'Beyond Bricks and Mortar - Building Quality Clinical Cancer Services' Symposium 2011

Experiences of a Regional Radiation Oncology Provider in Queensland - Associate Professor Michael Poulsen

Up to Radiation Oncology

prev page| TOC |next page

Director Radiation Oncology Mater Centre Queensland

Download powerpoint presentation by Associate Professor Michael Poulsen (PDF 1223 KB)

Introduction by Norman Swan:

So let's get another perspective from Queensland from Michael Poulsen, who is Director of Radiation Oncology at the Mater Centre in Brisbane and Director of Radiation Oncology Queensland which operates the facilities from Toowoomba through to Cairns.

Associate Professor Michael Poulsen:

Okay, look thanks Abel for the invitation to present and share with you some of our experiences from developing regional cancer centres in Queensland.

From the outset I think we should ask ourselves a question – what should a regional cancer setup offer? Well first and foremost I think we should be looking at integrated cancer care. Integrated cancer care is quite different to multidisciplinary care. I’m talking about not only sort of integrating the care between the medical oncology, surgical teams and radiation oncology teams but also how we’re going to sort of cross from the public sector to the private sector. As well as how we interface with the community. Multidisciplinary care is obviously critically important in terms of managing complex malignancies and within our centre at Toowoomba and the Toowoomba Base Hospital we operate MDM’s for head and neck cancer, there’s a combined colorectal and breast cancer clinic and in Cairns we’re also running MDM clinics for the common malignancies such as breast and lung.

These MDM clinics, as Shoni alluded to are, the data is entered into the QOOL data repository so with time we’ll be able to look at some outcome data comparing our services with the state.

I think it’s important to realise that the different centres have got different needs. The Toowoomba Centre is a regional centre, there’s a high level of health insurance of 60% and it drains quite a large area all the way from Northern NSW up to Bundaberg. A lot of our patients commute still. Although it’s a regional centre about 30% of our patients will be commuting to the centre. So that’s certainly an area that needs to be addressed.

In North Queensland the social demographics are quite different. Ten percent of our population is indigenous, there’s a much higher proportion of lower socioeconomic groups. So the model has to fit with the site. There need to be appropriate safeguards in place to ensure quality. The Toowoomba Centre has been fully accredited for three years with ACHS and it is a very rigorous process to get through that. It’s also important to look at how we develop our staff, how we make it attractive to recruit staff and how you retain them. And I’ll talk a little bit about how that has happened. And I think a regional cancer centre, there’s no reason why we can’t participate in research. And we developed a not for profit organisation called the Toowoomba Cancer Research Unit which is involved in participation in a number of TROG trial and drug related trials and is also the host centre for a phase three randomised trial looking at two dose fractionation schemes for prostate cancer. And once again the expertise at the Toowoomba site was pivotal in implementing the QA program for this highly complex trial which included fiducial markers and IMRT and IGRT. So it can be achieved within the rural setting.

For the community – what are the big advantages? Well for the patients the obvious one is they don’t have to travel anywhere near as much and this is a huge bonus. The amount of positive feedback we get from the patients who are just so relieved that they don’t have to negotiate the traffic of Brisbane, they don’t have to negotiate little things like, a lift to get up the floors. Things we don’t even consider as an issue. Parking, once again, the recurring problem of parking. There is far less impact in terms of the social upheaval, financial upheaval of moving to Brisbane. One thing we don’t think about is the carbon footprint. Now funnily enough we did some back of the envelope calculations after the first five months of operation when we’d treated 170 patients. And remember Toowoomba is only about an hour and a half from Brisbane so these patients used to commute on a daily basis. So after five months of operation they had saved 897,000 kilometres in driving which is equivalent of going from the Earth and Moon and back again. We should be getting some carbon credits for that I think.

So what are the challenges for us? Well there are many to get your teeth into, and I’ve listed the major ones here. I’m just going to talk briefly about that. Legal agreements – no-one’s talked about this but there’s a huge amount of effort that goes into the complex legal agreements and strangely enough this is often the rate limiting step. You can have a building design, built, linear accelerator installed, commissioned and the lawyers are still arguing about the details of the legal agreement. It’s absolutely amazing but it is an essential component of this complex thing.

