PSR Newsletter, August 2018

Communication with the profession

Regular newsletters have been sent to Professional Services Review (PSR) Panel members since 2016. Following a meeting with medical indemnity, private hospital and private insurance officers, I have decided to make these newsletters public. They will now be available on our website.

This measure adds to our communication engagement strategy, which includes:

• regular meetings with stakeholders
• speaking at conferences
• regular meetings with the Australian Medical Association and Medicare Compliance staff
• publishing case outcomes and
• providing formal feedback in the agency’s annual report tabled in Parliament.

I am also in the process of amending the PSR website (www.psr.gov.au). Publishing case outcomes was a new initiative last year to inform the profession about cases resolved by PSR. To highlight this initiative, the case outcomes will now be more accessible from the main interface of the website. New tabs on the main interface will also delineate advice on procedural issues for practitioners as opposed to employers/ corporations who are referred to PSR.

We have also revised the practitioner guide booklet to make it simpler and shorter, and are developing an employer/corporation booklet to assist non-practitioners referred to PSR.
 

Corporate referrals legislative amendments

Amending legislation has now passed both Houses of Parliament making minor changes to PSR’s powers surrounding the review of employers and/or corporate practices. These amendments came into effect on 1 July 2018.
 

Training days

Thank you to the Panel members who were able to attend the training days for PSR Panel members in the last quarter. These were held in Sydney and Melbourne and most members attended. Issues covered included an update on privacy awareness, topical matters arising in PSR matters, and procedural issues in Committee hearings.
 

Determining authority

Following an advertised recruitment process, the Minister for Health appointed new Determining Authority Members and a new Chair in May 2018. These appointees bring experience in both rural and metropolitan general practice, as well as psychiatry, community health and veteran’s health. A training day for these appointees has been held and the Determining Authority has already held several meetings.
 

Clarification of authorship of letters to practitioners from Medicare

Recently, the Medicare Compliance division sent a large volume of letters to practitioners in relation to prescribing Schedule 8 drugs and the rendering of selected MBS item numbers. A number of people have contacted me about this. PSR is separate from the Medicare Compliance division and had no role or input into those letters.
 

Urgent after hours

There are now a number of finalised cases relating to practitioners whose provision of urgent after hours items was referred to PSR. Some common themes have emerged from those cases. These include that inappropriate practice may be found if one or more of the following are present:

• A poor history (this includes findings over failure to document smoking status, allergies, relevant comorbidity, current medications, and to identify the red flags specifically excluded in the presenta- tion)
• A poor examination (this includes findings over failure to examine key systems involved in the presentation and specifically exclude serious concerns)
• Failure to make a diagnosis or list a differential diagnosis (this includes findings over merely repeat- ing the presenting symptom such as a sore wrist, a painful shoulder, a sore back, a cough or ab- dominal pain, without making a diagnosis)
• Inappropriate management (this includes findings over prescribing second tier antibiotics when there is no evidence of antibiotic resistance and/or where doing so is contrary to Australian antibiotic guidelines, or prescribing strong analgesic medication or benzodiazepines without clear cause)
• Treatment was not required urgently and could have been deferred to the next in hours period. This includes findings that consultations involving:
  • upper respiratory tract infections in patients with no underlying respiratory comorbidity
  • viral gastroenteritis
  • rashes
  • medical certificates
  • otitis externa or interna in patients with no underlying ENT comorbidity or
  • filling prescriptions for patients who have run out of medication may not be urgent.

Any finding of inappropriate practice, however, depends on the unique situation of each consultation and the particular conduct of the person under review.
 

Conducting a fair and effective hearing

I recently attended the 2018 Administrative Appeals Tribunal Annual Conference. A paper presented at that conference by Ms Anne Britton titled ‘Conducting a fair and effective hearing’ provides useful advice. The paper outlines the habits of effective tribunal members as well as principles, red flags and tips for ef- fective questioning. I commend the paper to you, which is attached to the email circulating this newsletter.
 

Appropriate prescribing and low back pain

I would like to draw your attention towards the outcome of Choosing Wisely in respect to the management of low back pain and prescribing. Please find an extract summarising the key recommendations about the management of back pain below.