Report Attacks Doctors' Hasty Referrals Regime

Sydney Morning Herald

Thursday April 3, 2008

Mark Metherell

IF YOU think your doctor is being extra thorough ordering a battery of pathology tests, you may be wrong.

Some doctors are requesting numerous unnecessary pathology tests as a result of "cut and paste" medical practices, according the Medicare watchdog, Tony Webber.

He is concerned by an unwanted spin-off of the computerised ordering of pathology tests which has made it easier for doctors to order a block of tests, most of them unnecessary, rather than ordering a single most appropriate test.

Dr Webber heads the Professional Services Review, which last financial year investigated 27 cases of doctors suspected of rorting Medicare, up from seven cases the previous year.

He says that while the benefits of computer-aided clinical care are well-documented, his agency's scrutiny of computerised medical records "has often found examples of extensive cut and paste in the medical record".

This was particularly the case where doctors created patient management plans to meet Medicare requirements.

"Patients are individuals; their records should reflect an individual and tailored approach," Dr Webber says in his annual review released today, Report To The Professions.

Doctors found to have health assessments with the same information for most patients will need to explain "why his or her patients are all carbon copies of each other".

Dr Webber linked the practice to the poor keyboard skills of some doctors who were still at the "hunt and peck" two-finger typing stage.

"Doctors who once wrote comprehensive notes in longhand are now sometimes reduced to a few lines of tortured text ... Doctors need to ensure their keyboard skills are sufficient for the task before adopting the new technology."

His report gives the example of one doctor's computerised medical records which contained only the dates of consultations.

"This doctor started using a computer for writing prescriptions in 2005. From that date he neglected to record clinical notes in either handwritten or computer form," Dr Webb said.

Another concern involving patient management plans was the emergence of patient-driven arrangements to exploit Medicare coverage of allied health services such as psychology and physiotherapy.

GP management plans and team care arrangements introduced by the Howard government have extended Medicare benefits to allied health care for patients with a chronic condition requiring their doctor and two other care providers.

Dr Webber says patients are pressing their doctors for a care plan in order to access coverage of allied care not normally provided by Medicare.

He had heard anecdotal evidence of psychologists telling patients to go back to their doctor to secure a care plan.

"This should be at the initiative of the GP, not the other way round," Dr Webber said.

Most of the cases investigated by Dr Webber's agency involve suspected overservicing, where doctors' claims of Medicare services are significantly above normal.

Of the 27 cases dealt with last year, six doctors were reprimanded, four were partially disqualified from Medicare for a total of 63 months and six agreed to make repayments totalling $594,887. The highest single payment was $400,000.

© 2008 Sydney Morning Herald

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