Concetta Fierravanti-Wells (NSW, Liberal Party, Shadow Minister for Ageing) Share this | Link to this | Hansard source

In many ways this bill, the Health Insurance Amendment (Professional Services Review) Bill 2012, is technical legislation. The coalition will not be opposing it and indeed has agreed to expedite the passage of this legislation. It is similar to a bill that was introduced into the last parliament.

This bill addresses a number of issues, including a number of court decisions, one of which was Daniel v the Health Insurance Commission and Others, a decision of the Federal Court of Australia, of 28 July 2003. That case looked at the conduct of the Director of the PSR and at various legislation involving the definition of 'inappropriate practice' and various other matters.

The legislation before us also seeks to implement certain recommendations of the review of the PSR Scheme, which are in the report of the steering committee of 2007. It also makes minor administrative changes to the scheme and, further to the bill that was presented in the last parliament, it introduces amendments in response to the decision of the full Federal Court in the case of Kutlu v Director of Professional Services Review, a decision of the full Federal Court of 28 July 2011. It looks at some technical matters there.

Senator Back is here and he will no doubt be speaking on this legislation as well. I commend the work of senators in the recent inquiry of the Senate Community Affairs References Committee. I am sure Senator Back will be speaking to the additional comments made by coalition senators in relation to that inquiry. I will pick up on some of those comments. The coalition senators did want to acknowledge those of the medical profession who were sufficiently courageous to expose some of the limitations of the PSR process. It was certainly clear from the work done by coalition senators that the processes were deficient and led to unjust outcomes. In turn, one of the obvious consequences of that will be to discourage people from joining or remaining in a medical profession at a time when there are real shortages.

As coalition senators stated, in relation to the genuine deep concerns of many in the medical profession, whether some of those concerns were exaggerated or were adequately expressed is a matter of judgment. The PSR is a peer review process and, as we know, it was established in the early 1990s. Importantly, it is charged with protecting the integrity of the Medicare system and the Pharmaceutical Benefits Scheme. The scheme currently covers medical practitioners, dentists, optometrists, midwives, nurse practitioners, chiropractors, physiotherapists, podiatrists and osteopaths who use both the Medicare system and the Pharmaceutical Benefits Scheme. It is an important process, the intention of which is to protect the public from inappropriate practice by ensuring that Commonwealth funded services, which are delivered by practitioners, are medically necessary and clinically relevant. The intention is also to ensure that the public are protected from the consequences of inappropriate practice by ensuring that payments to claimants are made in accordance with the relevant Medicare regulations and the relevant regulations under the Pharmaceutical Benefits Schedule, and most especially that the service that has been provided is adequate in the light of the associated requirements for which that payment may be claimed. The Medicare Participation Review Committee, or the MPRC, is the independent statutory body that decides whether or not practitioners who have engaged in the conduct retain the right to practise under Medicare as a consequence of that conduct. The Commonwealth currently spends nearly $18 billion on Medicare services and $10 billion on pharmaceutical benefits per annum. I place on record that the coalition does support processes which ensure the integrity of the expenditure and the appropriateness of the clinical services and does support having a process which ensures that integrity is maintained.

The explanatory memorandum states that the amendments proposed by this bill will not alter the PSR or the Medicare Participation Review Committee processes. Those amendments are intended to improve administration, to clarify issues that have been raised in recent court decisions that I made reference to and to address certain evidentiary matters. This was a point that was reiterated by the minister in her second reading speech. As I indicated earlier, the bill addresses the issues that were particularly raised by the full Federal Court in the decision in Kutlu v Director of Professional Services Review, where the court held that there was a technical problem with the appointment of PSR panel members. This bill will ensure that those appointments are treated as valid and effective and, accordingly, the coalition will not be opposing this bill.

Christopher Back (WA, Liberal Party) Share this | Link to this | Hansard source

As my colleague Senator Fierravanti-Wells quite correctly noted in her speech on this bill, the Health Insurance Amendment (Professional Services Review) Bill 2012, professional services review was the subject of a Senate inquiry and I thank my colleagues, led by Senator Rachel Siewert, for the Senate allowing us to undertake an investigation. I am pleased to record that the legislation we are considering this evening picks up on many of the issues which were the subject of concern to the committee and which appear in the report and, to some extent, in the coalition senators' report.

It is an absolute undertaking that the expenditure of public moneys, on this occasion through the Medicare system and through the Pharmaceutical Benefits Scheme, should be the subject of the highest level of audit and probity and that, if there is an occasion when a member of the medical profession or kindred professions is in default under this scheme and has been in some way defrauding the taxpayers of Australia, they should be dealt with in the harshest possible way. However, the representations made to me and other Senate colleagues which led to the PSR review and inquiry being undertaken illustrated that there were deficiencies and that there clearly was unfairness occurring. I will reflect on those issues for a couple of moments.

