Thread by @PaulWappett

So, after taking a deep breath this morning after seeing the Nine newspapers and the ABC continuing their deliberately provocative - and misleading - story about Medicare/bulk-billing rorting, I thought I might offer some observations. .../1

Last week marked my first anniversary as CEO of @RACGP. I hadn't worked in healthcare before. What has been extraordinarily evident in *every day* I've been in this job is just how committed GPs are to the communities they serve. .../2

Nobody goes into general practice to get rich. In fact, fewer and fewer doctors are going to into general practice at all. The reason is that general practice is *hard*: it's under-resourced, the stakes are high, the expectations are enormous, and *still* we get stories .../3

about greedy doctors rorting the system This, after GPs carried so much of the brunt of a system overwhelmed by a global pandemic, even when they were put to the back of the queue when it came to things like access to protective equipment. .../4

But, turning specifically to the allegations made in these latest reports:
1. *Any* misuse of public funds is abhorrent and anyone who rorts the system ought to be prosecuted;
2. However, the instance of proven Medicare fraud is miniscule; .../5

3. What is of more concern is that Medicare is clearly no longer fir for purpose;
4. The Medicare item number system is overly complex, and that complexity gives rise to the likelihood of both innocent mistakes and deliberate misuse; .../6

fit for purpose* (edit button, where for art thou?)
5. Many of the examples cited by the Age/SMH/ABC are not evidence of fraud at all (eg bulk billing of services to provide a death certificate after a person dies – an important public service that the Govt rightly pays for) ./7

6. We have overwhelming evidence that the conditions of general practice are providing a disincentive for doctors to join the profession and for those already in the profession to stay;
7. Those disincentives include an overly complex Medicare system that incentivises .../8

large volumes of short consultations, an approach to audits that are driven by statistical models without an understanding of complex care, and a gotcha media culture that leaps on any suggestion that there are greedy doctors rorting the system; .../9

8. Without a strong, healthy, well-resourced general practice sector, our hospitals will be overrun and Australia’s health and wellbeing outcomes will be severely compromised;
9. The overwhelming majority of GPs entered general practice to serve their communities, .../10

and these reports are an insult to their commitment to public good.

Please, please, P.L.E.A.S.E. ... support general practice, and help us to ensure that State, Territory and Federal Governments understand that comprehensive reform is required to keep Australia healthy ...11/11

POSTSCRIPT: The most recent annual report out of the Professional Services Review – one of four compliance layers that doctors accessing Medicare are regulated by – reveals there were fewer than 100 instances of proven inappropriate practice in 2020–21. .../12

The sum total of the money from those cases - all of which was recovered - was $24,674,440. Now, sure, these cases do not capture every instance of Medicare misuse in Australia, but it is a far cry from the figure of $8 B reported as being leaked from the system each year .../END

POSTSCRIPT 2: As a perfect illustration of how complex - and ludicrous - the Medicare rebate system is, I need to clarify that Medicare pays for a GP to attend a patient to confirm their death but *NOT* for the time taken to write the death certificate 🤦‍♂️

https://twitter.com/PaulWappett/status/1582119901103157250?s=20&t=WJY03gIlddLNMG6mzj2FoA

https://twitter.com/newsgpau/status/1582280402361757697