General Practice Business Model is Dead? A New Killing Season?!

General Practice Business Model is Dead? A New Killing Season?!

How are you feeling with recent national headlines like these?

1. GP Business Model Off the Rails!

2. The Biggest Threat to GP’s

3. Small or solo practices won’t cut it: Professor Hickie

Recently it is becoming rare to get up in the morning and read something positive about your local general family practice. We do not subscribe to the ‘do nothing’ or ‘leave it to someone else’ approach. There are many practices thriving in this period of change and for some, the current climate presents more opportunities than problems.

The one thing that makes them successful while others continue to struggle?

They have become self aware. Only they can drive change and not let change drive them over a cliff. Having an offensive position is far more empowering than having a defensive position and allowing others to do their bidding for them.

Questions you should seriously ask yourself?

Same mistake twice

Should your practice continue to rely on the Government model of healthcare funding? What can you do about it? The answer is to firstly change your attitude and thinking. Since Medicare was introduced in the 1980’s, the entitlement problem has become more serious than we have ever seen.

Secondly it is acting on proactive thinking and not leaving it to others like the Government or your practice manager or peers to fix. It is your problem as much as it is theirs as you are all on the same boat. Everybody has to have their oars in the water and it is important to set a direction and start paddling to the shore in a timely manner.

After much soul searching, you will find the rest is easy. If the patient survives but the practice dies or you drastically reduce the quality of care you provide to your patients and go hungry at the same time, there is no point. Eat well and sleep well is a mantra everyone should follow. It may be hard work – but what choice do you have other than to quit? Is quitting a real alternative?

Three heads in the sand

The reality is that most practices are starting to charge for their services in order to survive. This has a huge strategic and operational effect on the type of competition you will now face in the industry.

The hardest challenge is to know where to start and how to work through the plethora of ideas in order to ensure they are executed on a timely basis. With the appropriate governance, management and delegation structures in place, this is not difficult to achieve. For more information, see our Time Management Tips and Could you be responsible for the death of your Practice? Four key areas to watch!

The smart practices are already on top of this. To meet this headwind, they choose to work on and not just in their practices. They are also winning by not only increasing prices but improving and diversifying their services. The key focus is on being proactive to build trust with healthcare prevention activities.

We live in a world of instant gratification. Patients have become more demanding for prompt and efficient services. People are now looking for proactive, rather than reactive providers and practices, especially if they have to pay for it. For some ideas see our articles How to choose a good GP/Practice and what made good doctors cry!, Greedy Doctors?! and What happens when a Doctor Gets Sued?

Practices will need to ensure billing, debt collection systems and procedures are working. Most importantly, communicating this change can be difficult if patients do not perceive any real benefit other than a price hike.

A simple repainting of the waiting room or new practice uniforms, for example, can change this perception. Many ideas do not involve a lot of money, just a focus on what your patients value. Reception staff that sound more helpful and engaged over the phone or at the front desk can make a huge difference. Providers should not be immune to this sort of examination. A useful starting point is just to check your latest practice survey comments for honest and constructive feedback and or ask the reception staff. The little things can and do make a big difference.Be-So-Good-Steve-Martin

The bottom line is that all providers and staff will need to be even more attentive as practices become more competitive in this area in the search for discerning fee-paying patients, even if this is to subsidise the non-fee paying patient. We will be doing our best to communicate why your free healthcare dollar days may be numbered and what you can do about it so high quality services are not compromised.

The key is to offer continuity of care and a high quality service at every point of contact your patient has with you.

When you have a chance do something, it is always better than nothing. We do not agree with the doomsayers! It is all about the right attitude that you can control, and not pursing solutions that you cannot control.

Time-managementThis may sound cliché, but it is about working smarter and not harder. The real problem is time. On this you may be your own worst enemy. You will say you do not have time. This is only because it is not a priority. The reality is that one day you will run out of time and it will be too late and the best advisers in the world will not be able to help you.

Working out what works and what does not and implementing this on a timely basis will make the real difference and the great news is that it will cost very little to do.

Our practical ideas do work, they are implemented in Practices like yours. We have been doing this nationally for 24 years. If you follow them, you will have less to worry about. Unfortunately, there are no short cuts but at least you are not reinventing the wheel.
Stop being afraid of what could go wrong
You have nothing to lose if your practice is your most important investment in your life. For most practitioners and staff it is your engine room to your family’s financial security, so do not risk it with inexperienced advice. From our estimates, the freeze will severely bite in 2017 if it is not already hurting you and your patients now.

Time is running out to do something. There is a financial fail point for practices, when it is too late to fix things. We have already done these numbers. It is important that you make a positive change in philosophy and work with a sustainable business model urgently for the people you care about if you want to keep helping them. Contact us for a free and confidential no obligation consult at pa@healhandlife.com.au. We are always here for you.

