Pathology Funding Agreement
Pathology Agreement Advisory Committee Meeting - 2 December 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 10.00 am:Mr Alan Bansemer, Department of Health and Ageing
Ms Fifine Cahill, Department of Health and Ageing
Ms Debbie Stanford, Department of Health and Ageing
A/Prof Paul McKenzie, 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
Mr Colin Jackson, Australian Association of Pathology Practices
Prof Katherine McGrath, Australian Association of Pathology Practices
Mr Anoop Singh, Australian Association of Pathology Practices
Dr Dominic Mallon, National Coalition of Public Pathology
Mr Simon Holmes (proxy for Scott Jansson), National Coalition of Public Pathology
Mr Patrick Tobin, Catholic Health Australia
Secretariat
Ms Kim Williams, Department of Health and Ageing
Mr Rob Lillie, Department of Health and Ageing
Apologies were received from:
Prof Yee Khong, Royal College of Pathologists of Australasia
Dr Colin Goldschmidt, Australian Association of Pathology Practices
Mr Scott Jansson, National Coalition of Public Pathology
Mr Shane Porter, Department of Health and Ageing
2. Administrative business
2.1 Conflicts of Interest
Dr Mallon and A/Prof Stewart advised they were on NPAAC and Prof McGrath advised she was working with Health Workforce Australia. The Chair noted this advice.2.2 Confirmation of Minutes
The minutes from the previous meeting were accepted without change.2.3 Action items from the last meeting
Members noted progress on the action items.2.4 Pathology Associations Council (PAC) Request for Observer Status
Members discussed the letter from PAC seeking observer status on PAAC. Given that PAC is represented on the Workforce Advisory Committee, members decided against allowing it observer status on PAAC at this time, noting that this is open to reconsideration at a later time.Action: The Chair to write to PAC advising it of the decision.
2.5 IVD Australia Request for membership of the Finance Advisory Committee
Members discussed the letter from IVD Australia responding to PAAC’s original decision not to allow it membership of the Finance Advisory Committee. Members ratified their original decision.Action: The Chair to write to IVD Australia advising it of the decision
.3. Management of Pathology Outlays
Members discussed the July-October 2011 data noting a downturn in growth and a reduction in the overspend from $21 million at the commencement of the agreement to $11 million at the end of October.The volatility of the data that shows dramatic swings from month to month was discussed. The Chair advised that the Department is in ongoing discussion with the Department of Human Services (DHS) about the problem and will invite senior DHS people to address the next Finance Advisory Committee (FAC) to discuss the issue. Members agreed with FAC’s view that this is inconsistent with actual activity and that the sector is willing to engage. A report from that meeting will be provided for the next PAAC meeting for information.
Dr Mallon referred to a presentation provided at the Demand Management Advisory Committee (DMAC) meeting regarding incomplete data and offered PathWest data to assist in research into identifying drivers of demand suggesting that the industry generally should be able to provide additional data. Mr Tobin agreed that Catholic Health Australia would provide appropriate data for research. Prof McGrath suggested that a methodology would need to be established and agreed, including specific questions needing an answer, before AAPP members would consider providing data. She noted the AAPP view that there is not over-ordering at present.
Dr Mallon suggested that we need data to inform discussions with requestors who are better placed to influence demand and it is essential to have discussions with bodies representing requestors as part of any research into demand. The Chair acknowledged that a range of
short and long term strategies need to be looked at when considering drivers of demand and that DMAC (long term strategy) and FAC (short term issues) are tasked with these activities and noted that electronic decision support activities will assist over time.
Mr Holmes asked whether DHS still undertakes peer analysis, which is a useful, non-threatening way, to subtly influence demand. Mr Bansemer advised that this practice ceased after a change in leadership at DHS. Further discussion noted that attempts to influence requesting should be evidence-based, non-invasive, practical and at minimal cost to the sector.
All agreed that the aim is to have clinically appropriate quality requesting and that the Commonwealth get value for money in its pathology outlays.
Action:: A report on DHS’s discussion at the next FAC meeting will be reported to the next PAAC meeting[
.4. Recommendations from DMAC and FAC
Members noted that neither committee had any recommendations about managing the cap; both agreeing that it was too early into the agreement.Mr Jackson advised that the statement in the agenda paper (FAC) “Members indicated a preference for targeted adjustments rather than “across the board” fee reductions should action be required later into the agreement” was not correct as there was not specific agreement for targeted adjustments. The Chair explained that there was no suggestion agreement was reached, but agreed that this could be taken out of context and could be better worded. The wording will be checked with the members of that committee and corrected if required.
