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