Communication processes and how we move information, not only within the organisation but outside the organisation, is critically important and we’ve invested a lot of time and effort in developing a department that operates between Cairns and Toowoomba so we can view patients, the records and treatment plans at either centre. Developing workable partnerships is a really important thing. These partnerships are not only between the private sector and other private operators but with the public health facility. We are very fortunate with our initial operation in Toowoomba to have St Andrews Hospital which is a not for profit organisation. They bent over backwards to work with us, to assist us initially in things like managing payroll. All of these things that we were quite unfamiliar with and with time we’ve taken over responsibility with that.
Top of page
We shared joint positions in senior nursing roles which operated across the Day-Care Oncology unit and the Radiation Oncology unit. So these are really important things.

Brand name is the other important thing. How do you define your organisation? How do other people outside the organisation perceive you? Because this is going to be really important when you start to recruit staff and having and convincing the people in the organisation to believe in the organisation, go that extra mile for the group is really important and we’ve invested a fair bit of time and effort and I’ll talk a little bit about that.

Regional infrastructure – that’s been mentioned a number of times. These peripheral centres, not so much Toowoomba but Cairns, you can have a u-beaut department with all the bells and whistles but you might struggle to get a CT scan done in a timely fashion. A PET scan has to be done down in Brisbane. So when you sort of fill out the forms someone has to organise the flights, co-ordinate it, get it back, retrieve the result. If you want a Thoracic Surgeon to review a patient it’s down to Townsville. And you’re constantly chasing up information trying to pull it together. So these are great challenges.
The strengths of the private sector are listed here. There’s far less bureaucracy within the private sector so I think it’s true to say that we can get things done in a very timely fashion. For instance, in the Cairns Centre we were notified that we were the successful tenderer in November last year, the Department is operational by June this year and after a month we’ve treated 38 patients. We’ve got IGRT implemented, IMRT implemented, Rapidarc implemented. So I think this is a huge advantage. We can move quickly and seem to be able to cut through a lot of the red tape that we struggle with in the public sector. The other big advantage in the private sector, we can link input with output. The busier we get the higher the revenue stream comes in you can put on more staff. You can extend the treatment day.

Public sector we really struggle with this. The pot of money is fixed, 5% increase in workload there’s not a 5% increase in money. In the private sector we have the ability to offer attractive work packages. It may not necessarily just be salary, it may be flexibility in time, it may be professional education packages. And we’ve also got the autonomy to go with the new technology and once again this is important. One of the important things to make it attractive for particularly the radiation therapy staff and physics staff is to work with up to date equipment.

There are a number of perceived weaknesses in the private sector. One of the ones is this fixation with maintaining the bottom line. Now unquestionably this is a critically important thing when you carry the financial risk of running the organisation and you want to ensure that it’s viable. And there is a critical tipping point in radiation oncology – once you drop below a critical patient number the business is running at a loss and the banks will be after you. So it’s really important to make sure that you’ve done your numbers right and there will be sufficient patients using the service. Integration with other providers is challenging and a local community hospital you have to look at how you’re going to service private patients and public patients. And there’s going to be mixed social demographics and you’ve got to have a system that is able to accommodate the vast majority of them.

Participating in research is one area that has traditionally been not a strong point of the private sector and I’ll give you some evidence to the contrary with that. Participating in training new staff - at Toowoomba we have two PDY students so they participate in a professional development year. We have a fully accredited position for a Radiation Oncology Registrar at the Toowoomba Centre for one year and we’ll also be taking on a Physics Registrar. And these are important, not only things to stimulate the other workers in the environment to participate in teaching and helping others, it is a valuable work source when things get busy.

There are different models for different regions and I think I’ve alluded to this a little bit. Toowoomba is a private centre in a private hospital that’s located about 10 minutes away from the public hospital. When it was designed we looked at the fee structure so that public patients could be treated for either the Medicare Schedule fee or the Medicare rebate, depending on their means and the fee structure is linked in, tied in with the Commonwealth Agreement. There is a service level agreement with the public hospital so that public inpatients can be treated at the private hospital. The Cairns model is quite different because it reflects the social demographics. It’s a partnership with Queensland Health. Queensland Health own the building and we operate the treatment floor only. All the outpatient facilities, the MDM’s, the ward rounds and the teaching come under the auspices of Queensland Health with a VMO Agreement. And to date it’s working very well.