Do you use standard contracts/agreements in your practice? Are they legally binding? New ACCC Law 2016

Do you use standard contracts/agreements in your practice? Are they legally binding? New ACCC Law 2016

This new “standard form” law is designed to protect smaller parties such as contractors, employees and suppliers from unfair contract terms and conditions. If there is a breach, this term or agreement may not be legally enforceable.

“A standard form contract is one that has been prepared by one party to the contract and where the other party has little or no opportunity to negotiate the terms – that is, it is offered on a ‘take it or leave it’ basis”. This may affect your employment contracts or contracts with doctors and allied health. We have a solution.

“A standard form contract is one that has been prepared by one party to the contract and where the other party has little or no opportunity to negotiate the terms – that is, it is offered on a ‘take it or leave it’ basis”.

5-6 years old boy and plate of cooked vegetables isolated on white

Take it or leave it no longer works!

“The law will apply to a standard form contract entered into or renewed on or after 12 November 2016, where:

• it is for the supply of goods or services or the sale or grant of an interest in land
• at least one of the parties is a small business (employs less than 20 people, including casual employees employed on a regular and systematic basis)
• the upfront price payable under the contract is no more than $300 000 or $1 million if the contract is for more than 12 months.

If a contract is varied on or after 12 November 2016, the law will apply to the varied terms.

Effect of having an unfair contract term

If a court or tribunal finds that a term is ‘unfair’, the term will be void – this means it is not binding on the parties. The rest of the contract will continue to bind the parties to the extent it is capable of operating without the unfair term.”

Source: https://www.accc.gov.au/business/business-rights-protections/unfair-contract-terms

This new law will come into affect after 12th November 2016 and will affect all key contracts you have in your practice. For example – any service agreements with practitioners, supplier agreements or employment/contractor contracts you may have with your staff, including property leases.

We wish to advise our current suite of template contracts, which you can purchase from us meet the requirements of this new law and so will be unaffected. Any Health & Life template contract purchased prior to November 2015 need to be reviewed by your adviser. Please contact us for further information.

Clearly, the method of implementation of the agreement in your practice will make a difference as the implications of this new ruling goes beyond the words of the contract.

Please consult your adviser or us for further information. Note we are not lawyers. We do sell healthcare industry specific template contracts for employees, providers and leases.

Please seek independent legal advice before acting on any advice or templates.

New laws when employing a health professional

New laws when employing a health professional: Practices must do a background check!

Be aware of the Australian Health Provider Regulation Agency (AHPRA) laws in relation to hiring a health professional. For the benefit of your practice, it is important you do the relevant background checks and make them a standard part of your recruitment process when employing staff or arranging new contracts with contractors or associates.

See: AHPRA Obligations for employers.

New Pathology Pain: Warning for GP Practices: There is a price for certainty!

New Pathology Pain: Warning for GP Practices: There is a price for certainty!

Practices are on notice. In December 2015, the Senate proposed dramatic changes to reduce patient pathology and radiology rebates. These were announced by the Government late last year. We advise our pathology and radiology related clients that these changes in government policy may result in early pathology lease termination clauses based on “uneconomic” or “unviable” arrangements.

An uneconomic or commerciality viability clause really means that a private pathology collection centre can terminate with 90 days or less notice if the lease is found to be not commercially viable. Many practices have one of these arrangements and clauses in place.

Such a lease condition can put severe pressure on patient gaps. Private pathology providers are also being forced to reassess the viability of their pathology rentals for Approved Collection Centres that may be situated in your practice. Allegations of collusion by private pathology providers to counteract the fee drop are being suggested, and may be reported to the ACCC. Such allegations have been denied by the sector as patients face pressure to pay a gap for any previously bulk billed services by private operators. See: 2015 December Changes to Bulk Billing Incentives.

So are the good old days of market value rents for pathology over? Yes and no.

Short Term Rent

Unless they have some special buying power, many practices will face decreased rents. Smaller practices may find their leases become prematurely cancelled as the industry rationalises the number of collection centres. It is interesting to note that the Federal Government recently refused to entertain pathology lobby groups that targeted re-defining a lower market rental for collection centres. So the free market argument prevails. In fact, we have seen higher pathology rent offers in recent months.

For those of you that follow David Dahm and Health & Life, you would know we have had a colourful and successful history in the national media in relation to what a fair market rent is and when a kick back is a kick back (see: History of Pathology market rules in the national media).

We assure you that nothing we suggest is unethical or against the law. It is simply normal commercial practice.

kick back

If the changes are approved in June by the Senate, then you may find at short notice (less than 90 days) that your collection laboratory could terminate their lease with you because they deem the arrangement is no longer viable. Check your lease to be sure.

