Specialists have backed calls for an overhaul of “outdated” referral pathway rules, but stopped short of supporting a push for referral status to be decoupled from specialist billing.
Last week a Deeble Institute report, Optimising health care through specialist reforms, argued that existing rules requiring patients to obtain repeat referrals in order to continue receiving specialist care are outdated and have been inadequately reviewed since their introduction in the 1970s.
The authors said that expanding referral rights for specialists and “adopting a linear evidence-based model of patient transfer” would lead to more efficient case management and reduced patient out-of-pocket costs.
The report follows recent debate about “financial toxicity” and the barriers to optimal care caused by accumulating patient medical bills.
“Using referral expiration as a means of triggering GP involvement fails to optimise the skills of the health workforce and burdens patients and the health system with regulatory-led GP engagement that offers limited clinical benefit to patients,” the report’s authors wrote.
“There is a need to decouple specialist billing more broadly from referral status to ensure consultations are based on clinical need. In the absence of such reforms, specialists and consultant physicians should be authorised to extend a referral when clinically appropriate in order to retain the referral’s validity for MBS billing purposes.”
Professor Declan Murphy, director of genitourinary oncology at Melbourne’s Peter MacCallum Cancer Centre, told the limbic that while he supported careful regulation of referrals and rebates, the resulting red tape was often “tedious” for specialists and patients.
Among specialists’ key frustrations, he said, was the 3-month validity period for referrals to specialist colleagues without the involvement of a GP.
“In a multidisciplinary cancer group like ours for example, we’re constantly referring to other specialists,” Murphy said. “As a surgeon, I often want a radiation oncologist to see my patients and have a chat or to deliver ongoing care etc – so I don’t understand why 3 months is the rule there, as inevitably cancer patients are on a long journey.”