Pathology Funding Agreement
Pathology Agreement Advisory Committee Meeting - 26 August 2011 - Minutes of Meeting
The Pathology Agreement Advisory Committee (PAAC) has been established to oversee and provide advice to Government on the Pathology Funding Agreement.
1. Welcome
The Chair, Dr Richard Bartlett (DoHA) welcomed the following participants to the meeting which began at 1.30 pm:A/Prof Paul McKenzie - President Royal College of Pathologists of Australasia
Prof Yee Khong - Senior Vice President RCPA
A/Prof Peter Stewart - Vice President RCPA
Dr Debra Graves - CEO RCPA
Mr Colin Jackson - President Australian Association of Pathology Practices
Prof Katherine McGrath - CEO AAPP
Dr Colin Goldschmidt - AAPP/CEO Sonic Healthcare
Mr Anoop Singh - AAPP/Healthscope
Mr Scott Jansson - President National Coalition of Public Pathology
Dr Dominic Mallon - Vice President NCOPP
Mr Patrick Tobin - Catholic Health Australia
Mr David Learmonth - Department of Health and Ageing
Ms Angela Mikalauskas - Department of Health and Ageing (for Shane Porter)
Ms Debbie Stanford - Department of Health and Ageing (for Fifine Cahill)
Secretariat:
Ms Kim Williams - Department of Health and Ageing
Ms Linda Lantzke - Department of Health and Ageing
2. Administrative business
2.1 Conflicts of Interest
No conflicts of interests were declared.2.2 Confirmation of Minutes
The RCPA requested a wording change be made to item 11, paragraph three, to clarify that the working party should include people with experience in pathology business as well as genetic specialists. (Subsequently, the minutes were amended including the version available on the Department’s website).Outcome: The minutes were accepted with the above change.
2.3 Terms of Reference
The following amendments were agreed:- Change wording in Section 4 to reflect three rather than four sub-committees;
- At 4.1 remove the last sentence - This committee will also consider issues of demand;
- Move paragraph 5.2 - Quality Use of Pathology Committee to become 4.5 for the wording to reflect the relevant wording of the agreement.
Outcome: The ToR were finalised with the above change.
2.4 Action items from the last meeting
Members noted progress on the action items.2.5 Protocol including out-of-session work
Members noted and agreed with the suggestions in the agenda paper about out-of-sessionwork. Members also agreed that urgent work can be conducted by telephone as required noting that views provided by members should reflect those of their organisations.
Outcome: The out-of-session protocols were agreed.
3. Management of Pathology Outlays
3.1 Format for ongoing reporting on pathology outlays
Members agreed that the two tiered set of data designed at a workshop of agreement signatories on 5 July 2011 be accepted. The first tier will comprise high level data on total services and benefits, and will include the top 20 items by benefits and services. This first tier data is considered fundamental to the role of the PAAC. The second tier will comprise more detail.It was agreed that the data be reviewed for suitability and relevance in early 2012 after the sub-committees have begun their work.
Members requested that the data be circulated monthly.
Outcome: Standard suite of reports endorsed by members.
Action: Reports to be circulated monthly by the Secretariat.
3.2 Final 2010-11 outlays
Members noted that the expenditure target for the first year of the agreement was $2.166 billion calculated from a base of $2.065 billion that estimated growth for 2010-11 at 3.2%. However, actual growth for 2010-11 was 4.29% with actual expenditure of $2.086 billion. This puts immediate pressure on the target in the first year.The Chair suggested that DMAC be requested to provide advice on how to manage the overspend. The AAPP noted that it did suggest during the agreement negotiations that the growth for 2010-2011 would be higher than 3.2%, however acknowledged that it did sign the agreement with this estimate.
The AAPP also noted that it is too early into the agreement to make any recommendations for action.
Outcome: Final 2010-2011 expenditure outlays noted by members.
Action: The matter will be referred to DMAC for consideration.
3.3 July 2011 data
Members were advised that the July data would be available (in the agreed format) in the next few days and will be circulated.Action: July data to be circulated to members out-of-session.