We have always questioned the wisdom and legality of such clauses, as it may directly or indirectly force practice provider referrals to the pathology provider. This is not legal or in spirit of the law and means you could risk being the subject of an investigation that may involve losing your Medicare provider number or receiving a severe fine.

For this reason, we have never agreed to such terms – no matter how well intended the largest listed company is. Just because the Government has approved the lease, does not mean it has passed statutory law. Much like lodging a tax return, it is only correct if you pass a random audit and it is hard to deny something if your signature is on it.

Practices need to be wary of advisers who overlook the Heath Insurance Act and do not specialise in the correct field because unfortunately ignorance of the law is not an excuse. Be careful and seek independent advice. Advice from people such as a pathology laboratory’s lawyer is not independent.

23DZZIF “Meaning of permitted benefit

“Exclusions

(7) However, the benefit (in relation to rent) is not a permitted benefit if:

       (a) the benefit is related to the number, kind or value of requests for pathology services or          diagnostic imaging services made by the requester; or ..”

“(8) To avoid doubt, a benefit is related to the number of requests for pathology services or diagnostic imaging services made by a requester if the provision of the benefit is dependent on the requester requesting all, or a proportion of, the requests for one or more kinds of services that the requester makes from a particular provider.”

Source: Health Insurance Act 1973

HEALTH INSURANCE AMENDMENT (INAPPROPRIATE AND PROHIBITED PRACTICES AND OTHER MEASURES) ACT 2007 (NO. 88, 2007) – SCHEDULE 1

http://www5.austlii.edu.au/au/legis/cth/num_act/hiaappaoma2007756/sch1.html

Source: http://www.aph.gov.au/binaries/library/pubs/bd/2006-07/07bd136.pdf

If you are not a Health & Life client and we did not negotiate your lease with our pathology leasing templates, we understand many providers claim this is the “industry norm” and the HIC have “approved” such early termination clauses! The reality is there is little truth in both statements.

Early Termination Claws

Our real concern is it only takes one complaint for a nationwide investigation to occur in any practice, especially if there has been industry collusion. This is something your medical defence does not cover a practice for. So it can be an expensive and time consuming experience.

If you are experiencing this sort of pressure, we specifically quote the legislation within this article so you can consult your advisers and choose the right course of action. Make sure you receive any opinions in writing as often we find clients . Verbal promises that do not count.

The good news is this is not an issue for our clients as we have spent time negotiating long term leases to avoid this problem. As a side note, you should always seek professional advice when negotiating or renewing leases especially when they pressure you to sign.

It is only fair to assume that if you are going to borrow big money to expand your clinic, it may take up to 25 years to pay it off. So you would not invest unless you knew you would receive a good rental return on your investment. The pathology laboratories collect a good return as you expand. It is a win-win.

For those of you who have not removed the early termination clause, this sort of notice may come as a surprise and it should. After all, you cannot rent a home and give less than 90 days notice to leave without penalty. The same should apply to any commercial lease arrangement. We would question whether it was a fair contract from the outset.

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It is difficult to do anything this late in the game other than give us a confidential call. We are happy to review whether you have a problem without obligation and give advice as to what you should do next. This would also include making sure you are obtaining a fair market rent with fair terms and conditions on your lease. We can offer you peace of mind.

The good news is we have national buying power and may be able to help you.

Regardless of whether the Senate passes the new pathology reimbursement changes, you should ensure as a minimum these uneconomic early termination clauses are removed from your signed leases. This will keep the bank and your practice happy. There is a possibility that the ACCC may prohibit such a clause as being an unfair term commencing from the 12th November 2016 (see article 6 below: Do you use standard contracts/agreements in your practice?: Are they legally binding? New ACCC Law 2016)

For Practices new to Health & Life, contact David Dahm at pa@healhandlife.com.au for a no obligation and confidential chat about your lease should you have any concerns.

Got a spare appointment Doc? New immunisation law – no jab no pay from 1 January 2016 plus more!

Got a spare appointment Doc?

New immunisation law – no jab no pay from 1 January 2016 plus more!

The financial incentive for your children to get an immunisation jab is on. It may improve your health and wealth. We always believe in empowering patients to have freedom of choice through education. This is a personal family decision that you should discuss with your GP.

If your child does not undergo a Health Check, your family tax payment benefit could be affected.

It is now law that families can lose their family benefit payments from the Government if their children are not immunised. Practices should remind patients by email, websites, newsletters, waiting room signage and by phone when making appointments. In addition to this, a number of other new important initiatives have come into effect in the New Year. See the article below for more information that could affect your lifestyle:

http://www.news.com.au/lifestyle/real-life/the-new-laws-that-come-into-effect-in-2016-around-australia/news-story/d1c8d62202b041d3614a3d252fd049dc

Your Private Medical Condition Exposed?! A $20 solution!

