obligations. From current Award implementation advice, employment contracts and job descriptions we have addressed the major issues that can affect your place of employment.

We can confirm new amendments to our national Fair Work friendly and tested employment template kit bring the current changes and easy solutions into alignment with the latest significant Award and National Employment standards. This may be a solution to reversing the negative impact the current healthcare reforms will have on your practice.

The new variations to our employment kit are designed to minimise any significant statutory employee on-costs. More importantly the revised templates allow practices to pay for staff training e.g to the Australian Association of Practice Managers conference (www.aapm.org.au) (which is a great motivator). This can also significantly improve practice efficiencies and viability. This will allow for better structured long term career progression and a fairer remuneration package. The new terms will help identify, train and reward your key staff plus offer flexible working arrangements without significant risk to the practice. It is a win win for everyone.

This solution will enable you to continue to reward your staff on merit and provide high quality services and minimise patient fee increases.

In order to achieve this objective we have updated our employment kit to include:

happy

  1. Absorption of future statutory increases in Employer Superannuation contributions not based on productivity currently 9.5%;
  2. Employers can choose to absorb annual  Award wage CPI increases (i.e. e.g. 3% p.a) into any existing over award payment;
  3. Updates to the Individual Flexibility Agreements to keep them Fair Work Australia compliant;
  4. Confirmation of employment terms to ensure your employment agreements are legally binding, regardless of whether you have a signed employment contract;
  5. Motor vehicle and indemnity clause for vehicles used during work hours;
  6. Education and conference salary sacrifice clauses;
  7. Revised sustainable team based profit sharing arrangements based on productivity;
  8. Protection from the new 13 week notice period staff and employees need to pay out or work out if their employment is being terminated by either party;
  9. Addition of a useful Delegations Policy for your Practice Manager / CEO so owners no longer have to micro-manage the Practice;
  10. Updated the hyperlinks and referencing to the appropriate awards and legislation (this is a legal requirement);
  11. The most common and latest awards as at 1.7.2014 for the healthcare industry (also included for your convenience)
  12. Employer paid staff recruitment and retention clause to improve practice efficiency and pay for staff training and future remuneration increases.

Offer of initial free advice

How-to-OrderIf you are not sure whether you can benefit from our template, you can confidentially send a sample of your practice employment agreements and we can provide some no obligation tips. If you have any queries,  before making any changes, please contact us at no obligation, by email at pa@healthandlife.com.au on 1800 077 222 to find out more.

Do you want to purchase an Employment Template Kit or Upgrade?

Commencing 1.7.2013, if you have purchased the Employment Kit in the past 12 months, we are issuing you this upgrade free of charge (valued at $320+GST). If you have not purchased a kit or want to update the one you have purchased from us download our https://www.healthandlife.com.au/what-we-do/services-peace-of-mind-solutions/specialised-services/products-for-medical-practices/templates/ . The content of the employment kit including useful job descriptions and a quote. Email us at pa@healthandlife.com.au to order. We strongly recommend you consider reconfirming your employment agreements in order to implement these changes at your next 6 monthly staff performance appraisal. 

We continue to provide this unique and exclusive template in Australia. This will enable you or your practice to save thousands of dollars on expert advice and time. Most importantly this process will only add to your staff morale and recruitment and retention strategies.

This may be a perfect solution for your practice if your staff are concerned about their  future wages or working conditions.

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