Professional Documents
Culture Documents
17
YOUR PRACTICE
YOUR PRACTICE
How to
survive the
big squeeze
Owners are being forced to change the way they
operate, but many appear to be putting off tough
decisions until it is too late, writes Zilla Efrat
MALCOLM PARMENTER
We have introduced
a new process for
assessing people for
bulk billing DAVID TILLETT
but no longer do that. On the whole
patients have responded really well to
this. I think thats because weve communicated the issues effectively to them.
Weve also been more diligent in
following up on people who dont attend
appointments.
The prac ztice is trying to improve
the quality and depth of its services.
Weve been talking to orthopaedic
surgeons, gastroenterologists around
Hep C treatments, and to plastic
surgeons and dermatologists on how
to enhance skin care, he says. PAGE 18
18
YOUR PRACTICE
IMAGES: THINKSTOCK.COM
PAGE 17
In addition to boosting
consolidation among practices, Mr Dahm
expects the changes to change the way
practices are run in the future.
He says owners need to develop
a sustainable strategy for the future,
define this with actual numbers and
get practice-wide buy-in.
They should also decide what changes
they will tackle and which they wont.
You cant do everything at once. If you put
too many changes on to your staff members and doctors at once, they could hit
their breaking points, says Mr Dahm.
He supports weaning practices
off bulk billing.
As soon as you put a fee on your
service the patient becomes discerning.
So there is a fear among doctors that they
have to justify their services because
patients will demand more or go next
door to the bulk billing practice. But
thats a myth.
If they go to the practice next door,
it means you are probably not that good
at what you do. You need to focus on
patient surveys and what patients think
about your services.
You may come up with some great
ways to retain patients. For example,
some practices are introducing
membership fees to encourage patient
continuity. Others may charge $10 a
consult for the first 10 consults and bulk
bill for the rest of the year.
PAGE 17
and complex conditions. This
proposal has been well received, in large
part because the case for the adoption of
the Patient Centred Medical Home (PCMH)
model has been well made and supported
over the past few years. That the Turnbull
government announced its adoption of the
PHAG recommendations, through what it is
calling Health Care Homes, in the context
of increased funding for hospitals, highlights that the focus of federal policy makers
remains on illness care rather than on
prevention and early interventions to,
for example, tackle the rise in diabetes
or the impact of depression.
With the recent COAG agreement, the
devil is in the detail, and there are few
details, especially given the short time
frames. Are there realistic expectations that
the Commonwealthstate efforts to reduce
pressures on public hospitals will be fully
developed, implemented and delivering
evaluated results by July 2020 when the
agreement ends, let alone by 2018 when it is
proposed the next agreement is developed?
For Health Care Homes this will
require agreements about the appropriate
model or models, where the pilots will
be implemented, and how the target
populations will be selected. How will
the trial be funded (there are intimations
of contributions from the states and
territories and private health insurers) and
will this affect the modelling, locations and
participants?
The Health Care Homes proposal is
welcomed but it will struggle to deliver
hoped-for changes in care in an environment
where clinicians Medicare fees are frozen,
bulk billing incentives for pathology and
diagnostic procedures are threatened,
thresholds to access to both Medicare and
PBS safety nets are increasing and patients
out-of-pocket costs are growing.
There has been no mention of workforce
requirements, so it is not clear how busy
practices will deliver on issues such as
patient transport, house cleaning and
home modification needs, as highlighted in
examples provided in the ministers media
release. It is proposed that participating
practices will each have some 350 patients
enrolled this seems like a sizeable burden
given the increased levels of care expected.
Is it manageable and what will be the