It is a known fact that the public hospital system is straining to cope all over Australia.
Amongst doctors it is also a well-known fact that most, if not all, public outpatient departments increase their revenue by blatantly double-dipping. Doctors who are being paid a salary by State or Territory Government to run a clinic will not see the patient unless there is also a current referral letter from their GP – this is then used to bill Medicare for the visit as well (Even though it is often only a Resident/Registrar seeing the patient and not the Consultant to whom the letter was addressed). There are all kinds of creative schemes around to deal with this money but generally it goes into some sort of fundholding that the relevant Department has created to supplement their income. The net effect is that a State/Territory Hospital is propped up with a massive stream of Commonwealth Medicare funding that effectively subsides these clinics on a grand scale.
I don’t usually have too much of a problem in dealing with this scenario (after all who am I to judge if Medicare obviously casts a blind eye to this mass rorting) but I do have a problem when sick, often elderly and/or dying, patients are being threatened that they would not be seen unless there is a current referral letter in place (and, no, I do NOT do indefinite referral letters) or when I get messages from my Receptionist that “a Professor’s” staff member had called and insisted on a letter being written as the patient was there and needed to be seen but they needed a letter before.
I may be “just a GP” Prof but my patients are also important and I will not make them wait while I run around doing paperwork for your billing purposes. Don’t even get me started on those requests for backdated referral letters.
The worst example was a a pro-forma letter that our local Radiation Oncology Unit used to send to GPs – it was something along the lines of:
“Dear (GP’s name was mostly handwritten in here – sometimes this field was not even filled out), A specialist (did not identify who) has referred (patient’s details always fully given) to us for treatment ( no indication what for). Please provide us with an indefinite referral letter so that we can provide him with this service”
This was usually just initialed at the bottom by a Clerk in the Department – obviously the powers that be had a clear idea where GPs belong in the greater scheme of things – a source of $$$ for the department, no more, no less!
What really started my rant today was a notice from our local Northside public hospital. As most doctors would know the art of applying a proper circular cast on a limb with a fracture is a dying art amongst junior doctors. They are taught to apply a backslab/half-cast on limbs in the Emergency Department, at no cost to the punter, and the patient is then off-loaded to the Physiotherapists to apply a proper circular cast a few days later. Today I was presented with a list of the various “public physiotherapy clinics” at our Calvary Hospital.
The lists of the various fracture, lymphoedema, etc. clinics provided me with handy contact numbers and waiting times BUT they also clearly stated that all consumables, walking aids, etc would be charged to the patients at costs.
I had to read it twice to make sure I was seeing right – we are talking about public hospital patients who present to a public hospital clinic with their backslab from the ED who are told to pay for the cost of their cast and the crutches if they want a formal circular cast applied. All of this in Canberra, the good old Labor battler’s heartland – one can only wonder if Andrew Leigh is aware of this ?
How on earth does this happen? I tried to see if our Southside cousins face the same costs but my searching did not give me any answers. Regardless this is simply an amazing state of affairs and I do wonder what happens elsewhere in Australia