Soaring demand for after-hours GPs ‘open to abuse’
Growth in “urgent” after-hours home doctor visits has prompted a leading provider to call for greater monitoring to prevent operators ripping off Medicare or allowing patients to abuse the system.
The number of services — funded through higher than normal Medicare rebates and usually bulk-billed — has doubled in just four years, from 733,685 in 2010-2011 to 1,475,547 last financial year, when it cost Medicare about $200 million.
Non-urgent after-hours visits increased in the same period, albeit only to 310,948, whereas standard-hours home visits declined, from 1,288,377 to 1,176,724, continuing a downward trend.
While a commonwealth review last year found continued need for after-hours primary care, prompting Health Minister Sussan Ley to announce new funding mechanisms, growth in the sector has been noted.
GPs working in traditional practices are concerned that “rogue” operators might undermine the system, motivated by profit and willing to bend the rules by, for example, seeing patients during the day or dispensing sick certificates and hangover cures.
The head of one of the leading providers, National Home Doctor Service chief executive Ben Keneally, sought yesterday to reassure the sector of his company’s commitment to support general practice and take pressure off public hospital emergency departments.
Mr Keneally said urgent home visits were used mostly by young families and older patients — the official Medicare statistics show that 30 per cent of services in 2014-2015 were used by people aged 55 and older — and more than 60 per cent of calls to the triage hotline came from carers.
He said his service complied with Medicare rules — including those required to use registrars and overseas-trained doctors — and upgraded clinical guidelines where necessary, also providing strict protocols to prevent misuse by patients and to monitor repeat users.
“We’re concerned that despite many organisations being accredited in recent years there has been this proliferation of new, smaller services and it is not clear that they are actually complying with these requirements,” Mr Keneally said.
“We want to engage with the accreditation agencies and the department to ensure the continuity of care (between traditional GP clinics and after-hours providers) and quality in the sector.”
Mr Keneally said that about 2100 general practices had chosen the NHDS as their after-hours provider, with a combined commitment to care for patients, whereas other operators had not formed such relationships.
State governments have reported an increase in emergency department presentations but Mr Keneally suggested those were largely higher-priority patients, as the evidence showed after-hours home doctor visits had helped deal with demand from lower-priority patients. “About 40 per cent of patients who use a home visit service would otherwise have attended an (emergency department),” he said.
The rest might have gone to a late-night clinic, but typically included older patients or people with young children, for whom travel might be a problem.