Your Private Medical Condition Exposed?!
A $20 solution!

Did you know the Government will pay cash to your GP for your personal medical records without having to ask you?! This is now legal. Your local GP could lose up to $50,000 each year if they do not comply. Did you know over 60 Government agencies want access to your medical records without a search warrant?  How do you feel about this? We have a simple solution. Would you pay a small fee to stop Government access to your medical records?
Have your say join vote in our national poll.
[polldaddy poll=9301145]

Would you pay to not have your medical records shared with the Government?

The Federal Governments E-health record has few fans see https://www.healthandlife.com.au/wp-content/uploads/2016/02/E-health-records-have-few-fans-study-confirms.pdf.

They are also considering allowing the over 60 agencies to search your medical records without a search warrant is concerning see Here’s Every Australian Government Agency That Wants Your Data ,Gizmodo,18th January 2016

This issue is a moral, ethical and legal one. We believe that it is ultimately for you, the patient, to decide who has access to your confidential medical records. What are the key things you need to think about, so that you can make an informed decision and stay in control of your health care?

Lock Medical Record

You may or may not be aware that the Federal Government is asking practices to upload your private medical information so it can be shared in a secure Government IT system. This is called My Health Record. Many significant privacy concerns remain see Significant privacy concerns’ over myHealth Record system SMH October 2015.

Our primary concern is patient consent. Are practices being urgently coerced to upload your private medical records without fully considering the medico-legal and financial implications of doing so? Practices risk losing up to $50,000 in a Government grant each year if they do not comply by uploading a certain number of records to My Health. For patients, this means that you may be forced to pay more next time you see the doctor.

What you may not realise is that laws have just been passed in November 2015 where you need to opt out in order to protect your medical records from being uploaded to My Health Record. This means you may automatically have already been opted in and therefore the Government has access to your medical records. Are you happy with this?

In this edition, we explore this issue so you can start to make an informed decision about how your medical records are handled by your medical practitioner.

A real life scenario: What would you do? A MAJOR legal and ethical dilemma!

This is based on a true story. One Friday night, at Health and Life we took a call from a doctor at his practice. He was desperately looking for advice on what to write on his patient record.

caught-cheating

He had just seen a patient who did not want their identity to be written on his medical record. Why? The patient had been drinking and went home with a person that was not their married partner. The patient had contracted a sexually transmitted disease that night. The patient did not want the spouse to find out.

The doctor was asked not write down the patient’s name and the patient wanted some details modified on the record. Medicare would have not paid him for not keeping appropriate records. To the contrary, recording the patient’s name would have breached the patient’s privacy and the doctor risked being sued. The patient feared if this information got into the wrong hands it would result in a divorce.

We believe it is always better to ask the right questions than seek the right answers. Maybe the following questions you could put in writing or share (you have our permission) to your doctor, insurer, employer, lawyer, patient, Local MP or the Government for a written response. Let us know how you go!

Get the right Question and Answers

What would you do?

• Do you deny the patient care?
• Would you allow them to continue to reinfect other people?
• Do you do what the patient requests and just not get paid? Is this realistic if you are running a sexual health clinic?
• Do you mask the record to protect everyone so the person will continue to trust their doctor and seek treatment?
• What is the risk that another doctor may misunderstand the clinical notes?
• Is this worth the risk of running foul with Medicare?
• What do you do if someone demands this information such as a spouse, a lawyer, an insurance company or the Government?
• How do you protect the patient and the practice from legal claims?
• How do you continue to practice without fear?
• Is it worth the risk, given you cannot undo a privacy breach?
• Does sharing electronic medical records do more harm than good?
• Is there a better way? (Hint: we believe that there is, see the bottom of this article)

Pointless

As you can tell, Ashley Madison breach aside, this is more than just an IT hacking issue. The complexity of the problem is compounded by how practitioners keep “meaningful” and detailed medical records, which have contextual meaning.

Sharing medical records with anyone without patient consent and due process is fraught with danger, no matter who you are. As you will see, it only takes one moment to make a decision with lasting consequences for the lives of your patients.

However, the greatest damage of all is a loss of trust and complete lack of confidence in the healthcare system and in you, their healthcare advisor. Regaining trust is a fallacy, lost trust is never gained back.

The sharing of medical records without patient consent has huge implications, especially if it stops people wanting to visit their doctor and share their most intimate details so that they get the right care at the right time.