4. Fee Setting/Cost Transparency
A key milestone for fee-setting within the agreement is that in-principle agreement to the range of costs that should be considered in setting MBS fees for pathology is achieved by September 2011. However, it was agreed that given the Department is about to engage a consultant to assist in the development of a new fee setting process, it is best to wait until the consultant is engaged before considering the range of costs. Members agreed that although this will mean that the September 2011 milestone is not met, the outcome in the longer term will justify this approach.The RCPA sought advice about how this would impact on the recommendation at paragraph 22 of the agreement which states - “This process will evolve, incrementally working towards increased information collection on the costs of each item, commencing with nomination of no more than five items by the sector that they consider to be under-remunerated. The Government will nominate five items which it considers to be over-remunerated”. Dr Bartlett noted that this is a separate exercise from the consultancy and that the Finance Advisory Committee may be asked to undertake this activity.
Dr Bartlett advised that the current process for setting pathology fees will continue to be used until the results of the fee setting/cost transparency project have been completed.
Outcome: The September 2011 milestone to be delayed until a consultant has been engaged.
5. Changes to PSTC and its relationship to MSAC
Dr Bartlett provided a summary of the PSTC meeting held in the morning:- PSTC members suggested that the draft of the new ToR presented for discussion needed to be amended to clarify that membership is to be based on clinical expertise rather than on a representational basis and include selection criteria;
- Membership of the PSTC should cover all disciplines;
- Likely that up to 20 members will be required;
- The Minister will have the final say on the appointment of members;
- Sub-committees will no longer be required;
- Expert standing panels will be established to provide advice on an as-needed basis;
- PSTC will no longer be involved in the fee setting process;
- It is recommended that all requests for changes to the PST go through a single channel, preferably the RCPA; and
- PSTC agenda to be decided/driven by MSAC and PAAC, ie it won’t be able to generate its own amendments to the PST.
Outcome: Members noted the update from the PSTC meeting.
6. Integrating Pathology into the PCEHR
Mr Peter Fleming, CEO of the National E-Health Transition Authority gave a presentation about its activities and how pathology results can be integrated into the PCEHR. A copy ofthe presentation is attached. (not on online version)
The RCPA discussed a survey it conducted in January this year about the capabilities and readiness of laboratory information systems (LIS) to take up e-health. It showed a lack of readiness amongst pathology LIS to adapt to strategies to support e-health programs. A copy of the summary of results is attached. (not on online version)
Mr Fleming advised that NeHTA is doing a similar survey of state and territory government systems about their readiness to adapt to the PCEHR, noting that NeHTA was established by the Council of Australian Governments to ensure a nationally consistent approach to e-health.
The AAPP provided a summary on the private sector’s establishment of a working group to pilot PCEHR development and work with NeHTA. This group is currently developing a business case to put to Government shortly seeking funding to progress its work.
Outcome: Members noted the update from NeHTA; Members noted the update from the AAPP.
7. Prohibited Practice Legislation
Ms Jennifer Cooke, General Manager, Health and Business Compliance and Mr Laurie Monaghan, Business Manager, Prohibited Practice Taskforce and Criminal Investigation Section of the Department of Human Services provided a presentation of its activities in relation to prohibited practices. A copy of the presentation is attached. (not on online version)The AAPP responded that it seemed that there was not much activity while noting that rent for collection centres seemed extreme and has grown exorbitantly over time. The Department mentioned that current data about rent is not that useful and Ms Cooke advised that they are seeking support from the Australian Valuations Office to get better data on rents to assist in its investigations.
The AAPP advised that this is a major issue for the sector and must be addressed urgently and offered to meet with the Department of Human Services to help it better understand the issue. It has the potential to structurally change the industry and may impact on quality unless something is done soon. The CHA agreed that something needs to be done urgently.
The Department noted that the sector should provide any intelligence it has on situations where it is aware of the legislation being breached. The AAPP noted that other countries have much better defined practices and definitions and the Department should consider incorporating these into Australian legislation.
It was agreed that the Department will host a forum to look at a way forward. Issues such as whether the existing legislation is adequate; are our tools adequate; and who should be targeted for review will be considered.
