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Health Bulletin 14 November 2019

In this edition: Insurers’ push to fund GP visits, transparency in fees, telehealth improving remote access to doctors, medical and allied health practitioners payroll tax, Social Services Legislation Amendment, TGA sports supplement consultation

The latest insights from our Health Law team:

Concerns over insurers’ push to fund GP visits

More medical organisations commit to transparency in fees

Telehealth changes improve remote Australians’ access to a doctor

Medical and allied health practitioners may be liable for payroll tax on patient fees

Social Services Legislation Amendment (Drug Testing Trial) Bill 2019 

TGA sports supplement consultation

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Concerns over insurers’ push to fund GP visits

KPMG has released a report ‘Delivering healthcare services closer to home’, which looked at the role of community-based healthcare services around the world. 

The report found that moving away from hospitals and towards community-based preventative and primary care would lead to fewer complications, lower mortality rates, cost savings and better patient outcomes.

The report has led to private health insurers, led by NIB CEO and Managing Director Mark Fitzgibbon and Medibank Chief Executive Craig Drummond backing policy reforms that would allow health insurers to cover services outside hospitals that currently attract a Medicare benefit, such a visits to a General Practitioner.

I’ve found no policymakers who have yet been able to explain to me the policy logic for limiting our cover to hospital settings” Mr Fitzgibbon said.

The Australian Healthcare and Hospitals Association (AHHA) and the Australian Private Hospitals Association (APHA) expressed reservations about the move.

We do not support the recent suggestion by private health insurers to operate outside the hospital system to cover visits to GPs and Specialists… this would undermine our universal healthcare system we have with Medicare and raise fundamental issues of equity around who can access and afford to pay for their healthcare…” said acting AHHA Chief Executive Dr Linc Thurecht.

Acting APHA CEO Lucy Cheetham issued a warning that the proposed changes are a “money grab” and that any changes need to be in consumers’ best interest.

Federal Health Minister Greg Hunt indicated that he is open to considering new options for providing care in different settings that would benefit patients.

You can read more here, KPMG’s Report here, the AHHA’s statement here and the APHA’s release here.

 

 

More medical organisations commit to transparency in fees

The Australian Medical Association (AMA) has recently released a statement regarding the commitment of two additional medical organisations to the Informed Financial Consent: A Collaboration Between Doctors and Patients guide (Guide).

The Guide, released earlier this year by the Federal Government, provides patients with the information they need to help them understand medical costs and empowers them to discuss fees with their doctors and ask questions.

The signing up of the Royal Australasian College of Surgeons (RACS) and the Urological Society of Australia and New Zealand (USANZ) brings the total number of medical organisations partnering with the AMA on the Guide to 15.

The AMA President, Dr Tony Bartone, stated that the addition of RACS and USANZ sends a strong signal that the whole medical profession is committed to greater transparency in medical fees. 

A list of the medical organistions who have signed up to the Guide and the AMA’s media release can be found here.

Access the Guide and more information here.

 

 

Telehealth changes improve remote Australians’ access to a doctor

From 1 November 2019, general practitioners will be able to conduct medical consultations with patients in remoter areas via the new “GP telehealth” platform.

The product of a $45.5m investment by the Australian Government, the “GP telehealth” platform is aimed at providing Australians living in remoter communities with increased access to quality health services.

Patients eligible for consultations conducted through the “GP telehealth” platform may also claim rebates through the Medicare Benefits Scheme. To be eligible, a patient must:

  1. Live in an area categorised under the Department of Health’s “Modified Monash Model” as being “very remote” (category MM 6 or MM 7);
  2. Have an existing relationship with a GP who provides telehealth consultations; and
  3. Be at least 15km by road from such GP.

Mark Coulton, Minister for Regional Services, Decentralisation and Local Government, states in the Department of Health’s media statement that there are other telehealth programs that can also provide Australians living in remoter communities with access to psychologists, social workers and occupational therapists. He says extra telehealth support has also been provided to Australians in drought-affected areas.

Read the media statement here.

Read more about the "Modified Monash Model" here.

