Pathology Funding Agreement
Pathology Agreement Advisory Committee Meeting - 19 April 2012 - Minutes of Meeting
The Pathology Agreement Advisory Committee (PAAC) has been established to oversee and provide advice to Government on the Pathology Funding Agreement.
Pathology Agreement Advisory Committee Meeting 19 April 2012
Welcome
The Chair, Dr Richard Bartlett (DoHA) welcomed the following participants to the meeting which began at 10.00 am:Ms Fifine Cahill, Department of Health and Ageing
Mr Shane Porter, Department of Health and Ageing
Mr Scott Jansson, National Coalition of Public Pathology
A/Prof Roger Wilson (for Dominic Mallon), National Coalition of Public Pathology
Prof Yee Khong, Royal College of Pathologists of Australasia
A/Prof Peter Stewart, Royal College of Pathologists of Australasia
Dr Debra Graves, Royal College of Pathologists of Australasia
Dr Michael Harrison, Royal College of Pathologists of Australasia
Dr Colin Goldschmidt, Australian Association of Pathology Practices
Mr Colin Jackson, Australian Association of Pathology Practices
Prof Katherine McGrath, Australian Association of Pathology Practices
Mr Anoop Singh, Australian Association of Pathology Practices
Mr Fred Humphries (proxy for Patrick Tobin), Catholic Health Australia
Apologies
Mr Patrick Tobin, Catholic Health Australia
Dr Dominic Mallon, National Coalition of Public Pathology
PAAC SecretariatMr Alastair Wilson, Department of Health and Ageing
Mr Rob Lillie, Department of Health and Ageing
1. Administrative business
1.1 Conflicts of Interest
A/Prof Wilson advised he is involved in the National Pathology Framework being discussed at agenda item 6.3 and is a member of NPAAC (as is Prof Stewart). Mr Jansson and Prof Stewart noted their membership of MSAC.1.2 Confirmation of Minutes and Action Items
Members formally endorsed the minutes and the action item list as an accurate summary of the meeting.2. Management of Pathology Outlays
2.1 Members discussed the July 2011- March 2012 data noting that the overspend of $54 million as at the end of March had reduced compared to the $63 million overspend at the end of February.2.2 Mr Porter advised that the forecast for the end of June 2012 is around $40 million over target based on expenditure data to the end of 2011, and in response to a query, also advised that the leap day in February was included in the calculations. Mr Jackson noted that last year there was strong growth in April, May and June and it would be unlikely that there would be significant growth from that high base resulting in lower growth this year.
2.3 Members noted the new genetic items to be added to the PST from 1 May 2012 and asked how the fee was set. The Chair advised that the Government set the fees based on MSAC recommendations and discussion with the applicant and the sector. Members also enquired about the impact on the outlays target in the PFA. The targets will be adjusted on the basis of the expected expenditure for the new items and their usage will be monitored and reviewed after 12 months.
2.4 Some members noted that the new MSAC process seemed to be working well, particularly the Protocol Advisory Sub-Committee.
Joint PAAC/FAC Meeting
2.5 On the Department’s recommendation, it was agreed that the next PAAC meeting be a joint meeting with FAC. This will enable a quicker discussion on recommendations between the two committees if there is an overspend. This meeting will be held on 19 July in Melbourne.Medicare Data Issues
2.6 Mr Porter advised that the Department is in ongoing discussion with the Department of Human Services (DHS) about the problem and senior DHS people addressed the last Finance Advisory Committee (FAC) on 27 March to discuss the issue. Since that meeting, some progress has been made and it may be possible to obtain date of payment data on a regular basis which will assist in forecasting and managing the Agreement.3. Options for Expenditure Management
3.1 A number of options for bringing expenditure back on target were presented for discussion. Non-Government members advised that they were meeting out-of-session (on 27 April) to discuss the options with the intention of agreeing a position to put to the Department. The Department will model any proposals for discussion at the next.PAAC/FAC meeting
3.2 At that meeting, the Department will provide an indication of the parliamentary procedures required for a fee change including likely timeframes for implementation.3.3 Some members claimed that coned-out items were growing at a higher rate than items rebated by Medicare and that benefits were growing at a higher rate than services.
3.4 Several members queried whether the possible impact on requesting resulting from increased ACCs would be considered as part of negotiations on expenditure management.
The Chair reminded members that the deregulation of ACCs was already in place at the time the Agreement was negotiated and that there is not a proven definitive link between increased ACC numbers and increased requesting.
