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Health Bulletin (20 February 2019)

The latest insights from our Health Law team.

In this edition:

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Proposed changes to provision of Medicare funded services by nurses rejected by AMA

The Australian Medical Association Limited (AMA) has called on the Government to immediately reject draft proposals which would expand the ability of nurse practitioners to provide Medicare funded services and remove the current requirement for them to collaborate with doctors in delivering care for patients.

The Medicare Benefits Schedule (MBS) Review Nurse Practitioner Reference Group report (Report) proposed the changes arguing the current system to be inefficient and a ‘barrier to care’.

Under reforms introduced in 2010, nurse practitioners were first permitted to provide Medicare-funded services to patients. These reforms were carefully designed to prioritise patient care and patient access to a doctor. The Government had also introduced a legal requirement for nurse practitioners to work in collaborative arrangements with medical practitioners.

The AMA has stated that its recommendation to “remove the mandated requirement for nurse practitioners to form collaborative arrangements”, will encourage nurse practitioners to work in isolation of the medical profession. The AMA raised concerns that this will fragment patient care, delay access to treatment and increase costs to the health system overall.

Read the Report here and the AMA’s media release here.

Victims to have their say in forensic mental health cases

As a result of recent amendments to the Mental Health (Forensic Provisions) Act 1990 No. 10 (NSW), victims of forensic patients in NSW will now have a greater opportunity to be heard in the Mental Health Review Tribunal (Tribunal). 

The new legislative provisions came into force on 4 February 2019 and empower victims to make submissions to the Tribunal about the impact that a release or a grant of leave of absence would have on them. 

Read the updated Act here; in particular sections 74A, 74B and 76(2). 

In another move to support victims, the NSW State Government has established a new Specialist Victims Support Service (SVSS) specifically for victims of violence committed by forensic patients.  Sitting within Victims Services and acting on behalf of the Commissioner for Victims’ Rights, the SVSS team aims to provide support in 5 key areas:

  1. Early intervention;
  2. Crisis referral
  3. Planned support
  4. Communication and education; and
  5. Tribunal process support. 

Read more about the SVSS here.

AMA disappointed with mandatory reporting requirements

In a recent press release, the AMA expressed its disappointment at the decision of the Queensland Parliament Health, Communities, Disability Services, and Domestic and Family Violence Prevention Committee (the Committee) to pass proposed mandatory reporting laws for doctors treating other medical professionals for mental health issues. 

The AMA has long held the position that mandatory reporting laws need to be reformed to ensure that legislation does not actively discourage medical practitioners from seeking medical treatment when they need it.  The AMA recommended the Western Australian model, which exempts treating doctors from reporting their doctor patients, be adopted throughout Australia.

The Committee recommended passing the Health Practitioner Regulation National Law and Other Legislation Amendment Bill 2018 in its current form.  Under Council of Australian Governments (COAG) arrangements, once passed, the Queensland law will apply in all States and Territories except Western Australia.

The bill includes a higher threshold for mandatory reporting.  Under the proposed laws a mandatory report is only required if the practitioner-patient’s impairment reaches the threshold of substantial risk of harm.  However, according to the AMA, the bill effectively bars doctors from accessing the same level of health services their patients enjoy, for fear of potential repercussions.

Read the AMA’s response here.

Taskforce recommends time-tiered billing for specialists and consultant physicians

The Medicare Benefits Schedule Review Taskforce (Taskforce) has recommended that billing under the MBS be reviewed to better reflect the contemporary roles of specialists and consultant physicians. Under the proposed changes, a new simplified model of attendance items would be introduced – with the core change to set standard attendance schedule fees based on time.  The Taskforce considers that changing to this model would strengthen the capacity of consumers to give informed financial consent.

The Royal Australasian College of General Practitioners (RACGP) has welcomed the proposal saying it would deal with the “longstanding disparity between GPs, who have long had time-tiered attendances, and other specialists under the MBS”.

In particular, RACGP considers a change to time-tiered billing would reduce the number of unnecessary referrals between GPs and specialists as the incentive for engaging in initial consultations (which have a higher rebate attached) would be reduced.

Read the Taskforce report here. Read RACGP’s media release here.

Time critical defined transfer guidelines

The Department of Health & Human Services (DHHS) published guidelines for time critical defined transfers in Victoria (Guidelines) on 6 February 2019. The Guidelines have been published to safe guard patient care in circumstances where demand for critical care beds exceeds the immediate supply, leading to no ICU bed being immediately available for a critically ill patients requiring timely and appropriate investigations, interventions or ICU care.

The Guidelines outline the process to allow the Adult Retrieval Victoria (ARV) to nominate a hospital to receive critically ill patients. This is called a ‘defined transfer’ and reflects the time critical need for appropriate care for a critically ill or injured patient.

The Guidelines provide that the decision to authorise a defined transfer is at all times determined by the needs of the patient. Under the Guidelines, ARV may also refer to other factors when authorising a defined transfer, such as:

  1. the nature of the patient’s clinical condition;
  2. time critical defined transfer;
  3. the nature of the surgical or other intervention/s required by the patient; or
  4. the capability and capacity of the referring health service.

The Guidelines briefly outline the authorisation process that ARV must follow when a defined transfer process is required for a critically ill patient. The authorisation process includes an initiation of the process by the ARV Medical Coordinator, followed consultation and communication between the ARV Medical Coordinator, the referring and receiving Consultant clinicians.

Read more about the Guidelines here.

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