The booming after-hours home doctors industry has been slammed for deploying under-qualified doctors, disrupting a regular GP's continuity of care and demonstrating a "pricing failure", and may soon face new restrictions.
In a scathing report, the Medicare Benefits Schedule Review Taskforce concluded the after-hours industry was a drain on the health system and recommended changes that would stop it from exploiting four Medicare items.
But the industry has warned such changes would "shut it down" and "leave patients stranded".
The taskforce's report said: "The current structure of the urgent after-hours items supports the provision of comparatively low-value medical care and does not represent value for money for the taxpayer."
"The generous rebates ... have led to the proliferation of businesses which promote patient convenience ... with billing models structured to benefit from the higher rebates."
In a separate development, the industry's biggest player, National Home Doctor Service, or 13SICK, may lose its licence to claim Medicare items if it is found to have engaged in misconduct by the federal Health Department's Medicare Integrity Division.
The private equity-backed company has been criticised for heavily relying on junior and under-qualified doctors, compromising patient care and inappropriately claiming for non-urgent items.
Businesses, such as the National Home Doctor Service, have been accused of wasting taxpayer money by claiming non-urgent items as "urgent after-hours" items, which have much higher rebates - in some cases almost $100 more.
They've been accused of using a business model that "leverage[s] the opportunity provided by relatively high-priced Medicare items" and creating a demand based on convenience rather than filling a need.
"Some practitioners have billed these items for medical conditions such as an uncomplicated rash, re-issuing prescriptions for patients' regular medication and for routine completion of medication charts in residential aged care facilities," the taskforce said.
If the government adopts the taskforce recommendations, only GPs and those working in GP settings will be able to access the four urgent after-hours items and the definition of "urgent" will be expanded.
"The Government will carefully review the independent taskforce's report," a spokesman for Health Minister Greg Hunt said.
"The Government is committed to retaining Medicare funding for after-hours visits by trained GPs but we need to ensure every service is genuine and every doctor is up to scratch."
The amount paid by the government in Medicare benefits on after-hours items grew by 170 per cent between 2010-11 and 2015-16, from $90.8 million to $245.9 million.
The Royal Australian College of General Practitioners "applauded" the findings, but described them as a "first step in a larger process" of ensuring high quality after-hours care.
"We [want] to ensure any changes made do not have unintended consequences," said its president Dr Bastian Seidel.
"After-hours home visits should only be provided by specialist general practitioners, or doctors' actively working towards specialist recognition as a general practitioner."
Dr Spiro Doukakis, president of industry body National Association for Medical Deputising Services (MDS), who holds a large financial stake in the National Home Doctor Service, said if the recommendations are followed, the sector will have to shut up shop, leaving patients stranded.
Pointing to a Deloitte report it commissioned, he said after-hours doctors actually saved the taxpayer around $724 million a year by avoiding unnecessary emergency department presentations.
"This is because emergency department presentations cost the taxpayer three times what it costs to provide a home visit," he said.
"There simply are not enough GPs willing to work late at night and on weekends to meet the demand."
He dismissed concerns about junior and unqualified doctors, saying they are fully qualified and registered with the Australian Health Practitioner Regulation Agency.
"The National Home Doctor Service has a big program of continual professional development," he said.
"13SICK undertakes ongoing monitoring of all of doctors ... performs monthly AHPRA exception reporting checks and doctors attend regular education meetings."
Australian Medical Association president Dr Michael Gannon said it was wrong to smear all after-hours services, as they were a critical part of the health system.
He wants to see a model that employs doctors with the right skills, training and qualifications, and a system that has strong links back to a patient's usual GP, to ensure a continuity of care.
"The report picks up many of the issues and concerns ... but others fell outside the taskforce's terms of reference and will need further consideration and action," he said. "It is clear that focusing solely on Medicare rebates is not the answer."
Dr Gannon said the taskforce's report should not be used to attack the doctors who work for the MDSs, whatever their qualifications.
"We need to focus on tackling poor models of care, rather than demonising doctors or undermining confidence in the after-hours primary care services," he said.