The legal agreements – they’re very complex because they involve agreements between the operator and the collaborator, between the Commonwealth and the collaborator and often other people such as if you’re outsourcing your CT planning to a private operator, another agreement. So you’ve got to be very patient with it, you’ve got to pay out significant amounts of money for the legal contacts. And the photograph is Dr Ramsey signing off on one of the Shareholders Agreements and that was the paperwork that was sent through. That was for one agreement.

Good communication is critical to the smooth, safe and efficient running of the department. A paperless department has gone a long way towards helping us achieve that and we’ve got a 10 megabyte per second fibre optic link between Cairns and Toowoomba. There are not only efficiency savings but there are financial savings for operating the paperless record. In Cairns we run MOSAIC up in the outpatient area which is a legacy from the previous outpatient clinics, great program. On the treatment floor we’re running ARIA. So you’ve got two different oncology information systems that have to be linked. So, having that done is really important in terms of the smooth running. We’ve also got to look at how we communicate with areas outside the organisation. That may be other providers in the private sector or the public sector and also we are involved in allowing our patients access to communication and we participate as we heard yesterday in the Stay in Touch program where patients are given a laptop for home and the location site so they can keep in contact with their love ones.

Environment and morale is something that we’ve invested a significant amount of time and energy in, and I’m a great believer in creating a positive work environment because it’s a sound investment in the most important part of the organisation, that’s our staff. We’ve run a number of workshops involved in improving resilience and improving work life balance. All of our staff have taken the VIA Signature Strengths Questionnaire so that they know what their core signature strengths are and we try and encourage them to develop goals related to their signature strength. We’re also great believers in positive feedback for a job well done and our CEO, Mark Middleton and Jim Francis, they’re just exemplary examples of things that come naturally to them, very encouraging to the other staff members and very supportive. The staff are all encouraged to extend themselves and they regularly present at national presentations and sometimes international presentation and many of them find this challenge an enormous sort of improvement in terms of engagement in their work.

A successful cancer care unit depends on developing and nurturing many key partnerships. In Toowoomba for instance, as I said our senior nurse, we shared with the St Andrews Hospital between the Day-Care Oncology and the treatment floor and this has really helped us integrate those two services. We also have to look at important partnerships within the community. Not only the local Cancer Councils but we were involved with a number of philanthropic groups who came to us and sort of said “What can we do to help?” And one of the novel things we did was to get one of the local philanthropists to fund our PDY students. These were local Toowoomba students who came through the organisation, they were funded by the local philanthropists and they’re now working with us. So this is a great investment back into the community and I can commend other regional centres to look at strategies such as this. We also have another person fund our annual research day which is a day we set aside for in-house presentations and workshops.

The financial success of the Radiation oncology practice depends very much on getting sufficient numbers through and filling the machine. The cost of the machine is fixed, the maintenance contracts are fixed, and the staff costs are fixed. So, if you don’t have the machine full the financial bottom line does look pretty appalling. And there is a critical tipping point between making a profit and making a loss. So understanding where your referral base is coming from is really important. You’ve got to analyse where the referrals are coming from and you’ve got to try and find out where the gaps are to try and see if it can be improved.

Now for instance, our drainage includes several local towns such as Warwick, Stanthorpe, Goondiwindi. Many of those patients will still go to Brisbane and after two years of operation we did an analysis in Brisbane and still found that there are 100 patients with postcodes in that region that were going to Brisbane. So how do you address that? Part of the problem is relatives will more likely to be located in Brisbane. You can’t do anything about that.

The other problem is you’ve got to educate the local surgeons as to there is service in Toowoomba because often they’ll come to Brisbane for their surgery, need radiotherapy, they’ll get a local radiation oncology consult and it’s never brought up that the patient can have treatment locally. So minimising leakage out of the area is an important thing. And likewise developing your brand to say that yes this is a department, it’s up to speed, we’re doing lots of new and sexy things, we’ve got great equipment, participating in research, very important. A majority of regional cancer centres in Australia with two linear accelerators will be limited just by the population numbers to about a machine and a half load of work. It’s like the Cadbury factor, a glass and a half. So because the outgoings of your operation are fixed it’s really important to make sure that both machines are kept as busy as possible. And it’s something you’ve got to consciously work at if it’s going to be viable. There’s a risk of professional isolation when working in a cancer region. So consequently, you’ve got to go out of your way to look at professional development. Now we’re involved in some head and neck cancer trials as you can see, up there. And we’re involved in prostate trials, breast trials and a number of drug trials. We support all of our staff right through from the administrative floor through to the Radiation Therapists, Physics and medical staff to go on annual conferences to up-skill.