Outcome: Members noted the update from Ms Cooke and Mr Monaghan.
Action: The Department to organise a forum to further discuss prohibited practices processes.
8. Assessment of Qualifications for Approved Pathology Practitioners
The RCPA advised that it has a long-standing concern that Medicare Australia no longer consults it to assist with the process for reviewing approved pathology practitioner applicants’ formal qualifications and experience. Until several years ago, Medicare Australia would consult the RCPA if they were uncertain whether an APP applicant’s formal qualifications or experience were appropriate.The Department noted that this issue arose from a challenge to the relevant legislation which revealed Medicare Australia could not rely on advice from a third party. The primary legislation was changed to facilitate a more transparent basis for decision-making and a discussion paper on the issue was prepared in 2008 outlining a proposed revised framework for assessing APP applications. Work on finalising the matter was put on hold while the pathology funding review was conducted but could now be resumed. There has been considerable work undertaken in the revision of the NPAAC supervision requirements for laboratories that is relevant to resolution of this issue and could be undertaken as time allowed over the coming 18 months.
Outcome: Work will continue to finalise this issue and an update will be provided at the next meeting.
9. Standing Agenda Items
9.1 Demand Management Advisory Committee (DMAC)
The Chair noted that there are a substantial number of nominees for this sub-committee andasked members whether they are all needed.
The RCPA advised that its nominees have been chosen specifically for their skills and experience and they would prefer to keep each of these nominees. It was agreed that Dr Ross who had been nominated by the RCPA as an observer would be a full member of the DMAC.
There was discussion about the value of the non-pathology participants, such as those from NPS and BEACH. It was agreed that they all will have something to contribute and should remain on this sub-committee until they are no longer able to offer any helpful input. It was agreed that membership of this sub-committee (and the Finance and Workforce Advisory Committees) would be reviewed after 12 months operation.
Members agreed to review their nominations and advise the Secretariat of any changes within one week of this meeting. (Subsequently, the AAPP nominated Dr Stephen Fairy to join this sub-committee.)
The RCPA highlighted the huge body of work required of this sub-committee and queried the role of sub-committee members themselves in doing this work. It was agreed that theDepartment will undertake the bulk of the work under the guidance of members. The Chair advised that developing a workplan and prioritising the work for this subcommittee will be one of the first tasks for DMAC. A workplan will be drafted by the Department for consideration at the first meeting of DMAC and for subsequent endorsement by PAAC.
Action: Members to confirm their nominations for DMAC within one week. Membership of each sub-committee to be reviewed by December 2012.
9.2 Finance Advisory Committee
Members endorsed the following nominees for this sub-committee:Mr Simon Holmes - NCOPP
Dr Debra Graves - RCPA
Dr Len Moaven -RCPA
Dr Sanjiv Jain -RCPA
Dr Graham Armstrong -CHA
Mr Colin Jackson - AAPP
Mr Anoop Singh -AAPP
Mr Graham Collins - AAPP
Ms Margaret Duffy - AAPP
Members decided not to appoint a member from IVD Australia (nominee Dr Peter Harman) as they believed it posed too much of a conflict of interest. Members agreed however, to invite IVD Australia to meetings of this sub-committee on an as-required basis.
Outcome: Members endorsed the appointment of all nominees except for IVD Australia.
Action: IVD Australia to be advised of PAAC’s decision.
9.3 Workforce Advisory Committee
The following nominees were endorsed as members of this sub-committee:Prof Katherine McGrath – AAPP
Dr Michael Harrison – AAPP
A/Prof Paul McKenzie – RCPA
A/Prof Yee Khong – RCPA
Dr Bruce Latham – RCPA
Dr Debra Graves – RCPA
Dr Richard Williams – CHA
Prof Roger Wilson – NCOPP
Ms Renata Rustowski – DEEWR
A/Prof Tony Badrick – Pathology Associations Council
Ms Maureen McCarty – Health Workforce Australia
Members noted the update provided by the Department about national pathology workforce related projects undertaken between 2009 and 2011.