 

 

Medical and allied health practitioners may be liable for payroll tax on patient fees 

In the most recent chapter of the battle between the Victorian State Revenue Office and The Optical Superstore Pty Ltd (Optical Superstore), the Commissioner of State Revenue has claimed victory (Commissioner), with the Court of Appeal of the Supreme Court of Victoria finding on 12 September 2019 that transfers of funds made to optometrists by Optical Superstore were subject to payroll tax under Victorian law.

In this case, Optical Superstore entered into arrangements with optometrists working in its stores, either directly or via the optometrists’ companies or trusts, under which it was agreed that the optometrists’ entities would occupy consulting rooms at Optical Superstore’s premises, and perform eye tests for members of the public at the stores.

Under the terms of agreements between the parties, bulk billed Medicare fees and other fees charged by the optometrists to patients were collected by Optical Superstore, held on trust by it, and then partly reimbursed to the optometrists’ entities, after deduction by Optical Superstore of occupancy fees. The “reimbursement amounts” actually received by the optometrists’ entities were calculated by reference to hourly rates.

In the most recent appeal, the Court of Appeal unanimously held that a “payment” is made when monies beneficially owned by a beneficiary are provided to the beneficiary by a trustee.

The decision in Optical Superstore broadens the circumstances where payments will constitute “wages” for payroll tax purposes. It provides that distributions made under express trusts in circumstances where the moneys are already held beneficially by the recipient will be considered “wages” for payroll tax purposes.

This is an important case for medical practices and similar allied health clinics, as it confirms that a practice which derives patient fees and pays the professionals a wage would be subject to payroll tax on those wages.

Read more about the Optical Superstore case here.

 

 

Social Services Legislation Amendment (Drug Testing Trial) Bill 2019

The Social Services Legislation Amendment (Drug Testing Trial) Bill 2019 (the Bill) amends the Social Security Act 1991 (Cth) and Social Security (Administration) Act 1999 (Cth) to establish a two year mandatory drug testing trial in three regions across New South Wales, Queensland and Western Australia for 5,000 randomly selected new recipients of newstart allowance and youth allowance.

The rationale behind the Bill is to improve education and employment prospects by identifying and assisting persons with drug use issues. The drug testing would be managed by Services Australia (formerly the Department of Human Services), using contracted third party drug testing providers.

The Australian Human Rights Commission (AHRC) made a submission to the Senate Community Affairs Legislation Committee outlining its concerns about the potentially damaging impacts the legislation, if passed, would have on the financial security and human rights of participants.

The AHRC noted that the people who would be captured by the reform included some of the most vulnerable Australians including young welfare recipients, Aboriginal and Torres Strait Islander peoples and people with a drug dependency that constitutes a disability.

The Bill is currently before the Senate and you can read it in full here.

 

 

TGA sports supplement consultation

The Therapeutic Goods Administration (TGA) has opened consultation with the public on a proposal regarding the advertisement of sports supplements.

The TGA wants to resolve uncertainty around the regulatory status of sports supplements to ensure that they are advertised, presented and supplied in a way that will ensure public health and safety. Sports supplements are often advertised as having therapeutic value, though many are legally considered mere food items. 

The draft order (Therapeutic Goods (Declared Goods) Order 2020) released by the TGA proposes that certain goods are declared to be therapeutic goods. Such goods are those which contain or are represented to contain prescribed substances, and when advertised, represent that they will provide a therapeutic benefit, including:

  • gaining muscle;
  • increasing stamina;
  • losing weight or fat; or
  • preparing or recovering from a workout.

The TGA proposes that if supplements are advertised in a way which suggests therapeutic use, then they should be subject to the stricter controls, including licensing, manufacturing, supply and advertising, imposed by the TGA.

Currently, some sports supplements are excluded from the Australian Register of Therapeutic Goods because they are subject to a relevant standard under the Food Standards Australia New Zealand Act 1991

For more information, you can read the consultation documents here. Provide your submission to the consultation here.

 

 

Learn more about Russell Kennedy's expertise in the Health sector here.

If you'd like to stay up to date with Russell Kennedy's insights, please sign up here.

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