3.5 A wide ranging discussion about ACCs and the prohibited practices legislation then took place. Some members suggested that a change in the prohibited practices legislation is required to constrain the level of rents being paid to GPs for ACC space within their practices. Other members noted that a stricter compliance monitoring system is required from the Department of Human Services (DHS). The Chair advised that the Department of Health and Ageing has been continually engaged with DHS on compliance matters in an attempt to speed up the monitoring and reporting process.
3.6 Some members suggested that an educational awareness campaign targeted at both GPs and providers would alleviate many of the problems. The Chair suggested that the pathology sector should continue to work to persuade other stakeholders, particularly the AMA, to agree about the nature of the problem and a strategy to address this.
Action: Non-Government members to meet out-of-session (on 27 April) to discuss the options with the intention of agreeing a position to put to the Department.
Action: The Department will model any of the above proposals for discussion at the next
PAAC/FAC meeting.
4. Fee Setting/Cost Transparency Consultancy Update
4.1 Ms Cahill advised that Ernst & Young has commenced work on the transparent fee setting project and has already contacted some providers to begin the consultation process.Action: A copy of the E&Y presentation provided at the last FAC meeting to be emailed to members’ out-of-session.
5. Quality Use of Pathology Program
5.1 Dr Harrison, as QUPC Chair, advised members that the first meeting of the newly formed QUPC was held on 28 February 2012. He also advised that QUPP would no longer be focusing on workforce issues given the establishment of the Workforce Advisory Subcommittee of PAAC. Its new focus will be demand management and decision support ensuring that any funding for new projects will be aligned with the directions and priorities outlined in the PFA.5.2 The Chair advised that the Department is looking at streamlining the application process for QUPP funding to reduce the workload for organisations seeking funding. RCPA members suggested that one way of reducing the workload would be to call for a list of ideas from organisations, and for QUPC then to decide which one’s may warrant funding at which point full proposals would be requested.
5.3 The Department noted that the annual allocation of funding for QUPP projects remains at around $2 million per year.
5.4 The revised QUPC Terms of Reference were endorsed by PAAC.
Action: It was agreed that at future PAAC meetings a list of current QUPP projects would be provided as part of the standing item update.
6. Standing Agenda Items
Workforce Advisory Committee Update
6.1 Ms Cahill provided members with an update on WAC activities. She advised that WAC last met on 23 March 2012 where it was agreed that its immediate priorities are to:- collect pathology workforce data by seeking and analysing current workforce information from reliable sources;
- to work collaboratively with Health Workforce Australia on workforce modeling, including demand for services and standardisation and alignment of data;
- to develop competency based standards as a basis for curriculum development and VET training; and
- facilitate the development of career pathways for senior (or clinical) scientists.
Demand Management Advisory Committee Update
6.3 DMAC’s meeting scheduled for March was deferred to 3 May. As such, there were no recommendations from DMAC. The Terms of Reference for DMAC were endorsed by PAAC.National Pathology Framework Update
6.4 Ms Cahill advised that the NPF Working Party has been established and will meet soon. (Subsequently, that meeting has been scheduled for 31 May). Draft NPF Working Party Terms of Reference have been developed and were provided for information.The ToR will be considered by the Working Party at its first meeting and subsequently submitted to PAAC for formal endorsement at its next meeting.
6.5 The Department advised that the NPF will not be completed by 30 June 2012 as detailed in the Agreement and PAAC will be asked to agree a revised timeline once the Working Party has met and finalised the ToR as above.
PSTC Update
6.6 Ms Cahill provided an update to members and presented draft Terms of Reference and proposed selection criteria for future PSTC members for comment.6.7 Ms Cahill advised that nominations for membership of PSTC will be sought from the AAPP, RCPA, NCOPP and Catholic Health Australia. Requestors and other relevant stakeholders will also be approached to provide nominations for membership on the PSTC. It is anticipated that it will comprise between 12 and 15 members. It will not be a ministerially appointed committee and the Department will decide on the final composition of the membership.
6.8 Members agreed that dot point 2 of the ToR be amended to read:
- “To formally report to PAAC on advice that it has provided to MSAC and other organisations including the TGA”.
6.10 There will no longer be formal sub-committees but time-limited expert panels established as required to provide advice on specific issues unable to be resolved by PSTC itself.
Action: PTSC Terms of Reference, dot point 2 be amended to read:
- “To formally report to PAAC on advice that it has provided to MSAC and other organisations including the TGA”.
MSAC Update
6.10 Members noted the MSAC update provided. Mr Porter advised members that he now has responsibility for MSAC matters and would welcome any suggestions from members on how to improve the process.6.11 In response to a query, the Chair advised that the results from the E&Y fee setting project will feed into the process for consideration of fees for new pathology items.
