Open referrals to specialists needs to be the norm: report

Medical politics

By Tessa Hoffman

27 Mar 2018

To promote “patient choice” regulations need to be amended to better inform patients that referrals to private specialists do not need to contain a doctor’s name and can be used by anyone who practices in the specialty, the Productivity Commission says.

The Commission is also recommending that patients be give the option of specifying the public outpatient clinic they will attend, with clinics  directed to accept any patient with a referral for a condition that the clinic covers, regardless of where they live.

In a report released this week the Commission said while the law already allows it, there was a “common misperception among patients and providers that named referrals  can not be accepted by alternative providers.

This should be addressed by amendments to the Health Insurance Regulations 1975 which make it clear that referrals do not need to name a specialist, and that any doctor practising the relevant specialty can accept a patient referral even if it is addressed to a doctor with a different name.

The message of patient choice should be relayed by GPs and prominently displayed on pathology and imaging forms, under further amendments to the regulations, the commission advises.

The move will enable patients to choose a specialist they believe best meets their needs and capacity, or desire, to pay out-of-pocket costs, the report says.

It will also “sharpen” incentives for doctors in private practice to maintain a good reputation, provide high-quality care and keep prices competitive, driving efficiencies and quality.

“Patients should also have the option, following support from a GP, to choose their provider independently after leaving the GP’s practice.

“This would enable them to take time to consider their options and to draw on additional sources of information, such as the views of others. The Commission is not proposing that patients make referral choices without any GP input.”

The report notes that private patients pay an average $75 out of pocket cost on top of the schedule fees of $150.90 for an initial consultation with a consultant physician.

The Royal Australasian College of Physicians has backed the proposal, saying it “helps to clarify existing patient rights”.

However AMA president Dr Michael Gannon says  the ability to take a named referral to a different specialist is already enshrined in law and a common occurrence, and a requirement for GPs to inform patients of their rights would just add a further  compliance burden on them.

“Good GPs think hard when they make referrals and choose carefully, taking into account their knowledge of specialist in their area, sub specialist expertise, their assessment of different personality types, cultural issues, gender issues,” he told the limbic.

AMA vice president Dr Andrew Bartone, a Melbourne GP, said the Productivity Commission report was  a utopian vision of empowering health literate patients to direct their own referrals, but in reality there was a lot of background knowledge required .

“When I’m looking for a rheumatologist, I’m considering what people in this area have the skills, the interests and have the patient reports coming back, and it’s very difficult to encapsulate that in a comparison website,” he told the limbic.

“At the end of the day it’s a relationship we have. We care for our patients, and our patients trust us on the referrals that we make to do the best by them,” he said.

“This new recommendation is a not a change to the bottom line and I think most of our patients will still default to our recommendations on referral,” he added.

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