Home doctor services that provide after-hours visits face stricter conditions on their Medicare billing practices after a government review found they did not represent value for money to the taxpayer.
As part of a broader review of Medicare items, the Medicare Benefits Schedule Review Taskforce examined after-hours services in response to concerns they were increasing far in excess of population growth.
Medical deputising services, which perform after-hours services on behalf of GP practices, have been booming since they expanded to regional areas and advertised their services, and providers such as the National Home Doctor Service and Dial-a-Doctor have become household names.
The amount paid by the federal government in Medicare benefits on after-hours items grew by 170 per cent between 2010-11 and 2015-16, from $90.8 million to $245.9 million.
After-hours services attract a rebate up to $80 more than the standard Medicare item.
The industry has argued these services save the health system more than they cost, because many of the patients would otherwise go to emergency departments, which are vastly more expensive.
But the taskforce found, in its consultation report released on Wednesday, that the current structure of urgent after-hours items provided low-value care and it was not convinced the growth in home visits had a significant impact on hospital emergency departments.
"The growth in provision of after-hours services appears not to be driven by increasing clinical need for these services, but has coincided with the entry of new businesses into the market with models that promote these services to consumers, emphasising convenience and no out-of-pocket costs," the report found.
"Many urgent after-hours services claimed as urgent are not truly urgent, as intended when the items were created, and the distinction between 'urgent' and 'non-urgent' appears not to be well understood by many medical practitioners."
It recommended the rebate should only be payable when a GP who normally works during the day is recalled to manage a patient who needs urgent assistance.
"Urgent" would be clarified to refer to an assessment that cannot be delayed until the next in-hours period and would require doctors to visit the patient or reopen their rooms.
Taskforce chairman Bruce Robinson said after-hours services were important but their current use did not reflect clinical need in Australia.
"The Australian medical community recognises the need to remove MBS funding from unnecessary, outdated, ineffective and potentially unsafe services," Professor Robinson said.
"We must ensure that patients get the right test or treatment first time, every time and not be subjected to unnecessary and inappropriate care."
But the National Association for Medical Deputising Services said the changes would result in rolling closures of services in regional communities and cost lives.
Nearly 80 per cent of doctors employed by the providers are on a training pathway and not registered GPs, so they would not be eligible for the higher rebate and it would not make financial sense for them to do after-hours work.
"Emergency departments across Australia will be flooded if these recommendations are pursued by the government because our services will have no choice but to close," association president Spiro Doukakis said.
"This would be a death knell for after-hours home visits."
Research published in the Australian Family Physician last month indicated that the growth in after-hours services had not reduced the number of emergency department admissions, which continued to increase along the same trajectory they were on before the services were established.
Co-author Barbara de Graaff, a postdoctoral fellow at the University of Tasmania, said medical deputising services had recognised after-hours services were a good business opportunity.
"As these companies have set up in new communities that's been followed by advertising, newspaper articles and you've got supplier induced demand occurring," Dr de Graaff said.
"And subsequent to that you've got demand induced supply kicking in, where people are demanding access to these services in their homes."
The Royal Australian College of General Practitioners president Bastian Seidel said it was appropriate that only GPs who normally worked during the day were eligible for the higher rebate.
"This would deliver better outcomes for patients because the healthcare provided would be based on the GP's deeper knowledge of the patient's circumstances, better access to their health records and better follow-up to ensure continuity of care," Dr Seidel said.
The federal opposition said any reform of after-hours GP services must strengthen it rather than be used as a cost-cutting exercise by Malcolm Turnbull's government.
"This can't be used as a green light for the government to cut Medicare," said health spokeswoman Catherine King.
"People are desperate to access GP after-hours care so they don't have to present to emergency departments when it isn't required but the government has been asleep at the wheel."