Losing trust

1.0 You, the Patient – Some things to seriously consider:

1.1 Why does the Government urgently want this?

Improves Healthcare Services and Reduces Waste

Like all good well intended ideas, they are great but the devil is in the detail. How you engage people makes the difference.
The holy grail for a patient, the provider and the Government is a centralised medical records system that is timely, accurate and accessible to all of your healthcare providers at an instant. Ideally, this is the cornerstone of an efficient and effective healthcare system. It would save billions for you, the tax payer, by reducing waste and avoiding duplication and unnecessary services and processes. A centralised system would be more open and transparent. This means that the system would be more accountable to everyone Patient Controlled Medical Recordwho uses it, including the patient. Ultimately, predictions are that this will dramatically improve your health outcomes.

Ideally, you could enjoy elimination of the need to repeat yourself next time you are at the doctor, whether it is your usual GP or a different doctor or healthcare professional.

In reality, this is unlikely. Why? People’s circumstances change daily, and the doctor and the practice will need to continue to revalidate this information, albeit to a lesser extent i.e. it would reduce the re-keying of basic data about you. The system would also save on duplication and errors. We note that there is merit in the concept. However, the reality is that records are only as good as the authors who keep them up to date. Building trust in the system will take a long time.

Health budgetOver the last 11 years, the Government has spent 2 billion dollars on the My Health Record system, and it is yet to be nationally rolled out. Furthermore, healthcare costs Australians 160 billion dollars a year. It grows by 10 billion dollars a year. It is clear that our economy can not sustain such an annual increase in costs. There is enormous pressure on the Government to decrease healthcare spending, as well as improve the quality and access to care – or they may lose the next election on a very emotive election issue.

Ultimately, we need to have a sustainable healthcare system. This requires openness, transparency and accountability. This is a big undertaking.

The My Health Record project is seen as key tool to solving this problem.

1.2 “Trust Me” – If the White House Security cannot get it right, who and what systems can you trust?

“Trust me” glossy statements or advertising without accountability and responsibility can be bad for your health and wealth.

Breach of privacy

Besides being of benefit for lawyers, you cannot insure for a loss of reputation once trust is broken. At the end of the day, it is the Practice’s fault and you cannot blame anyone else, especially if you read the Government Disclaimer:

Governement Privacy Disclaimer

Source: Myhealthrecord.gov.au

When you have one new and big system that many people do not understand, it is a baby elephant and a juicy target for hackers and identity thieves. As a very senior health bureaucrat once told us “Where there is confusion, there is always opportunity”. Medical records are a gold mine for hackers and blackmailers. No organisation is immune to rogue employees despite the fines and jail terms on offer, the payoffs may be perceived to be greater than the penalties.

There are multiple examples of Government staff who have had unauthorised access to people’s records and hackers who have successfully hacked the White House in the last year. There is no super safe system. Even our Tax Office, after many decades, has not got it right. Can we believe that after 5 years, the Health Department has?

Medical records

It will take a lot more public consultation and education before we all hit the “trust me” button.

If the White House cannot get it right who can you trust? For more information about how serious this issue really is, see the following articles:

1. How the U.S. thinks Russians hacked the White House ,CNN, April 8th 2015

2. AMA 8 Reasons to avoid the latest e-health record system , 6 minutes, 15th October 2015

3. Taxpayer records exposed by serious ATO, myGov security flaw ,SMH, 19th November 2015

4. Here’s Every Australian Government Agency That Wants Your Data ,Gizmodo,18th January 2016

It is still early in the development process. We remain supportive of an electronic medical record health system, despite these highlighted challenges, that to our knowledge no country to date has fully overcome.

1.3 Ah Sorry: You need my permission (or get used to paying more to see a GP!)

financial-worry1This new Government policy for practices to meet “upload targets” is causing enormous financial pressure on doctors and practices to meet these targets. Recent national media announcements reveal these Government sanctioned upload targets.

1. GPs must upload PCEHR Summaries , Australian Doctor, 13th January 2016
2. New EPIP Rules ripe for Gaming ,Medical Observer, 15th January 2016

What we find most disturbing is a Government spokesman stating in the media

“the eligibility requirements could be met by one GP uploading the required number of shared health summaries per quarter on behalf of a whole practice”.

Source: New EPIP Rules ripe for Gaming Medical Observer 15th January 2016

With the above suggestion, as lay people, we are not sure how a Practice can ensure consent, as well as complying with the “meaningful uploads” quota. This would be in breach of the new Government grants (e-Pip ) rules and do more harm than good. It would be easy for the Government to ask practices to pay the money back via a Medicare Audit. It would probably be an automated process, which would be easy to dispute, open to interpretation and embarrassing to argue. There are no clear, generally accepted, professional body endorsed National Medical Health Research (NHMRC) reviewed guidelines on what constitutes meaningfulness in a medical record. Therefore, this is yet another subjective exercise. For our solution on how such a challenge could be overcome, see Doctors are set up to fail – The evidence so far.

