National Health Reform Briefings – Questions taken on notice – Brisbane

• How are Medicare Locals funded by the Commonwealth and state/territory governments?
• What are the reporting requirements and reporting lines for Medicare Locals?
• What are the indicators, reporting requirements and measurements of general practice as a speciality against other disciplines of medicine?
• In regards to Medicare Locals, what arrangements are being put into place to inform the professions (doctors, pharmacists, physiotherapists and other allied health staff) as to what these bodies will actually and specifically do?
• What funding will Medicare Locals have?
• What will be the role of allied health within the Medicare Local structures?
• Will the focus of Medicare Locals be “doctor” centric?
• How are hospitals going to achieve targets without acting in the disinterest of patients?
• How will the issue of perverse incentives be policed and dealt with?
• With the introduction of Medicare Locals, is there an intent for the Medicare Locals to handle referrals to community based services or will this continue through local General Practitioners?
• Where are the nurses coming from to staff emergency departments and support elective surgery, given the nursing workforce shortage?
• With the new health registration processes, how will mental health nurses be registered and accredited?
• Will community controlled health services continue to receive funding from the Department of Health and Ageing or will they be funded through the Medicare Locals?
• Where is the review of Medical Benefits Scheme (MBS) items up to?
• Medical Benefits Scheme (MBS) items for General Practitioners are needed for advanced care plans and end of life procedures
• How will the public be informed of changes to the Medical Benefits Scheme (MBS)?

How are Medicare Locals funded by the Commonwealth and state/territory governments?

Medicare Locals will receive annual core funding from the Australian Government Department of Health and Ageing, via a funding agreement.

Medicare Locals will also be provided with funding to deliver individual programs (e.g. after hours primary health care). From July 2012, Medicare Locals will be provided with flexible local funding through the Australian Government’s Regionally Tailored Primary Health Care Initiatives through the Medicare Locals Fund.

Over time, the Fund will consolidate funding provided to Medicare Locals and other primary health care organisations for the delivery of a range of initiatives. The Fund will provide Medicare Locals with greater flexibility to respond to evolving priorities, as identified by Medicare Locals in conjunction with their local communities.

What are the reporting requirements and reporting lines for Medicare Locals?

Medicare Locals will be subject to, and contribute to, the broader performance monitoring and reporting requirements of National Health Reform. They will be subject to the performance monitoring and reporting requirements of the Performance and Accountability Framework as required in Schedule C of the National Health Reform Agreement 2011. This will provide Australians with information about the performance of their health and hospital services in a way that is both nationally consistent and locally relevant.

New reporting requirements will be centralised and standardised, focussing on achievement against performance standards. Healthy Communities Reports, to be published by the National Health Performance Authority (NHPA), will include performance assessments for each Medicare Local against service and financial reporting standards. Medicare Locals will be expected to adapt to, and comply with, this new reporting framework as it is finalised.

While the new performance reporting framework is being developed, Medicare Locals are required to submit the following reports to the Department of Health and Ageing:

• A Strategic Plan, covering a three year minimum period;
• Annual Plan and Budget specifying transition arrangements, program activities and associated budget allocation;
• Annual Report against the program objectives and outcomes;
• Six-monthly progress reports and information on health service activities; and
• Other reports as specified in the Funding Agreement for financial acquittal purposes.

What are the indicators, reporting requirements and measurements of general practice as a speciality against other disciplines of medicine?

Healthy Communities Reports, to be published by the National Health Performance Authority, will include performance assessments for each Medicare Local against service and financial reporting indicators which will focus on access to services, quality of service delivery, financial responsibility, patient outcomes and patient experience. These indicators are to be developed and agreed by the Council of Australian Governments.

The Healthy Communities Reports will also provide information to the public concerning GP and primary health care services and outcomes in the local community and region of each Medicare Local. Information within the Reports will include local demographics and health status, local services and health outcomes.

Additionally, the Commonwealth is developing a national strategic framework to set out agreed future policy directions and priority areas for GP and primary health care. This framework will be informed by bilateral work on state-specific plans for GP and primary health care with state-specific plans to be completed by July 2013.

In regards to Medicare Locals, what arrangements are being put into place to inform the professions (doctors, pharmacists, physiotherapists and other allied health staff) as to what these bodies will actually and specifically do?

