Case Study

Pressure of own culture

Dr C, a general practitioner of Greek heritage was relatively new to Australia and had an inner city practice which was comprised almost totally of elderly Greek patients with limited English and complex medical problems. The patients were demanding and practice hours were often exceeded as no patients were ever refused.

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Extensive pathology and management plans were demanded and usually initiated.

Medicare were running their standard practice profile review audit reports and as a result contacted the doctor and expressed their concern about the abnormal practice profile, requiring an explanation and strategy going forward. Medicare concerns included excessive consultations and investigations on the MBS.

MIPS suggested a number of strategies be adopted to deal with the concerns of Medicare.

Dr C agreed that he should make changes to his practice by:

  • by reducing hours
  • not taking on any new patients
  • seeking another GP’s assistance 
  • appropriately modifying the number and type of test requests
  • undertaking education from Medicare as to the requirements for eligibility for team care patient management.

Medicare agreed that these changes were appropriate and took no further action.

For any new doctors the health system in terms of processes, procedures, rules, regulations and protocols can be complex, and possibly more so for international medical graduates. Make sure you understand the Medicare Benefits Scheme (MBS) and Pharmaceutical Benefits Scheme (PBS) and remember to stick to the rules:

  • avoid prescribing for your family (or yourself)
  • don’t take any shortcuts
  • don’t provide favours; and 
  • don’t bend the rules. 

It is not worth risking your job and career.

Be mindful of long working hours, stress and fatigue. Also be aware of unusual amounts or types of Medicare and/or PBS benefits that might be claimed in servicing such groups and that might trigger concerns from Medicare.

 

Resources

Medicare www.medicareaustralia.gov.au/provider

MBS www.medicareaustralia.gov.au/provider/medicare/mbs.jsp

PBS www.medicareaustralia.gov.au/provider/pbs/index.jsp

 

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