At the request of Mr Tobin, the options to be developed by the Department for consideration by FAC at its next meeting will include volume discounting, an option discussed during the review of pathology funding arrangements.
It was agreed that the full minutes from sub-committee meetings will be provided at future PAAC meetings as well as a summary of recommendations.
Action: Volume discounting to be included in the options for FAC to consider; Full minutes from sub-committee meetings will be provided at future PAAC meetings as well as a summary of recommendations.
5. Fee Setting/Cost Transparency Consultancy Update
Ms Cahill gave an update on the consultancy for which tenders closed at 2pm today. She advised that there were nearly 200 registrations on the tender website indicating that there was likely to be a good field of applicants to consider.6. Quality Use of Pathology Program
Ms Stanford advised that letters had been sent to the following organisations inviting nominations for QUPC membership:- Australian Association of Pathology Practices;
- Australian Medical Association (x2, including a trainee doctor);
- Consumers Health Forum of Australia (x 2);
- Medical Deans of Australia and New Zealand;
- National Coalition of Public Pathology;
- Royal Australasian College of Surgeons;
- Royal Australasian College of Physicians;
- Royal Australian College of General Practitioners (x 2); and
- Royal College of Pathologists of Australasia.
Ms Stanford provided a summary of how the strategic priorities were developed through extensive consultation with the sector. She also provided a list of all past and existing QUPP projects for members’ information. RCPA members noted their support for QUPP and appreciated the funding it provided for many and varied projects.
Prof McGrath stated that she thought there was considerable overlap in the strategic priorities of QUPP. The Chair advised that it is not PAAC’s role to dictate to QUPC. PAAC’s role is to identify areas of conflict and duplication and provide evidence to ensure relevance and appropriateness. Its role is not exclusive. Members discussed some potential for future overlap between QUPC priorities and the work of PAAC. QUPC is very aware of the potential overlap particularly with workforce projects and is keen to engage with PAAC.
There was some discussion about the methodologies used on QUPP-funded projects. Prof McKenzie advised that all QUPP project consultants/ organisations were required to provide QUPC with a rigorous project methodology as part of the funding approval process.
Prof McGrath asked whether the cost-implications resulting from QUPP-funded projects are taken into consideration. Ms Cahill advised that essentially most projects are research-based but if any recommendations from the projects would result in additional pathology expenditure, it will be referred to PAAC for consideration of the implications for the targets in the agreement.
The Committee noted its appreciation of the work of Ms Stanford over many years in QUPP. She is soon to embark on another career outside the Department
.7. Standing Agenda Items
It was agreed that at future PAAC meetings the updates from the sub-committees will be incorporated into the agenda item “Recommendations from sub-committees”.7.1 Finance Advisory Committee Update
Members noted the data issue outlined in the update and endorsed the draft Terms of Reference for this committee.7.2 Demand Management Advisory Committee Update
Members noted the update provided. The Terms of Reference for this committee had not been finalised as the committee had just met (on 24 November) and suggestions from that meeting had not been incorporated into a revised ToR. The revised ToR will be presented at the next PAAC meeting for formal endorsement.Action: DMAC draft Terms of Reference will be presented to PAAC at its next meeting for endorsement.
7.3 Workforce Advisory Committee Update
Members noted the update provided and endorsed the draft Terms of Reference.7.4 National Pathology Framework Update
Members noted the update provided, including that it is anticipated that the NPF Working Party will meet early in 2012.7.5 PSTC Update
Ms Cahill advised that the Terms of Reference for the revised PSTC are being drafted and will be presented to the Minister early in 2012. It is recognised that PSTC will need to work closely with MSAC and PAAC and this will be reflected in the ToR. Once they have been approved by the Minister, nominations for membership will be sought from the sector.7.6 MSAC Update
Members noted the update provided. It was agreed that the date of the submissions to MSAC would be included in future updates.8. Other Updates
8.1 Genetics Working Party
Members noted the update provided including that the first meeting of the working party will be held on 14 December in Sydney. Membership is still being finalised.The Department advised that the tender for a genetic consultant will close on 7 December.
8.2. Assessment of Qualifications for Approved Pathology Practitioners
The Department advised that key stakeholders were invited to participate in a brief meeting following the recent Workforce Advisory Committee meeting on 18 December to discuss concerns with the assessment of qualifications for APPs. A number of actions were agreed as indicated in the agenda paper. Members noted the update.9. Other Business
9.1 Specimen Poaching
Dr Graves advised that the College is aware that some pathology providers’ staff are collecting specimens that have been referred to a different provider. In a recent reported case, a specimen clearly intended for a specialised pathology practice was taken from the operating theatre by a courier from another provider and a specific example was cited.Some members suggested that this behavior is a result of the recently introduced non-directed referral legislation for pathology requesting and asked that the Department issue a notice directing that this practice is to stop. Mr Bansemer acknowledged that this is a serious issue but that the industry itself must ensure its staff adhere to the laws/legislation around specimen collection and suggested that the College, AAPP and NCOPP write to their members about the matter.
