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Ask Dr Dave - April 1998
GPs are supposed to go EBM and divisions OBF. But what does it all mean?
Acronym Agnostic
Dear AA
Outcomes based funding is the division's equivalent of evidence based medicine. It provides a rational basis for investing resources in addressing health problems. It will be refined as we become more familiar with how to use it.
Some divisions will generate a large income by running efficient programmes that deliver health results. These divisions will undergo a significant change in both their function and structure. No longer will they be the playthings of a few GPs who spend the money that should have gone to rebate increases. The new look division will provide targeted health care to the community by using the resources of an extensive network of GPs.
The efficient divisions will prosper and may take over those divisions that fail. The management structure of the new look division will be leaner and focused on the specified tasks. There will be less waste and the division will be more accountable to both the local community and to the funding authorities.
The most pressing concern for GPs is if divisions become exclusively focused on implementing health programmes, they will no longer be able to support innovation and experimentation in general practice. It would be a tragedy if this nurturing role of divisions was lost.
It is surprising to many GPs that their divisions are undergoing such a dramatic change in direction at the very time they are increasing in size and becoming significant players in the health field. So far there has been little debate about the effect of the new funding arrangements in GP circles even though divisions are currently preparing strategic plans for the changeover period and beyond.
Who will be the masters of divisions in this brave new world? Will it be GPs or the government or consumers or more likely a combination of all three. Perhaps it will be yet another acronymous body. How about SWMBO, as Rumpole once suggested?
DD
Dear Dr Dave
I have to keep my records for seven years, unless the patient is a child, in which case I have to keep them for up to 25 years. I am not confident that when the lawyers call I will be able to find that one crucial document amongst the sea of paper. I am told that it is possible to archive my records on CD-ROM. What is the medico-legal view of storing records in this format?
Inundated
Dear Inundated
Governments make lots of bad decisions but occasionally they make some good ones. Documents are legally valid if their authenticity can be determined and it does not matter which medium is used to store the information. The Health Insurance Commission accepts that an email is a valid form of referral if it can be verified that the signature on the email is in fact that of the referring doctor and the referral date has not been falsified. Digital signature technology will accommodate both of these requirements
Similarly government and the medical defence organisations are happy with any storage medium as long as the record cannot be altered. The current CD-ROM technology is superior to paper in this regard. The information is recorded by burning the data onto a compact disc. Once burnt it cannot be altered.
The data can be easily duplicated from one CD to the next. This ensures against data loss by allowing the record to be kept at a number of different sites. It poses a new problem, however, of ensuring the privacy of confidential information. This can be easily addressed by keeping the CDs in a bank deposit box or other secure location.
DD
Dear Dr Dave
I read in Australian Doctor that someone from the College suggested that the HIC halve the rebate and give GPs a Better Practice Payment of $80,000 each year. The article went on to say that the Minister was looking at this suggestion as well as a number of others. I feel that adopting this method of payment would give the government too much control over GPs' income and professional practices.
Concerned
Dear Concerned
You can see why some GPs think the College is run by a bunch of lunatics. Fortunately this plan will never be trialed. The behavioural scientists at the HIC know that such a large change would cause a mass revolt of GPs. Almost all of them would stop bulk billing and charge what they felt their services were worth. Some would prosper, some may be forced to go bush and some would take up taxi driving.
Gradual change is the key to the HIC's plan so that you are numbed to the pain of decreasing personal income. Despite Dr Woolridge's most recent comments, it is unlikely there will be significant changes to the rebate. Currently the rebate increases about 1/4 the rate of the CPI and 1/10 the rate of the average weekly earnings. For those who continue to bulk bill there will be sweeteners to keep you going. Tidbits like BPPs, immunisation and Pap smear incentives, after hour block payments to GP co-operatives. You might might survive by imitating Monsieur Thenadeier, the innkeeper in Les Miserables.
"Here a little slice
There a little cut
Three percent for sleeping with the window shut."
DD
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