PCEHR confusion for GPs … and patients

by Charles Wright on March 29, 2012

Today’s piece in Medical Observer suggests that Health Minister Tanya Plibersek’s attempt to relieve what she described as “some uncertainty in the profession” with yesterday’s address to the Health-e-Nation conference on the Gold Coast fell short of its goal. GPs and doctors’ groups are no less confused about the “additional support” she outlined.

This is her outline of the additional support:

“The Level B, $35.60 benefit will be available for consultations that involve taking a medical history for less than 20 minutes.
“The Level C, $69 benefit will be available for consultations that involve taking  a detailed medical history for more than 20 minutes.
“And the Level D, $101.55 benefit will be available for consultations that  involve taking a more extensive medical history for more than 40 minutes.”

While the RACGP and AGPN regarded the announcement as welcome news, AMA president Dr Steve Hambleton said it was not news at all. He said the item descriptors would not change, and GPs would not be entitled to claim the longer consultation in circumstances where the content involved a shorter level B consultation, and the length was extended to allow the GP to create or curate the shared health summary.

According to Dr Hambleton health department officials told the AMA yesterday that the MBS descriptors would not be changed and GPs would not be entitled to claim the longer consultation.

“Sources in the department have confirmed if the content of the consultation was going to be a level B and the length of the consultation was extended – to create or curate the shared health summary – that would not justify claiming a level C,” Dr Hambleton said.

“The level C and D consultations are for complex conditions and you have to demonstrate that in your notes when the PSR comes knocking.

“The department will take a dim view if it is clearly a level B consultation and the GP is claiming a level C.”

According to the Medical Observer story, however, a ministerial spokesperson confirmed this morning that “a GP making what would normally be a level B consultation would be entitled to claim a level C if the extra work involved in creating a shared health summary made the consultation longer than 20 minutes”.

Judging from the minister’s speech, the GP is definitely going to have to justify the longer session. Ms Plibersek pointedly told her audience, “I want to confirm that the use of the longer consultation items will be seen as
appropriate by the Medicare Australia Practitioner Review Process and the Professional Services Review in circumstances where there is clear evidence of patient complexity and there is documentation of a substantial patient history.”

The other area of the minister’s speech that I want to clarify is her outline of the procedure for patients registering for an ehealth record.

This is the way Ms Plibersek put it: “From 1 July, patients will be able to register for their own eHealth record through Medicare shopfronts and over the phone.  And mums and dads will be able to register for their kids.
When they’re registered, patients will be able to go online to view their record and add a range of basic health information, including emergency contact  details, the location of their advanced care directives, any allergies they have or medication they’re on.

“Patients will also be able to create their own private ‘diary’ area of the eHealth record, where they can enter their own health-related notes.”

There’s no mention there of setting up an ehealth record via one’s GP, which is how I’d imagined things would proceed. If, instead, the patient first has to register through Medicare, one assumes that the GP would subsequently be advised by Medicare to create the record. But that surely would cause problems, because the patient would presumably have to be present in order to advise the doctor whether or not he or she approved of particular items going online.

I’m seeking further and better particulars. Does anyone have any insights?

{ 2 comments }

David Guest March 29, 2012 at 7:09 pm

Charles

I am not sure that there is any official documentation, but the NEHTA view is that the first person to upload data is the curator of that patient’s ehealth record. It is expected that that will most commonly be the patient’s usual GP and that she has obtained the appropriate consent.

David

Paul March 30, 2012 at 7:57 pm

To be more clear, the last uploader of the shared health summary is the nominated provider. A clinician should not upload a shared health summary unless their patient has asked them to be nominated provider.

But I think your question related more to the creation of a record itself. The patient/consumer can register for a record, which creates the shell (including security settings etc). They can populate that record with their consumer entered information.

A clinician can also upload documents to that record, and they would only do that if the patient had asked them – usually (perhaps always) because that patient had some sort of clinical consultation with them.

So we should separate the act of creating a record from the act of publishing one or more clinical documents to that record.

In future it will be possible to create a record (register for PCEHR) in a clinicians premises (known as assisted registration). This relies on that clinician having conformant software that supports that particular transaction.

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