Members agreed that if this behaviour was inadvertent then a telephone call would have fixed the problem at the time. However, if it was deliberate, it is unethical.
It was also recognised that control of the specimen is the responsibility of the requesting practitioner who must put adequate procedures in place to ensure the specimen is collected by the intended pathology provider.
9.2 Carbon Tax and Healthcare
A letter to the RCPA from the Victorian Minister for Health was tabled for discussion.Members advised that it was an issue that they were monitoring and that they may raise the matter at a later stage if there are cost implications.
9.3 Definition of a Person
A letter was tabled from the PSTC Genetics Sub-committee which is concerned that some genetic testing that may be clinically appropriate is not Medicare-eligible.Ms Cahill noted that the Genetics Working Party will consider more broadly the appropriate funding framework for genetic tests.
9.4 Management of Records and Diagnostic Materials
Dr Graves advised that although NPAAC has regulations governing the retention of records and diagnostic materials in cases of amalgamation, mergers and change of ownership, there are no guidelines from the Department, Medicare, NPAAC or any other authorities as to what happens to records or diagnostic materials in cases of closure of business.Mr Bansemer noted that this is a state matter and each state has legislation in place detailing the procedures to cater for this situation. He suggested that the College raise the matter with state governments which may result in the issue being discussed at AHMAC level.
9.5 PEI Payments
Ms Cahill notified members of a problem with processing of some PEI payments due to an unintended consequence of a legislation change some time ago. The Department has put a 3C Determination in place which will resolve the issue and payments will recommence shortly.9.6 E-Health
Members advised that the AAPP paper on e-health has gone forward to the Department for consideration.Action: The paper will be included on the agenda for the next meeting.
10. Guest Speaker – Professor Leslie Burnett
Prof Burnett provided an update on recent NPAAC activities and advised that the 3-year Strategic Plan is currently under review. As part of this review he has met with major stakeholders.He also noted that NPAAC is constantly reviewing all its 30 documents to ensure they align with international standards and to reduce any duplication, always with patient safety the primary concern.
He advised that the recently circulated draft supervision documents have been amended to take into consideration comments from stakeholders and in the follow up consultations after the revision there was general acceptance of the revised documents.
In response to questions about whether NPAAC considers the cost implications to industry of its standards, Prof Burnett advised that it does a cost-benefit analysis for all its standards and is acutely aware of the possible implications for the sector and for the targets in the funding agreement. As part of the consultation process, stakeholders are asked to comment on any potential cost implications of the standards.
There was some debate amongst members about potential workforce shortages and some members asked what role NPAAC has in relation to workforce. Prof Burnett advised that NPAAC has three main areas under its constitution: developing standards, providing advice to Government and advising on education issues for pathology. It is in the education area that NPAAC had completed a number of studies in relation to workforce shortages and has advised Government of the impending shortage within the senior scientific workforce.
Members noted their appreciation to Prof Burnett for his presentation.
11. Closing business
11.1 Clarification of in-confidence items
The Chair advised that only the data with EMSN is confidential. All other matters can be discussed with members’ organisations.The meeting closed at 2.15. The next meeting will be held on 19 April in Sydney and then on 8 August in Melbourne.
Action: The Secretariat to prepare a 2012 meeting schedule for PAAC and its sub-committees as soon as possible.
Summary of Action Items
Agenda 2.: - The Chair to write to the Pathology Associations Council advising it of the decision not to agree to its request for observer status on PAAC
Agenda : - The Chair to write to IVD Australia advising it of the decision not to allow it membership of the Finance Advisory Committee
Agenda 3 - A report on DHS’s discussion on the problems with data at the next FAC meeting will be reported to the next PAAC meeting.
Agenda 4 - Volume discounting to be included in the options for FAC to consider; Full minutes from sub-committee meetings will be provided at future PAAC meetings as well as a summary of recommendations.
Agenda 7 - DMAC draft Terms of Reference will be presented to PAAC at its next meeting for endorsement.
Agenda 9.6 - The AAPP e-health paper will be included on the agenda for the next meeting.
Agenda 10 - The Secretariat to prepare a 2012 meeting schedule for PAAC and its sub-committees as soon as possible.