The RCPA noted that there is a need for the Department to approach Health Workforce Australia (HWA) about a more extensive workforce review if the profession was not happy with the existing study. This action was agreed during the Agreement negotiations. The RCPA will write formally to Dr Bartlett with this request.
Outcome: Members endorsed the appointment of all nominees.; The RCPA to write formally to the Department to approach HWA regarding an extensive workforce review.
9.4 QUPC Update
Members noted the update provided in the meeting papers.9.5 PSTC Update
Members noted the update provided under item 5.9.6 MSAC Update
Members noted the update provided in the meeting papers. It was agreed that the date of the submissions to MSAC would be included in future updates.9.7 NPAAC Update/Chair
Members noted the update provided in the meeting papers including the advice that Prof Leslie Burnett would not be seeking reappointment as NPAAC Chair when his term expires in July 2012. Members were invited to provide nominees for a replacement Chair within one month of this meeting.Action: Members to provide NPAAC Chair nominees from their organisations within 1 month, with reference to the position outline included with the agenda paper.
10. Other Updates
10.1 Genetics Working Party
The Chair noted that there were a large number of nominations for this working party and asked whether members would consider reducing their number of nominees.The NCOPP indicated that it did not expect all its nominations (7) to the included but was unsure of what expertise was required so offered a range of people with a range of skills.
The Chair indicated that given that the working party will be looking more broadly than the MBS on funding issues, knowledge of how states fund their genetics testing would also be useful. It would be useful therefore to have some state representation. The AAPP noted that nominees needed knowledge of business and funding processes as well as genetics.
The RCPA indicated that their nominees had both genetics expertise and a good understanding of how funding is allocated at the state and MBS levels.
It was agreed there would be an initial body of work that would include more generalist people, and then engage more specialised genetics people for the next phase.
Outcome: Members endorsed the approach where generalist representation in the first instance, followed by specialised genetics representation.
Action: Members to resubmit their list of nominees to participate in the Genetics Working Party within a fortnight.
10.2 National Pathology Framework
Members endorsed the following nominees to the working party. The CHA will provide a representative shortly.A/Prof Paul McKenzie – RCPA
A/Prof Yee Khong – RCPA
A/Prof Peter Stewart – RCPA
Dr Debra Graves – RCPA
Dr Terry Brain – NCOPP
Ms Penny Rogers – NCOPP
Prof Katherine McGrath – AAPP
Mr Colin Jackson – AAPP
Outcome: Members endorsed appointment of all nominees provided, noting that CHA will still provide a representative.
11. Closing business
It was agreed to hold future meetings at a date that allowed as much data as possible to be presented for discussion. Given that the Department gets access to data mid-month, it is suggested that meetings be held in the first week of the month to allow the Department to prepare the data tables as requested. As such, it is suggested that the next meeting be held on 2 December 2011 in Melbourne and the following meeting be held on 2 March 2012 in Sydney.Action: Dates for next meeting to be circulated by Secretariat ASAP.
11.1 Clarification of in-confidence items
The Chair advised that only the data discussed is confidential. All other matters can be discussed with members’ organisations.Outcome: Members noted confidentiality of data, which is not to be circulated until publicly available.
The meeting closed at 4.50pm. The next meeting to be held in Melbourne on 2 December 2011 subject to members’ agreement.
Summary if Action Items
1. Action: Data reports to be circulated monthly by the Secretariat.2. Action: 2010-2011 expenditure to be referred to DMAC for consideration.
3. Action: July 2011 data to be circulated by the Secretariat ASAP.
4. Action: The Department to organise a forum to discuss prohibited practices legislation and a way forward.
5. Action: Members to confirm their nominees for DMAC within one week.
6. Action: All sub-committee memberships to be reviewed after one year.
7. Action: Secretariat to advise IVD Australia of PAAC’s decision not to appoint it to the Finance Advisory Committee.
8. Action: Members to provide nominations for NPAAC Chair within one month.
9. Action: Members to resubmit their nominations for the Genetics Working Party within a fortnight.
10. Action: Secretariat to circulate possible dates for the next two meetings ASAP.
