At Last: A Solution to Plibersek Uncertainty Principle

by Charles Wright on August 23, 2012

We imagine the world’s top cryptographers will have been consulted to dissect and analyse the third-generation (or possibly fourth-generation) explanation offered last night by Health Minister Tanya Plibersek  of what she meant four months ago now, when she detailed “additional support” for clinicians creating or adding to a shared health summary.

Readers may recall that the first-generation explanation, issued by a ministerial spokesman, appeared to state categorically 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”.

That was widely assumed to mean GPs could in some circumstances actually be paid to gather and upload their information to a patient’s PCEHR.

Regrettably, this temporary, and completely illusory clarity was subsequenty superseded by a second-generation explanation, or a revised revision, delivered by the minister on ABC Radio.

In this re-explanation, Minister Plibersek expressed some astonishment that anyone could possibly imagine that the “additional support” she was so pleased originally to be announcing was actually additional support in the sense that it was (a) additional and (b) support and that (c) “The idea that [doctors] would during a longer consultation be paid extra for recording that information in a computer program that many of them are already using is probably not the best use of extra health funds.”

In other words, what the minister explained on the national air waves was this: When she announced that MBS numbers would be available, what she meant was that they would not be available.

What with the ensuing spectacle of highly-intelligent officials of the AMA and the RACGP wandering around with heavily bookmarked and underlined copies of the Oxford English Dictionary and The New York Times Dictionary of Misunderstood, Misused and Mispronounced Words, a bold and completely new explanation was shortly forthcoming from the RACGP.

It was about this time that this blog identified the phenomenon of the Plibersek Uncertainty Principle, as the RACGP produced a variety of scenarios aimed at clarifying for their members the precise circumstances, including tide tables and lunar progressions, under which it might theoretically be possible to extract public funding for the uploading of data.

In the circumstances, you can possibly understand why there is still just the tiniest residual doubt at eHealth Central about the assertion by officials of the AMA and the RACGP that “absolute clarity” has been delivered on the matter with Minister Plibersek’s address at the AMA’s annual parliamentary dinner in Canberra.

According to the MO, the minister announced “ehealth billing would now be time-based instead [of being based on complexity] and that the e-health PIP would be extended until May 2013”.

The new explanatory notes specify the time spent by a GP reviewing a patient’s history on an e-health record or preparing an event summary or shared health summary “may be counted towards the total consultation time”.

“When either of these activities are undertaken with any form of patient history taking and/or the other clinically relevant activities that can form part of a consultation, the item that can be billed is the one with the time period that matches the total consultation time,” the notes say.

MBS rebates will still not be available for creating or updating a shared health summary as a stand-alone service.

What might be required it seems to us, is a ministerial explanation of what Ms Plibersek actually meant when she proclaimed that “The idea that [doctors] would during a longer consultation be paid extra for recording that information in a computer program that many of them are already using is probably not the best use of extra health funds.” We suggest that the word “not” now appears to be surplus to requirements.


{ 1 comment }

Anon August 26, 2012 at 6:09 pm

As an interested observer, I think the Minister’s various explanations boil down to:
1. The Minister thinks that much of the recording that needs to go on is the same as recording that happens today, and is not keen to pay twice for the same thing. In particular, a GP who creates a care plan or other summary today is doing most of the work associated with a shared health summary – the difference largely being what software they use to create said summary.
2. This is particularly true of those already following the RACGP guidelines, and already having an electronic records system
3. The Minister is not particularly keen on people having a clinical consultation purely to get an eHealth record. Not just because this costs money, but also because the health system is generally limited by clinician time, not by demand. If existing clinicians spend time doing purely eHealth consults (i.e. helping people who otherwise weren’t coming in for treatment) then it stands to reason that some other people who are sick aren’t getting treated
4. Having said that, to the extent that there is a real increase in workload in uploading data to the system as part of an existing consult, and if that increase happens to be the difference in time between a B and a C, then the Minister is OK to pay a C

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