At a national level, the main mechanism for informing medical professionals is via the yourHealth website, where the Medicare Locals guidelines and other current information relating to Medicare Locals can be found. Additionally, Medicare Locals will be expected to engage with health care service providers within their catchment. Medicare Locals will need to form strong linkages with primary health care providers in their area, and will take different approaches to consultation depending on the needs and circumstances of their community.

What funding will Medicare Locals have?

Medicare Locals will receive annual core funding from the Australian Government Department of Health and Ageing to cover the costs associated with operating a Medicare Local, and meeting its strategic objectives.

A total of $493 million has been allocated over four years, from 2010-11 to 2013-14, to establish and operate Medicare Locals. Once fully operational, annual core funding of approximately $171 million will be available for Medicare Locals.

Medicare Locals will also receive additional funding to deliver programs (for example after hours primary health care).

What will be the role of allied health within the Medicare Local structures?

Medicare Local governance arrangements should adequately reflect the Medicare Local catchment’s community and health care service providers within the area, as well as business and management expertise and have strong clinical leadership. The form of allied health engagement will reflect the local needs of individual Medicare Locals.

Will the focus of Medicare Locals be “doctor” centric?

While the Australian Government recognises the central role of general practitioners in primary health care, Medicare Locals will be expected to engage with the full range of primary health care providers in their community, such as general practitioners, physicians, pharmacists, practice nurses and allied health professionals.

Medicare Locals will be responsible for working collaboratively with these providers to ensure that primary health care works for the whole of the local population, including, for example, people with chronic illnesses who require health care and services from multiple providers.

How are hospitals going to achieve targets without acting in the disinterest of patients?

The Expert Panel consulted widely and has recommended the emergency and elective surgery targets that are now incorporated in the National Partnership Agreement on Improving Public Hospital Services (NPA). The Expert Panel emphasised strongly that achieving targets should not be put ahead of patient safety, and also recommended a range of Key Performance Indicators (KPIs) to monitor the safety of patients.

The Commonwealth is making available to states and territories over $1.5 billion to help achieve these targets.

How will the issue of perverse incentives be policed and dealt with?

The change of targets, especially in emergency departments, was recommended in part to minimise the potential perverse incentives under the National Partnership Agreement on Improving Public Hospital Services (NPA).

With the introduction of Medicare Locals, is there an intent for the Medicare Locals to handle referrals to community based services or will this continue through local General Practitioners?

Medicare Locals will not manage General Practitioners or instruct them to provide specific services, and fee for service arrangements through Medicare will continue. Medicare Locals will work collaboratively with General Practitioners and other primary health care service providers in their area in order to meet the primary health care needs of their communities.

Where are the nurses coming from to staff emergency departments and support elective surgery, given the nursing workforce shortage?

The Commonwealth is providing over $1.5 billion in the National Partnership Agreement on Improving Public Hospital Services (NPA). Under this NPA, states and territories determine the best use of these funds to achieve the outcomes of the NPA and meet local needs. Projects under this NPA can, and do, include allocating funding for staff for direct care provision.

The Australian Government is supporting nurses and nursing students through the Nursing and Allied Health Scholarship and Support Scheme (NAHSSS). The allocation of NAHSSS scholarships reflects the Australian Government’s priorities, with 320 scholarships available for nurses in emergency departments in 2012, as well scholarships for non-clinical emergency department support staff.

Additional scholarships will be available through the NAHSSS in 2012 for nurses and nursing students at the undergraduate and postgraduate levels, as well as for continuing professional activities and clinical placements.

With the new health registration processes, how will mental health nurses be registered and accredited?

Registration: Under the National Registration and Accreditation Scheme (NRAS), the Nursing and Midwifery Board of Australia (the Board) registers nurses with post-graduate mental health nursing qualifications in the general registration type.

For those nurses who hold a sole qualification in mental health nursing (i.e. who do not hold a general nursing pre-registration qualification), the Board registers them in the general registration type with the notation: solely qualified in the area of mental health nursing.

Accreditation: The Australian Nursing and Midwifery Accreditation Council (ANMAC) is responsible for accrediting nursing courses for the Board’s approval.

The mental health nursing programs that were accredited by previous state and territory nursing and midwifery boards were transitioned on 1 July 2010 onto the Board’s Approved Programs of Study for Nursing list. This is available on the Board’s website at: http://www.nursingmidwiferyboard.gov.au/Accreditation.aspx

Will community controlled health services continue to receive funding from the Department of Health and Ageing or will they be funded through the Medicare Locals?

