Calling time on the referral pinball rort

4 minute read

The RACGP supports the MBS taskforce over its proposed restructuring of specialists' fees

Time-tiered attendance fees should replace the “initial” and “subsequent” attendance items that specialists frequently abuse, wasting GP and patient time, the RACGP says.

In fact, College President Dr Harry Nespolon says GPs should not be so hasty to refer patients onwards, since GPs are capable of managing many conditions without specialist involvement.

The practice of pinging a patient back to their GP for another referral so that the specialist may claim an initial attendance fee, which is worth 30-50% more than a subsequent attendance fee, has long annoyed both GPs and their patients.

The committee reviewing specialist fees for the MBS Review Taskforce, which reported in December, looked at the issue of repeated GP referrals at the specific request of Federal Health Minister Greg Hunt.

“In 2016-17, 229,511 repeat initial attendances occurred between the same patient and provider within nine months of another ‘initial’ attendance,” the report of the Specialist and Consultant Physician Consultation Clinical Committee says. “Consumer complaints regarding charges for repeat initial attendances are common.”

The RACGP has responded to the committee report, supporting its recommendation that time-tiered attendances for specialists mirror those currently in general practice.

“It is incredibly annoying to have to write another referral to a specialist when you’ve already sent them an indefinite referral,” Dr Nespolon told Rheumatology Republic.

“GPs have been complaining about it for a very long time. It’s a waste of our time and the patient’s time. We’d support anything that stops those shenanigans.”

He said that GPs should carefully consider whether the patient needed a referral to a specialist in the first place.

“It’s like Coles saying, why don’t you go down to Woolworths and shop there? There are lots of things GPs can do, as well as lots of things they can’t do, and GPs should really be trying to keep patients in their practice.

“I once heard of a practice that said if anyone had two cardiovascular risk factors they should be referred to a cardiologist. I was flabbergasted.

“It depends where you are in your training – younger doctors understandably will refer more often than more experienced doctors. But GPs do have the skills to manage lots of chronic conditions and they should be managing them.

“No, I can’t do a hip replacement. But should I be able to manage their blood pressure and cholesterol? Of course.

“Specialists charge a lot, so it’s disappointing to have a patient come back and say ‘I didn’t understand what he said’, or ‘I was in and out in five minutes’. So that’s another area where GPs might consider whom they refer to.”

There is also the question of terminology, and whether it contributes to the perception that GPs are somehow less trained or qualified than specialist physicians.

The committee takes issue with the 50-year-old distinction between specialists and consultant physicians, the latter being fellows of the RACP whose practice consists of longer and more “cognitively complex” consultations, rather than procedures.

In its response, the RACGP objects to the term specialist when it is used to exclude GPs, which it says probably contributes to “the undervalued role of GPs within the MBS and the perception that GPs are not specialists”. It proposes the term consultant instead.

But Dr Nespolon said specialists were specialists, and it was up to GPs to market themselves better.

“A lot of people don’t understand what it takes to become a GP. We use the term specialist general practitioner, that’s what we are. The issue is about the way we market ourselves – which we’re trying to do, despite the criticisms,” he said, referring to the “Your specialist in life” campaign.

“But that’s going to be a perennial issue.”

The committee report also recommends scrapping 10 complex plan items from the MBS, which it says are claimed inappropriately. The committee says 41% of patients with complex plans do not visit their referring practitioner in the next six months, “which suggests that care has not been appropriately handed over”.

Specialists should build upon a General Practice Management Plan, where one is in place, rather than creating their own standalone plan, it says.

“Access to specialists is quite restricted, and often a patient’s problems are multidimensional, so it seems appropriate that the person doing the care plan should be the GP,” Dr Nespolon said.

“GPs are set up to do it, I’m not sure the neurologist is set up to do a care plan.”

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