Red tape snarls flagship Medicare chronic disease scheme

The federal government’s MyMedicare initiative is mired in administrative burden, say doctors.

RACGP president Nicole Higgins.

The federal government’s MyMedicare initiative – an enrolment scheme designed to provide patients with chronic disease comprehensive and co-ordinated care – is mired in bureaucracy six months after its introduction, with medical practices still unable to enrol patients on their medical software.

Patients are being asked to enrol in MyMedicare at a home GP practice, which is a vehicle to provide team-based care in exchange for practices receiving incentive payments, but clinics have been forced to take applications from patients to join the scheme on paper forms and manually upload them. They are only now about to be able to enter patients who enrol in the scheme into their medical software.

“MyMedicare holds potential to meet similar goals of the general practice incentives but is currently in early stages and is reported by doctors to be administratively burdensome,” says an RACGP submission to a federal government review into incentive payments to GP practices. “We recommend an urgent priority is to increase investment in the general practice incentives program until MyMedicare is functioning optimally. This includes addressing barriers to MyMedicare’s implementation such as its limited functionality and high administrative burden.”

As of 17 January 2024, 5,587 practices and 710,499 patients were registered to MyMedicare.

GPs say existing workforce incentive payments that incentivise practices to provide complex care have stagnated over years and are now too low to make providing allied health and nursing staff in practices worth the cost.

They want a sustained increase in investment to expand the practice and workforce incentive programs to meet the growing and changing needs of the community with increased ageing and chronic disease, and to minimise costs to patients, which have been rising sharply. They also want general practice incentives to ensure that clinics are supported in the management of complex chronic disease through blended funding models, integrating incentive payments with fee-for-service, and funding quality bundles of care for targeted population groups.

These are all stated policy goals of the federal government but so far are only in the early stages of implementation.

Australia spends only 2 per cent of its health budget on preventive care, compared to 6 per cent in the UK, even though investing in prevention could save the nation billions. In 2017, the Productivity Commission conservatively estimated that if we can improve the health of people in poor or fair health, it would lift Australia’s GDP by $4bn a year. That figure would be substantially higher now.

Doctors want a dramatic ramping up of preventive health spending as part of the national reform agenda, which is being recrafted.

RACGP president Nicole Higgins said greater amounts of investment in preventive care was a proven method to “stop chronic disease in its tracks”.

“Chronic disease is exploding,” Dr Higgins said. “Almost half of all Australians now have a chronic disease, including mental health concerns, and they need complex, ongoing care in the community from their GP and care team.

“The vast majority of funding goes to acute care in hospitals – governments pay more for a single patient hospital admission than what it would cost to send that same patient to their GP twice a week for an entire year.

Dr Higgins said that while they were critically important, workforce incentive programs “come with administrative burden … and there is a lot of room for improvement and simplification so GPs have more time to spend with their patients”.

The RACGP submission also calls for the reintroduction of incentives for four-year-olds’ health checks, which were highly successful but abolished several years ago. The checks had the capacity to “set children up for life” and avoid illness and disability down the track, Dr Higgins said.

Federal health minister Mark Butler said the Federal government was making significant investments in workforce incentive strategies.

“In the 2023 Budget our Government invested a further $445.1 million to increase the WIP,” Mr Butler said. “Practices could receive up to a 30 per cent increase in their WIP payment.

“The Government has also made it easier for smaller practices to access incentive payments.

From November 2023, midwives and paramedics also became eligible health professionals in the WIP-Practice Stream.

“The WIP provides financial incentives of more than $400 million per year to assist eligible general practices with the costs of engaging nurses, midwives, allied health professionals and Aboriginal health workers.”