Genetics Review Update
6.12 Ms Cahill advised that the Genetics Working Party (GWP) has been established under the PFA to provide advice to the Department on options for reform, including for a national framework for genetic testing, by 30 December 2012. The GWP held its first meeting on14 December 2011 and its second on 15 March 2012. The work of the GWP is being augmented by consultants engaged by the Department, Sironis Health.
6.13 Sironis Health has developed a comprehensive Project Plan to assist the GWP and the Department through the review process and has also produced an overview of genetic testing arrangements in selected countries, which will be developed further as the project progresses.
6.14 A key document being developed by the GWP is a Discussion Paper, which will form the basis for public consultation and it is expected to be released for public consultation later this year.
7. Other Business
AAPP Paper on E-Health
7.1 As requested at the last meeting, the AAPP proposal on e-health seeking funding of $50 million per year for the private pathology sector was provided for discussion and Prof McGrath spoke to the issue. She explained that pathology involvement in the PCEHR is a government initiative that will be a cost to the sector and, as such, the AAPP is seeking funding to reimburse costs and to provide financial incentives to become involved.7.2 The Chair explained that the Department would require a more detailed business case to be provided for any consideration of funding. It was agreed that the AAPP and the Department will meet separately to discuss the proposal further.
Funding of Pathology Tests for Refugee Screening
7.3 Dr Graves noted that the issue has been raised with the RCPA by a number of public and private providers. The Chair stated that the Department has been previously made aware of this issue and considers it to be an issue for state and territory governments to consider.7.4 It was agreed however, to reconsider this issue in mid-2013.
Manpower to attend PCEHR Meetings – Letter from RCPA
7.5 Prof Khong advised that the RCPA is regularly required to send fellows to NeHTA meetings at very short notice and is finding it difficult to provide representation at all meetings. In addition, the RCPA is concerned that the technical requirements the NeHTA is suggesting will result in additional costs to providers. Prof McGrath noted that the cost issues could be overcome with a few changes to the technical specifications required by NeHTA.7.6 The issue of the number of meetings more broadly requiring pathology representation was discussed and, although it was considered an onerous task, it was agreed that it is essential that the sector be represented whenever there is a likelihood of any impact on
providers or pathology patients.
MSAC Application on HbA1C – Letter from the RCPA
7.7 Prof Stewart advised that the RCPA had been informed by the MSAC Secretariat that if the current application for HbA1C was approved, funding would need to come from within the existing pathology budget. Ms Cahill clarified that any MSAC-recommended test approved for Medicare funding that increases costs to the MBS would need to be matched to equivalent savings. However, such savings would not necessarily be sought from pathology.Changes to MBS funding for pathology would only be made in accordance to the Agreement.
National Pathology Harmonisation Summit – Letter from the RCPA
7.8 Dr Graves explained that the National Pathology Harmonisation Steering Committee is a committee of the RCPA. It is intended to ensure that the RCPA Advisory Committees and the RCPA Faculty of Science are actively engaged with other laboratory medicine and clinical societies, IT and eHR providers, safety, government and consumer advocacy groups.The RCPA considers that this body of work is essential in facilitating the implementation of e-health in pathology safely.
7.9 The College submitted a proposal in April 2012 to the Department seeking funding support to hold a National Harmonisation Summit to scope the project. The Department and the RCPA agreed to discuss this proposal bilaterally.
Prohibited Practices Update
7.10 Ms Cahill provided a brief summary of recent activities including the meeting of 4 April that included the RCPA, AAPP, RACGP, AMA, DHS and the Department. She also reiterated that the Department continues to meet with DHS to encourage it to respond appropriately to concerns raised.8. Clarification of in-confidence items
The Chair advised that only the data provided is confidential. All other matters can be discussed with members’ organisations.9. Next Meeting
The next meeting will be held in Melbourne on 19 July 2012 and will be a joint meeting with the Finance Advisory Committee.Summary of Action Items
Action: Members to meet out-of-session (on 27 April) to discuss the options with the intention of agreeing a position to put to the Department.Action: The Department will model any of the above proposals for discussion at the next PAAC/FAC meeting.
Action: A copy of the E&Y presentation provided at the last FAC meeting to be emailed to members’ out-of-session.
Action: It was agreed that at future PAAC meetings a list of current QUPP projects would be provided as part of the standing item update.
Action: PTSC Terms of Reference, dot point 2 be amended to read: “To formally report to PAAC on advice that it has provided to MSAC and other organisations including the TGA”.