The first point I would make relates particularly to doctors in rural and regional areas of Australia, where their workloads are often very high, where they often do not have the support of colleagues and where they are therefore placed in a position of having no option but to have high caseloads. It was of concern that too many instances were occurring in which doctors who appeared out on the right-hand end of the normal or bell curve—in other words, that end of the curve where there would appear to have been a high degree of client consultation and therefore overcharging—were being unfairly discriminated against or were being unfairly targeted. I have been assured, as a result of the inquiry we held and as a result of questions asked in Senate estimates only in the last month, that if that practice occurred in the past then it has certainly ceased. In fairness to the then director, he would argue that that had not been the case. But the evidence before the committee was that those who were very high in their caseloads, those who were perhaps in positions where they had no option but to see large numbers of patients, did appear to actually attract the attention of, firstly, the Medicare officers responsible in this area and, subsequently, the Director of Professional Services Review. That is an area that I believe this place needs to continue to examine to ensure that doctors who are legitimate as to the workloads they undertake—and therefore as to the incomes they generate under the Medicare system and subsequently under the PBS—have adequate opportunity to explain that situation before they find themselves either the subjects of allegation or indeed in default.

The second area I want to alert the Senate to is the process of panel membership—those who will judge doctors or allied health professionals in this area. It is absolutely essential that, firstly, they are competent to assess their peers on whom they are sitting in judgment. They would argue perhaps that they are not sitting in judgment and that they are only putting advice to the director, but it is one and the same to somebody who is the subject of such investigation. The panel members must be drawn from a wide group of professionals who, first of all, are actively practising—I would suggest actively practising full-time—and who can assess the doctors on the capacities for which they are before the panel.

I can recall an instance in which a doctor who was not a cardiac specialist and who had a very prolonged series of interviews with a patient in consideration of some psychological affairs became cognisant of the fact that this person appeared to have a cardiac condition. They immediately referred that person to a cardiologist, who in fact undertook treatment and was able to save the life of that person. The psychologist was then the subject of an adverse inquiry by the PSR because they had not undertaken an electrocardiogram of that patient. That is unconscionable and should never, ever have gone to a full assessment by a panel. In fact, in his evidence, that doctor produced documentation from the cardiologist supporting the argument that his excellence as a clinician probably saved the life of the patient. I know that is only one isolated case, but it did seem to keep coming up in our inquiry.

The points I would make are these. Panel members (a) have to be drawn from a wide background and (b) have to be themselves engaged in the profession actively—and, I would say, professionally—full time. If I could just advert back for one moment to those from rural and regional areas, I would plead that those panel members should at least, if not currently in rural and regional practice, have had experience themselves in rural and regional practice so that they understand the constraints and the pressures on their peers whom they might be judging.

Coming back to my support of Senator Fierravanti-Wells and the legislation: where there is corruption or fraud, it must obviously be rooted out. The other point I would make relates to specialties—an area that we identified in the inquiry. With the evolution of medicine, there are new specialties emerging. Once again, it comes back to panel membership.

I make this point in conclusion about the whole question of the past—and I believe it is picked up in the legislation—in which somebody who had been the subject of an adverse report could only appeal on the legalities of the mechanism of which they were the subject but they could not appeal based on the medical facts. As a person who has been a member of a somewhat kindred profession, I believe that is medically nonsense. It is incompetence. In fact, should there be a challenge, it should be possible for the person who has been the subject of an adverse report, with their solicitor and through their solicitor, to challenge not only the legality of the process which has led them to where they are but also the medical facts upon which decisions have been made.

In conclusion, I have to say to you that the current and newly appointed Director of the Professional Services Review is, I believe, a person of enormous integrity—not that I reflect on those of the past, but I do understand and know this person. I for one believe that we will see in his stewardship of this new legislation a complete change—hopefully very, very harsh on those who genuinely are in default but at the same time understanding of those whose case should be the subject of meritorious study before it goes on to the more harsh legal constraints.

David Feeney (Victoria, Australian Labor Party, Parliamentary Secretary for Defence) Share this | Link to this | Hansard source

I thank the members of the Senate for their contributions to the debate on the Health Insurance Amendment (Professional Services Review) Bill 2012. The Professional Services Review Scheme and the Medicare Participation Review Committee process are important parts of the government's efforts to protect the integrity of the Medicare Benefits Scheme and the Pharmaceutical Benefits Scheme. The bill will ensure that the Professional Services Review Scheme continues to operate effectively so that Medicare can provide high-quality, appropriate and safe health services for all Australians. I commend the bill to the Senate.

Question agreed to.

Bill read a second time.