Engagement in an active research program has been achieved by developing the Toowoomba Cancer Research Centre and we looked at a six month audit in the Toowoomba Centre compared to one of the large Brisbane Hospitals and we’d actually entered more patients in the clinical trials than some of the large Brisbane Hospitals. During the four years of operation we’ve published 19 peer reviewed articles in journals and the staff have put an enormous amount of investment in presentations at various national and local meetings.

Radiation oncology relies on the comprehensive medical infrastructure, and this isn’t always easily available in regional centres. For instance, in Cairns our radiology service is run from Adelaide so we have a Radiologist we’ll fly in for three days and then they’re gone. And so you don’t always have that luxury of taking up a CT and sort of running it past the Radiologist. There are other limitations in terms of the surgery and medical oncology needs. We’ve got one Medical Oncologist in Cairns. When she goes away on leave there’s a delay, no new consults get seen. And this delays the progress of the patient through the system. Surgical services often have to be outsourced to either Townsville or Brisbane.

I think with time though, with the availability of a regional cancer centre this will change and it will make it more attractive for some of these specialist services to come through to the regional centres. There are several assumptions that are out there about the private sector: they treat with more fractions, they milk the system, the staff carry much heavier workloads, they only treat breast and prostates, you know the money for jam type things. They don’t get involved in the complex cases, they’re not interested in participating in research, they’re not interested in training staff. So, to that end we actually did a six month audit in 2009 I think it was, looking at a whole number of parameters within the organisation and comparing it with a Queensland Health facility in Brisbane. And we published this in the Journal of Medical Imaging and Radiation Oncology. And what it showed is, just using some very simple metrics the case load curative/palliative, very little difference. The case mix very little difference. Breast and prostate make up the lion's share of your work. There is about a 10% of patients will involve complex cases such as head and neck malignancy at both sites.

The field fraction number and overall treatment length, very similar in both centres. Not much to pick. The cost per treatment course was also available. Now this is interesting data because you’re able to look at the total cost of your unit and the total number of treatment courses and work out the cost per treatment course. And within the private sector it’s about 13% cheaper per treatment course. Now, a lot of this relates to staffing costs. In the private sector you don’t have the luxury of having all the allied health staff, you know, speech pathologist on call, OT’s, dieticians and psychologists, that’s part of the thing. And also the case mix, not the case mix but the staffing per machine is a little bit tighter. But these are real savings when you look at the merits of what sort of model. And this is another thing that is rarely done. If you look at an average treatment course and work out what the actual costs were according to what the patient pays, what the State pays and what the Commonwealth pays, there is a huge difference. Now the Commonwealth costs are pretty much the same because that relates to the Medicare Schedule. And what you can see – the States are the huge winner here because in the Toowoomba Centre they’re only paying for the cost of inpatient radiation oncology services. They pay nothing towards the cost of a standard outpatient treatment, which makes up 95% of your workload. And that equates to a 30% difference in total costs.

As far as research is concerned, we believe that it is achievable to look at an active research program within the private sector and within a regional sector. Research is an enormous catalyst to providing extra challenges to the staff, which I believe and the evidence suggests that it improves general wellbeing, increases productivity and improves the organisational culture. Patients also appreciate having the availability of access to clinical research and I think we’ve been able to demonstrate that this is achievable.

So, this is the new centre in Cairns and you can see that there are enormous hazards to developing regional cancer centres. You can see coming in from the West is a nasty looking storm, coming in from the East are crocs and box jellyfish and god knows what. But it is achievable and it is workable. These challenges can be met with careful planning, good communication and the net result is one that will be embraced by the local community. There is absolutely no doubt in my mind that it’s a worthwhile exercise.

So in conclusion, I think that regional cancer centres are viable. As I said, they can deliver multidisciplinary care and it is deliverable for many of the common malignancies. Infrastructure – a big challenge. Legal agreements – complex, expensive, you’ve got to be patient with them. Important to market your organisation, look at where your referrals are coming from. And you actually have to extend yourself and go out to some of these regional centres to make sure that you’re getting out there to the local communities. Brand name – how you see yourself. How the organisations sees itself and working at stimulating your staff and keeping them are all very important. And the other thing you’ve got to do is you’ve got to look outside the organisation. There’s a lot to be learnt in terms of organisational management from other industries which are applicable to radiation oncology.