Get used to paying more to see a GP!

Man-and-woman-looking-at-bills-563138

Currently, there is a Government-sanctioned 4 year Medicare Freeze . This is also putting extreme financial pressure on doctors and Practices to upload your private medical records.

Can you imagine if you were not going to get a pay increase in 4 years while the cost of petrol and food keeps increasing? I can understand how my GP is feeling!

At your local GP, wage and other practice costs are going up far in excess of the Medicare rebate. Your GP cannot keep squeezing in more patients in a day to cover this shortfall whilst maintaining a high quality of care. Ultimately, such a strategy could result in your GP making a mistake on your health or burning out and quitting the profession. Ultimately, something will have to give, and solutions will need to be implemented to prevent these scenarios occurring.

Prioritise your financesOne clear solution is that you will have to start paying more to see your doctor. You will have to make you health a priority and budget for it like you do for food, petrol, alcohol and cigarettes.

In the meantime, do not be surprised if your medical records have been uploaded by your doctor without them formally seeking your written consent. Many practices are not aware of the issues raised in this edition because the Government has told them it is law and it is OK to trust them. The majority of GPs and Practices are not naïve, but it is not clear what they should do next.

So bring this edition to their attention.

If you want to see if your information has been uploaded, check the Government’s My Health Record website for more information or ask your GP.

Consent is King

informed consent
On the 22nd November 2015, the Federal Parliament passed a bill that allowed for automatic opting in of your medical records so the Government could have access to your records without requiring your consent:

See Health Legislation Amendment (eHealth) Bill 2015

To the contrary, we believe your written consent is king. At the very least, awareness of the scope of information that is being kept and how that information will be used should be communicated to you before such an action is undertaken. Remember, this program is new to the nation. There will be trials and errors, as they are inevitable. The Government accepts this.

How will your data be handled?

patient_records_tug_war_250x188
We believe that the Privacy and Security section at Myhealthrecord.gov.au is mandatory reading for all patients, providers and Practices. If you are satisfied with the Privacy and Security statement on Myhealthrecord.gov.au then you will be in the position to make a more informed decision on if you should opt in or out of the Government’s My Health program. We recommend you write or email your GP/Practice whether you opt in or out as a precautionary measure.

This should be a personal choice. You should feel free to choose without any undue coercion or bias.

Legally your Permission is not needed to provide your data to certain third parties

Willy wonka Disclaimer contract

Source: Willy Wonka

In an “emergency” an authorised person can have “temporary access”. We are not sure what that means or involves.

As a side note, from the last time we read the Practice data contracts with the Government, there was nothing stopping your medical data being copyrighted, on sold or used in a manner that required your consent. There are many good reasons for doing this for research, teaching and quality assurance purposes. Some commentators have said the contracts read more like a terms and conditions of use by Facebook or Google, all care but no responsibility. Legal experts have claimed this can expose the practice to liability claims.

It is also important to be mindful your information can end up elsewhere for unknown reasons. So be careful about what information you allow to be entered on the website. This is the best and only way to protect yourself if you are unsure.

2.0 Doctor and the Practice – Some things to seriously consider

General Practice Liability and Viability
Risk v return
There are four key things that Practices need to consider:

1. Can you protect yourself from liability and Medicare audits
2. Loss of patient trust and respect
3. Loss of E-PIP: up to $50,000 pa
4. A simple solution is to let your patient decide: offer a $20 annual non-upload privacy fee?!

1. Can you protect yourself from liability and Medicare audits

litigation_dispute
The simple answer is no. If you are unsure, simply put in writing the issues that we have raised to your lawyer or malpractice insurance company and you will find that there will be many disclaimers and qualifications. This means there will be loopholes in any policies and or advice. This change is unprecedented. It will not pass the sleep well test. Our best advice is to protect your personal assets like the family home, the practice and investments. Hint: 9/10th of the law is possession. It is a legal system and not a justice system that is reliant on deep pockets. There are ways to legally protect your assets and the Practice assets. Contact your adviser or us and get it right.

Expect doctor’s insurance companies to sue their Practices for any breaches. This environment is set up for a blame game. So ensure your service and contractor agreements are up to date. Practices can purchase templates from us.

Get it in writingPlease do not believe empty insurance policy promises. Everybody is going to try and sell you something. Read the fine print. Relying on verbal advice is a waste of time. If anything, encourage your children to become an electronic medical record lawyer or expert. Without clearer mandates and roles and responsibilities, this will become a boom industry.