Aboriginal Community Controlled Health Organisations (ACCHOs) will continue to receive separate and direct funding from the Australian Government to support the delivery of comprehensive primary health care services for Aboriginal and Torres Strait Islander peoples.

ACCHOs will also be able to access additional funding through Medicare Locals – for example, for the delivery of face-to-face after hours care.

Where is the review of Medical Benefits Scheme (MBS) items up to?

Medical Benefits Scheme (MBS) items are being reviewed to ensure that they reflect contemporary evidence and are safe, effective and appropriately used. This process is being tested by four demonstration reviews—colonoscopy, obesity surgery, pulmonary artery catheterisation (PAC), and whole-of-specialty review of ophthalmology services.

The process began with the development of review protocols, which were refined through a public consultation process, followed by fit-for-purpose evidence assessments in line with the agreed protocols. The assessments are provided in review reports, which are also going through a public consultation process before finalisation.

Any proposed MBS changes arising from the reviews will be assessed by the Medical Services Advisory Committee (MSAC) prior to consideration by the Government.

To date, the review reports for the obesity surgery and colonoscopy reviews that have undergone public consultation, and will be presented to the Evaluation Subcommittee (ESC) of MSAC in October 2011 before submission to MSAC itself in November 2011, or in the new year.

The PAC review report is nearing completion and the Department anticipates receiving the final report by the end of September 2011, with public consultation to commence shortly afterwards. The whole-of-specialty review of ophthalmology services is expected to be finalised next year, also following a public consultation process.

Further information on these reviews, including the review protocols and reports can be found at: http://www.health.gov.au/internet/main/publishing.nsf/Content/MBRTG-demonstration-reviews

Medical Benefits Scheme (MBS) items for General Practitioners are needed for advanced care plans and end of life procedures

The term 'advance care planning' refers to a process enabling a patient to express wishes about his or her future health care in consultation with their health care providers, family members and other important people in their lives.

Advance care planning is based on the ethical principle of patient autonomy and the legal doctrine of patient consent. Advance care planning helps to ensure that the concept of consent is respected if the patient becomes incapable of participating in treatment decisions.

More information is available at: http://www.racgp.org.au/guidelines/advancecareplans.

The issue of MBS items for advanced care planning has previously been considered by the Australian Government.

On 20 September 2007, the House of Representatives Standing Committee on Legal and Constitutional Affairs tabled its report entitled, Older People and the Law, on the adequacy of current legislative regimes in addressing the legal needs of older Australians in the following specific areas: fraud, financial abuse, general and enduring ‘power of attorney’ provisions, family agreements, barriers to older Australians accessing legal services, and discrimination.

More information is available at: http://www.aph.gov.au/house/committee/laca/olderpeople/report.htm).

Recommendation 23 from the Committee was for the Australian Government to include advance health care planning services provided by medical practitioners on the Medicare Benefits Schedule.

The Government’s response of 26 November 2009 did not accept this recommendation, outlining that Medicare Benefits are claimable only for ‘clinically relevant’ services rendered by an appropriate health practitioner. A ‘clinically relevant’ service is one which is generally accepted by the profession in question as necessary for the appropriate treatment of the patient. The Government’s response can be found at: http://www.ag.gov.au/www/agd/agd.nsf/Page/Publications_Governmentresponse-OlderPeopleandtheLaw

Where advance health care planning is part of consultations that are clinically relevant to an existing condition for which the medical practitioner is providing appropriate treatment, they are currently covered by the Medicare Benefits Schedule (MBS). In relation to older people, specifically, recognition of advance health care plans, is currently included under Geriatrician Referred Patient Assessment and Management Plan (MBS items 141–147).

Advance health care planning services may not be covered where they are general in nature or unrelated to a current course of treatment. Any change to this requirement would be a substantial change in the intent of the services covered by the MBS.

How will the public be informed of changes to the Medical Benefits Scheme (MBS)?

The Medical Benefits Scheme (MBS) Online contains the latest MBS information and is updated as changes to the MBS occur. Users can subscribe to electronically receive the latest news articles for MBS Online at: http://www.mbsonline.gov.au/.
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