1. LEGISLATION: Mandate to allow doctors to charge a gap fee only on top of a bulk-billed consultation.
2. TIME: Look to relative value of time. Have equally weighted six-minute time slots — six, 12, 18 minutes and so on. This recognises some quality medicine can occur in six minutes, but this is not unduly rewarded at the expense of longer appointments.
3. PBS: Abolish the PBS authority hotline and develop a schedule of payment for Centrelink and other reports (possibly paid by government, not Medicare). Introduce doctor shopper alerts/registration as per Tasmanian model for drugs of addiction.
4. GANFYDs (acronym for Get A Note From Your Doctor): Ensure employers pay for GANFYDs or allow self-certification.
5. REFERRALS: Make them valid for 24 months or longer, and aggressively chase those specialists who ask for a routine ‘new’ consult every 12 months and charge higher fees. No repeat ‘new’ referrals for the same old problem.
6. PRACTICE NURSE SUPPORT: More funding for practice nurses.
7. MEDICAL HOME REWARD: Providing an incentive for continuity of care for chronic health conditions but a voluntary one and not capitation (perhaps a higher rebate for the patient).
8. ALLIED HEALTH: Direct referral to allied health for eligible patients.
9. NON-PATIENT CONTACT TIME: Reward for hours spent in following up patient requirements, paperwork and information sharing.
10. NON-GP DOMAINS: Much of the needed savings could be found elsewhere in the healthcare sector.
11. Co-payments for all non-concessional patients.
12. No reduction in GP rebates and no freeze. General practice needs more support, not less, to keep patients well and out of expensive hospital care.
13. Introduce a dedicated item number for all patients aged 60 and over, or with a terminal illness, to do an advance care directive with legal backup to protect the patients with terminal illness from futile treatments. This would save a lot of money.
14. Negotiate cost of generics down to match New Zealand and UK prices.
15. When ordering radiology/pathology, multiple doctors involved in care should include copies to all treating doctors to avoid expensive duplication.
16. Remove non-evidence-based treatments from Medicare and private health funding.
17. INCREASE the Medicare levy by another 0.5%. It was recently increased from 1.5% to
18. Also, save another $500 million by getting rid of care plans and simply substitute an ordinary referral to the same allied health personnel as you would to a specialist under tighter guidelines for chronic diseases. Get paid Item 23 instead of the inflated payments for a template that is usually filled in by a nurse and contains less useful information than a well-written referral.
19. CONTINUE to bulk-bill those on a fixed or no income such as pensioners and school students (18 and under, not the nonsensical 16 years and under), while all people who are employed pay the AMA-recommended fee and claim back their rebate of $37 or higher if the rebate rises yearly. (Hopeful thinking, I know.)
20. MAKE all consultations a standard one — from five minutes to 20 minutes. Patients should pay for medical certificates, Centrelink, RTA documentation and the like.
If we have to take rebate cuts for these services, the politicians should also take a pay cut.
21. Abolish “private” bulk-billing clinics in public hospitals. These are not private clinics. The patient does not get a choice as to whom they see, the doctor is not paid for service as a private doctor is, and these clinics should not drain the Medicare pool of funds available to it.
22. If a patient attends an emergency department and is assessed as having a GP problem, then they are advised that they will have to make a co-payment and wait to see a doctor, or an appointment can be made with their chosen GP. This allows the government to place a price signal, which they seem to want to do, and encourages the patient to see a GP (a cheaper and more efficient option).
All suggestions amended from articles from www.medicalobserver.com.au/news