Medicare Audits

1.-medicare-card-coins-generic-data.Remember, once the Government has access to any information, this provides them with evidence for a Medicare investigation. Medicare investigations can and usually occur when there is evidence. You automatically waive your right to self incrimination once you bill Medicare. Medicare cannot review your work from a clinical point of view. They can only look at the administrative component of the records. However, they can refer any concerns to the Australian Health Practitioner Regulation Agency (AHPRA). This agency can prosecute and/or de-register a practitioner without evidence. A poorly documented medical record can easily trigger such an outcome.

For more information, read our article Doctors are set up to fail – The evidence so far.

We have, over the last two and a half decades expressed concern about how intimidating a Medicare audit is and have questioned how they will data mine Practice databases. See this 10 minute video https://www.youtube.com/watch?v=M-n5Q7MnL0E

We are happy to be challenged on any of these points. A simpler and better solution is forming a strategic view on how to handle this issue.

2. Loss of patient trust and respect

respect-and-trust-the-two-easiest-things-in-life-for-someone-to-lose-and-the-hardest-things-to-get-back
Despite the warm and fuzzy reassurances of professional associations, the Government and anyone else who is being paid to encourage a doctor or a Practice to use e-health, ultimately you are liable to your patient. None of these people have this responsibility and nor can this be avoided. There may a case for contributory negligence. The sobering reality is it is not fun getting sued. It hurts when somebody says you are not competent. You may then second guess yourself.

People suing a Practice extends beyond clinical mistakes. Administrative mistakes can also kill a person. A privacy breach may lead to a patient suicide.

Being sued destroys staff morale and clinical confidence. If it hits the media, patient numbers will decrease and your existing patients may start to second guess you. This is a horrible way to work as nobody sleeps well at night. Most importantly, it is next to impossible to win back the trust and respect of your patient. The patient will tell their friends and portray that you are unprofessional. It takes decades to build a great reputation. It takes seconds to destroy it. Can you afford to risk your reputation?

It is important to take each patient along with you for this journey and never assume they gave you permission. You cannot undo a breach of trust and it starts by asking them.

3. Loss of E-PIP up to $50,000 per annum

A GP Practice could lose up to $50,000 p.a. if it does not upload a set number of patient records to the new My Health Government patient electronic health record system.

If your practice does not comply, then you may be forced to charge larger patient gaps as practice overheads continue to increase and Government support for your Practice continues to decline.

The NEW E-PIP RULES

EPiP

From 1 May, General Practices will be required to upload a Shared Health Summary (SHS) to the My Health Record system for 0.5% of the practice’s standardised whole patient equivalent (SWPE) to be eligible for their payment. This contribution equates to about five shared health summaries per full-time equivalent GP per quarter.

The new payment structure based on SWPE will take effect from the May-July 2016 reference period for the August 2016 payment quarter.

This equates to about five shared health summaries per full-time equivalent GP per quarter, or for a practice with five full-time equivalent GPs, it would equate to 25 uploads per quarter at $500 per record.

This proposal is subject to further consultation with the general practice community.

Source:

1. https://www.servicesaustralia.gov.au/organisations/health-professionals/services/medicare/practice-incentives-program/how-apply

2. http://www.pulseitmagazine.com.au/australian-ehealth/2845-eligibility-for-epip-will-require-uploads-to-my-health-record

Out of pocketThe practice has to seriously consider charging a larger gap. We have been running successful trials of a membership-fee style system to counteract this fall in income. Practices with high service standards will see an increase in income and will experience little patient resistance.

For larger practices, the loss of the E-PIP component is not significant compared to the costs and risks associated with compliance. We are not convinced yet that the E-PIP is worth the risk and investment when easier alternatives exist.

3. A Simple Solution – Let your patient decide – offer a $20 annual non-upload privacy fee?!

Good news kittenNow for some good news! A possible solution. So far we have been receiving great feedback from practices.

It is urgent that by May this year the practice agrees on a clear strategy as to whether they take the E-PIP or not. You could have your cake and eat it, too!

If patients chose to opt out, assuming the average GP has 1,100 patients, this would generate $20,000 p.a. Clearly, in a group practice of 5 full time doctors, this is greater than $50,000 p.a. You may find yourself better off than you think if you do the numbers and then you can continue to bulk bill disadvantaged patients. The key is about communicating this information to your patients on a timely basis.

So the solution is simple: let your patients decide. Empower them to make the decision about their medical records. The last thing a doctor or a Practice wants to be blamed for is the unintended consequences of a breach of privacy or trust with their patient. Putting this solution in place will help doctors dodge a legal and ethical dilemma and assist in providing affordable services.

Are you not better off offering patients a choice? After all is it not the patient’s decision? They will respect this.

the-freedom-to-choose-21-728

The answer is to offer patients a choice. Ensure you have full, informed consent and ask them to make their election in writing. This activity takes staff time and more paperwork.

