HEALTH INSURANCE AMENDMENT (PROFESSIONAL SERVICES REVIEW AND OTHER MATTERS) BILL 2002: Second Reading
Mr CADMAN (Mitchell) (5.36 p.m.) —I thank the previous speaker for the manner in which he has moved his amendment. I know that the government will consider such a sensible proposal. I am not in a position to know whether or not it can be implemented, but I guess he will find that out at a later point.
The main provision of the Health Insurance Amendment (Professional Services Review and Other Matters) Bill 2002 is to make some changes to the Professional Services Review Scheme. It was substantially amended in 1999, first of all, following a detailed review by the Professional Service Review Committee. The committee looked at the PSR arrangements, and it was made up of representatives of the Australian Medical Association, the Health Insurance Commission, the Professional Services Review and the Department of Health and Ageing.
In November 2001, the revised arrangements came under the scrutiny of the Federal Court in Pradhan v. Holmes & Others. The court made findings which suggested that the legislative amendments made in 1999 following the review may not have had the effect intended by the review committee. I will refer to some of the cases and processes which are outlined in the Professional Services Review annual report 2000-2001. It makes interesting reading in terms of the way in which the review process has taken place and the way in which the intended changes will apply. The intention of the amendments in this legislation is to address certain issues identified by the Federal Court and to clarify the intended operation of the PSR Scheme as envisaged by the recommendations of the review committee and the legislation.
The process of review for a doctor or medical person who is not playing the game really hinges on three points. There are three points or stages of review. The first is that the Health Insurance Commission request for review is based on broad statistical data on services provided. They look across the conduct of medical practitioners and say whether or not there are an extraordinary number of particular procedures carried out by a general practitioner or whether a large number of patients are seen over the period of a year. The second point is the director's review, where the matters are further refined and service is identified for committee consideration. The third stage is the PSR committee investigation, where the conduct in connection with the provision of the specified services is examined by a committee of peers.
The ultimate responsibility in all of this is via peer review. A group of trusted and worthy individuals appointed by the various professional bodies have a look at the conduct of one of their peers. They make a decision about whether or not that person has been behaving in a manner which is appropriate. Of course, in the ultimate event, there is a fourth tier or step, which involves the imposition of a sanction of some sort or other. The Health Insurance Commission's reason for limiting the scope of subsequent investigations arises from these court cases. I think, at this point, it would be a good thing to draw the attention of the House to some of the instances that are contained in the annual report of the Professional Services Review.
The first one I want to identify is Dr James Tankey, a general practitioner in Ipswich in Queensland. The Health Insurance Commission stated that he rendered 27,048 services during 1994 at a cost to Medicare of $580,576. The HIC doubted whether the appropriate level of clinical input had been given to make that number of services over a period of one year. The determining officer had a look at the whole process and found that Dr Tankey had developed a consistent pattern of extremely high and rapid throughput of patients and had abdicated from the professional responsibility required of allocating an appropriate time to elucidate and address patients' health problems and to record a proper medical history. There were a number of other factors involved.
The determining officer directed that Dr Tankey be counselled, that he repay Medicare a total of $258,277.45—it would be very interesting to see how they arrived at that figure, but I will leave that to one side—that he be fully disqualified from Medicare for six months and that he be disqualified in respect of certain items for 12 months. Dr Tankey did not agree with that, so he requested a review by the PSR Tribunal, which doubled the amount and said, `Righto, chum, you're going to pay $580,576—the full amount that we think you took out of Medicare.' They otherwise affirmed the original decision. He went to the Federal Court on nine questions of law, and the court restored the original determination—they knocked it back and halved it. [start page 8198]
Off it went to the Federal Court, and the full bench of the Federal Court said, `No, they were right. You pay the $580,000-odd after all.' So there was a bit of ping-pong with this one, but there is no doubt about it: there was general agreement of some abuse, overservicing and lack of attention to the details—
Mr Fitzgibbon —It sounds like your threshold for unfair dismissals. Fifteen, 20—grab a figure out of the air.
Mr CADMAN —Well, there is a lot of money involved, so I suppose somebody has to be prepared to say, `We need to come to a sound conclusion on this one.' An interesting case is that of Dr Jessica Ho, who is a general practitioner in Springvale South in Victoria. She was referred to the PSR in April 1997 on account of her high overall volume of service. She was investigated, and she had rendered 19,749 services during the year, costing Medicare $420,243.90. The review concluded that she had consistently rendered brief consultations with questionable clinical input, her rendering of acupuncture was unacceptable, her procedures for storage of vaccines at proper temperatures were inadequate, her knowledge about restricted pharmaceutical benefits was inadequate and her care of patients with chronic conditions was sometimes inadequate, and there were a number of other items. It finished with the committee making a decision, and she was asked to repay Medicare only $4,104.85, which was subsequently reduced.
I include those examples so that we can grasp what this is all about. It is fair enough to say that if the courts are uncertain as to the intent of the parliament then changes are needed. Therefore, I am in support of this legislation. Arguments would be put by some that certain human rights factors, legal rights factors or natural justice processes are not being observed. But, at the end of the day, I take comfort from the peer review process, where a bunch of highly skilled professionals have a look at a colleague and decide whether their practice is appropriate. I have no trouble with that. We should not have some bureaucrat or administrator deciding what they think doctors should be. That has nothing to do with what I might think about bureaucrats or administrators; I think it is appropriate in this area of health that somebody who is remote and properly qualified should look at this matter and that there should be more than one person making that decision. I wish to conclude my consideration of this aspect of the bill by saying that it is during the process of peer review that the committee is able to properly assess the appropriateness of the conduct of the person under review. That enables the committee to make its finding and to report to the determining authority. The determining authority then looks at the conclusion and decides whether or not a process involving the imposition of a sanction is necessary. The sanction can take the form of a fine or it can involve having a doctor removed from the practise of certain, or all, services.
I wish to draw the attention of the House to the fact that we as a nation need to apply ourselves to health matters. I have become aware of the situation in New South Wales, and it concerns me that there are long waiting lists. I am told there are 50,184 people currently awaiting elective surgery in New South Wales hospitals. Many people—5,796—have waited for more than 12 months for their surgery compared to half that number four years ago. I am also told that 9,000 patients—approximately 31 per cent—who required admission to a hospital ward were forced to wait for more than eight hours. That is not a good record. I would like to see the New South Wales government apply itself to rectifying these problems. We can deal with the doctors here, and that is proper, but that area of health in New South Wales deserves serious attention.
Author: Alan Cadman MP
Source: House Hansard - 23/10/02
Release Date: 24 Oct 2002