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Warnings over new diabetes payment scheme

GPs may face financial risks under the new diabetes payment scheme which could result in “cream-skimming” rather than an improvement in the quality of care, according to Australian experts.
The Coordinated Care for Diabetes reform, which is being piloted this year, will see GPs no longer able to claim for MBS items for management and team care plans.
Instead they will receive a payment for each diabetes patient they treat as well as payments for their performance, while still having continued access to MBS rebates and PIP payments.
Writing in the MJA, (link) Professor Anthony Scott at the University of Melbourne and Professor Mark Harris at the University of NSW warn that a payment per patient scheme may be good for the government who “wants to control costs” but will shift the financial risk to doctors.
This could lead to GPs choosing not to take part in the scheme or enrolling only healthy patients, they say.
And it could also lead to ‘exception reporting’, with some practices excluding patients in order to increase their measured performance.
The authors propose financially rewarding doctors for improvements in quality of care.
They suggest payments be ‘risk-adjusted’ to be higher for practices with patients with higher needs, and they propose payments for each patient who achieves a desired change in performance.

“[The scheme] should attempt to maximise the impact of the incentives on quality of care while also ensuring an “appropriate” sharing of financial risk with providers, in addition to minimising any unintended consequences, such as exception reporting and cream-skimming,” they conclude.

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