PSR Newsletter, July 2020

Welcome to the July 2020 edition of the quarterly PSR Panel Newsletter.

Agency activity summary for the quarter

In the period from 1 April 2020 to 30 June 2020 the Agency received 28 new requests (including one practitioner who had previously been referred). The Agency finalised 25 requests. This comprised:

• 20 effective section 92 agreements
• 4 effective final determinations
• 1 section 91 ‘no further action’ outcome

A total of $6,009,861 in repayment directions were made from the finalised matters.

Due to delays in the appointment process, the Determining Authority did not meet in June 2020 and this reduced outcomes in the quarter.

Of the finalised matters, 21 involved some form of disqualification.

In this period five new peer review Committees were established and seven practitioners were referred to AHPRA because of significant patient safety concerns.
 

Increasing number of employer referrals

PSR has received five employer referrals in the last quarter. The Director’s Review stage

will be managed by a dedicated group within the Agency, headed by Ms Kylie Neville, who will provide advice to the Director.
 

Telehealth

PSR received its first referral in the last quarter that involves telehealth items.

The Medical Board of Australia has released advice indicating that telehealth may not be appropriate if a patient examination is required for patient safety.

Bearing in mind that the scheme’s objects include protecting patients from the risk of inappropriate practice, in reviewing telehealth items the Director will consider whether a patient examination was a clinically relevant activity in determining if practice in connection with rendering or initiating a MBS service could be found to be inappropriate. PSR reviews currently evaluate the need for patient examination in face-to-face consultations, and this consideration will also be applied to telehealth consultations.
 

Invitation to apply to become Medical Practitioner Panel Advisors for the Australian Financial Complaints Authority (AFCA)

PSR has been asked to help promote a new role for medical practitioners.

The Australian Financial Complaints Authority (AFCA) is the independent, not for profit, external dispute resolution scheme for the financial sector and offers a free dispute resolution scheme for consumers and small business. AFCA have a new opportunity for healthcare practitioners.

AFCA’s rules provide that AFCA may consider a complaint by a medical practitioner against a Medical Indemnity provider, including a complaint arising from a decision to refuse to provide insurance cover. AFCA currently determines such disputes through a medical panel that comprises an Ombudsman, a person with extensive industry knowledge of medical indemnity insurance and an experienced medical practitioner.

The Medical and Midwife Indemnity Legislation Amendment Act 2019 was given Royal Assent on 28 November 2019. It amended the Medical Indemnity Act 2002.

Amendments came into effect on 1 July 2020 and affect both the rights and obligations of medical indemnity insurers, and complaints to AFCA as the relevant External Disputes Resolution Scheme.

The legislative amendments allow medical indemnity insurers to refuse cover if, among other things, a practitioner’s private medical practice places patients or the public at risk of substantial harm. If refused cover it is unlikely other medical indemnity insurers would offer cover. The effect of a refusal to offer cover is that the practitioner can no longer conduct a private practice. AFCA may receive complaints about these decisions.

To deal fairly with these complaints and provide procedural fairness, AFCA is seeking to establish a pool of external medical practitioners. The advice provided by this pool will include insight on practitioner conduct where this is relevant to the complaint.

The panel (typically 2 peer practitioners) would be provided all the relevant material exchanged between the parties from which it could form its opinion as to the appropriateness or otherwise of the medical practitioner’s conduct and provide a report for the medical panel.

When appointing a panel, AFCA will seek to appoint practitioners who practice in the same field as the practitioner under review. Therefore, they are seeking expressions of interest from highly experienced and well-informed, fair, honest and accountable medical practitioners from across the medical field to join the ACFA advisory panel pool.

Remuneration

This role is remunerated at a daily rate of $997 per day plus GST and allows full time practitioners to flex around their work.

To apply

AFCA promotes a workplace that values fairness, respect and social and cultural diversity. Aboriginal and Torres Strait Islander peoples, people with disabilities and people from different cultural backgrounds are encouraged to apply.

To apply, please submit your resume and cover letter including your contact details outlining why you are interested and feel you are suitable for this position to careers@afca.org.au
 

Privacy and security

As always, we ask that panel members remember to prioritise the privacy and security of all PSR materials and information.

• Do not take PSR materials overseas
• Do not copy or transfer any medical records provided by PSR, including those provided on a secure USB drive, onto any other device, including your personal computer or cloud storage spaces
• Do not keep a written copy of the password for the secure USB drive
• Do not review medical records where other people can see your computer screen
• Do not disclose any information provided to you by PSR to third parties
• Return any material provided by PSR as soon as it is no longer required; a PSR staff member will contact you at the conclusion of a matter to facilitate the return of material
• If you become aware of, or suspect that there has been, a privacy breach in relation to PSR materials, you must advise PSR as soon as possible
• Only use the materials provided by PSR for the purposes of performing your role as a Panel Member
• Notify PSR if at any time you identify a conflict of interest in the performance of your services as a Panel Member

Meeting with medical indemnity providers

The Director held a meeting with medical indemnity providers to help develop strategies to improve processes and reduce stress for practitioners under review.
 

Audit of PSR s92 outcomes

The PSR has conducted an audit of the impact of submissions made by 111 consecutive practitioners in cases where the Director did not make a decision under section 91 to take no further action in relation to the review. In these cases the Director issued a report in accordance with section 89C setting out the reasons why a decision was not made under section 91. Practitioners were invited to make written submissions about the action the Director should take in relation to the review. After the case was finalised, a PSR staff member not directly involved in case decisions, independently audited submissions.

The key finding of the audit was that practitioners referred to Committee (N=11) were significantly less likely to submit that they would make a change in clinical practice as a result of the review (36%) compared to those practitioners where the review outcome was a section 92 agreement (N=100; 90%; p=0.0001)

Many practitioners outlined many changes in practice in response to the section 89C report depending upon the nature of concerns.

Practitioners who were referred to Committee were significantly less likely to reduce the number of patients they saw each day (9% versus 41%; p=0.049) and were also significantly less likely to undertake a course to improve their medical record keeping compared to those practitioners who had a section 92 outcome (0% versus 48%; p=0.0022).

Many factors may influence a decision to refer a practitioner to a Committee or offer a section 92 agreement other than a willingness to change behaviour in response to a review. These may include, but are not limited to:

1. concern over patient safety or fraud and a consequent desire for a more thorough peer review evaluation to address concerns;
2. new area of review involving item numbers where clear peer feedback has not been documented;
3. matter where it may be desirable to hear evidence from witnesses to clarify matters of fact
4. failure to resolve the terms of a section 92 agreement.
    

Determining Authority

The Minister for Health has appointed the following individuals to the Determining Authority

• Associate Professor Aniello Iannuzzi (Chair)
• Mr Paul Murdoch
• Dr David Smith
• Dr Karen Flegg
• Dr Michael Badham
• Ms Susan McDonald
• Mr Stuart Macfarlane
• Mr John Kilmartin
• Associate Professor Neil Peppitt
• Ms Katerina Angelopolous
• Ms Yvonne Rowling
   

Federal Court outcomes

No outcomes from Federal Court cases were handed down in the last quarter.
 

PSR Outcomes

PSR publishes a monthly summary of case outcomes on its website. Each summary provides some idea of the person under review's practice profile (in comparison to their peers) and this helps explain why they were referred to PSR for review. In addition, the summaries detail the items investigated, the findings (in the case of a Committee) or the agreement reached between the person under review and the Director (PSR), and the sanctions applied.