The practice could start offering patients the freedom of choice to opt out of the system. A fee could be charged to stay out of the system.

To compensate and protect practices, the practice could engage in a patient education program. They could be offered a choice to participate or not to participate. An annual fee could be charged to each patient who elected not to participate.

waitingroom_1-1

1. At the front desk or online, each patient should be asked in writing, using a standard form, if they wish to stay in the My Health program. They should be adequately informed of any risks and benefits of participation. Use your messages on hold, waiting room wall posters and staff prompting at the time of the appointment to ask this question. Direct them to your website as to the Practice’s policy; alternatively

2. Offer to charge each patient $20 p.a. plus GST not to upload their medical record.
Where to from here?

Where to from here?

1. More public consultation is required – encourage patients need to speak up!

where-to-from-hereElectronic health records are possible, but appropriate, broad consultation is required to overcome many of the issues described above. We note that political expediency due to budget and election-related pressures can undermine even the best intended project. Any great idea needs to be developed with caution, especially when it affects all of us.

public debateWhat is done can not be undone. Encourage patients to speak up – send them this article and ask them to share it with their friends and politicians. There has been no public awareness campaign or debate on this issue. We need to start a grass roots dialogue.

Everybody must engage on this critical issue. It is not just for the doctor to solve. Patients must be at the front and centre of this engagement process. It is easy to underestimate those with less information than ourselves. Ultimately, patients will make an informed choice as long as they are empowered to choose by being provided with the information required to make that decision, in language that they understand.
2. Consent is King! – Patient written consent is necessary

Get it in writing
Trust me, without accountability and responsibility, the process is not properly implemented. Do not accept any answer as a good answer from your doctor, your practice or your Government unless you trust and verify any concerns you may have in writing. The same applies to doctors and Practices contemplating using the system.

For Practices, this is not about the money but about losing your reputation, which you cannot get back. It only takes one bad incident to hit the national media. Follow the correct process. Just because it is law, this does not make it right not to ask your Patient’s permission;

3. Consider alternatives? Plan now!

Act now

Consult your staff on a practice strategy like adopting ideas like offer a small fee not to upload a patients record as suggested in this article. Please consult your adviser before acting on them. Implement as soon as possible. Note the Government is currently running trials and will seek further consultation. Keep up to date on this issue by following us on Linked In and the local media, or simply contact us if you have any concerns at pa@healthandlife.com.au.

Is there a better way?

Consider using a snap chat virtual medical record. I will leave that to our budding entrepreneurs. 🙂

snapchat-logo-676x286There are more opportunities than problems in improving our precious healthcare system.

We all need to continue to work together to develop these well-intentioned ideas for the benefit of a more sustainable and socially responsible healthcare system. Contact us for more information at pa@healthandlife.com.au.

Congratulations: More clients making the RACGP National Awards!

Congratulations to Littlehampton Medical Centre and Inglis Medical Centre. They both feature in the latest national RACGP (Royal Australian College of General Practitioners) magazine. The RACGP each year recognises practices for their approach to patient’s health and wellbeing. The award criteria takes into account a number of factors, including services offered to patients, health promotion initiatives in place, provision of high-quality care to patients and involvement in general practice training.

NATIONAL WINNER was Collie River Valley Medical Centre (WA), with other state Winners Camp Hill Healthcare (Qld), Inglis Medical Centre (Vic), Littlehampton Medical Centre (SA), and Hornsby-Brooklyn GP Unit (NSW).

VICTORIA:
Inglis Medical Centre

Inglis Medical Centre

 

 

 

 

 

 

 

Inglis Medical Centre provides holistic quality family medical care to the community of Sale and its surrounds. Its passionate team covers a wide range of medical expertise from mental health, paediatrics, obstetrics, and women’s health to wound care, acupuncture, immunisation, and counselling. Purpose built in 2010, the centre is also a dedicated teaching practice with links with the University of Melbourne and Monash University.
https://www.healthandlife.com.au/wp-content/uploads/2016/01/Good-Practice-Inglis-Dec-2015.pdf

SOUTH AUSTRALIA:
Littlehampton Medical Centre

Littlehampton Medical Centre

 

 

 

 

 

 

 

Set in a small town in the Adelaide Hills, this practice is a state-of-the-art facility that was established three years ago. It offers a diverse range of multidisciplinary primary care from preventive services through to complex general practice procedural services such as obstetrics. The clinic’s implementation of modern staff management programs and investment in the adoption of the latest in online resources and technology also ensures continual innovation and improvement in the practice.

https://www.healthandlife.com.au/wp-content/uploads/2016/02/GP2016JanFeb-in-house-specialist.pdf

Source: AAPM Magazine December 2015