So I’d like to finish there. I’d like to acknowledge all the great members in the ROQ Team. We call them the Rock Stars, they actually make us look good though and some of them are here today so thanks very much.
Top of page
Norman Swan:

Thanks Michael. So you’re different, excuse my ignorance, but you’re different from a normal private radiation oncology practice because you’re providing a much greater range of services. You’re more of an (inaudible) cancer service.

Assoc. Prof. Michael Poulsen:

It’s the same as any other private operator – you’re a company but I guess our role in the Cairns Hospital is we’re a private operator working in a public hospital. It’s a little bit different in Toowoomba, we’re a private operator in a private hospital but we’ve had a community focus and sort of say “Well, you know, this service is for everyone”.

Norman Swan:

But you’re being paid by the Commonwealth to be regional cancer centre aren’t you?

Assoc. Prof. Michael Poulsen:

The Commonwealth paid the start up money. So they put the money on the table…

Norman Swan:

So they’re expecting more from you than radiation oncology aren’t they?

Assoc. Prof. Michael Poulsen:

They’re expecting us to provide a quality service at an affordable price and the pricing is locked into an agreement between the Commonwealth and us. So we can’t (inaudible) go out there and sort of price gauge.

Question (unidentified male):

Ah, thanks for that presentation Michael. Just two questions – having probably received the contract in November for the Cairns, have there been any issues with the actual design moving in with probably no input into that design having sort of gone in there and I guess the second question is how have you gone about integrating with a tertiary hospital, being a very regional place in Cairns starting up a new service?

Assoc. Prof. Michael Poulsen:

Sure. Great. Obviously the hospital was well underway, the cancer centre was well underway to being built by the time the tenders had been issued, and fortunately we had the expertise of our colleagues in Townsville who are very much involved in the design of the building and they did a fantastic job. It’s, you know, that very generous proportion. It’s future proof, we’ve got three bunkers there, two machines. So we’re very lucky in that regard, they did a great job and they had sensible input in terms of the design. Now the second part of the question was?

Question (unidentified male):

Integrating with the tertiary hospital?

Assoc. Prof. Michael Poulsen:

Integrating with the tertiary hospital – once again we have regular meetings with the tertiary hospital. We’re working in the Department shoulder to shoulder with them, remembering on the outpatient area we’re a VMO working the outpatients, the Medical Oncologists is beside us, the Haematologist is across the way, Allied Health are right on the floor. So there’s nothing sort of tattooed across our forehead saying we’re different from anyone else. At the coalface we’re just like every other sort of Queensland Health worker. So I think that model has some merit in terms of how that is able to be used in a sort of regional cancer centre. From the patients point of view it’s a no gap system.

Norman Swan:

So there's actually no gap in both Cairns and Toowoomba?

Assoc. Prof. Michael Poulsen:

No. No. They’re different models because:

Norman Swan:

So how does that work? So one patient comes in through the door from Toowoomba who’s a public patient gets bulk billed and then another patient who happens to have health insurance gets a gap but the health insurance doesn’t reimburse them for that.

Assoc. Prof. Michael Poulsen:

They do get some reimbursement through Medicare Plus. What we’ve got is very… In Toowoomba we’ve got a very defined billing policy. If they’re a pensioner or a health care…

Norman Swan:

I understand all that, I’m sure you’re fair about it. The fact is you’re disadvantaged by carrying health insurance in Toowoomba.

Assoc. Prof. Michael Poulsen:

There are patients there who will carry a significant financial burden where others won’t. That’s absolutely true.

Norman Swan:

Right. And this is a Commonwealth funded service.

Assoc. Prof. Michael Poulsen:

It’s a Commonwealth funded service. What happens in the public hospital – some of the public patients will carry a small gap payment as well. But the choice is, the choice is that they…

Abel MacDonald:

You’re getting the better of me Norman.

Assoc. Prof. Michael Poulsen:

... or they can have treatment in Toowoomba.

Norman Swan:

Abel has jumped to the microphone.

Assoc. Prof. Michael Poulsen:

Oh Abel.

Norman Swan:

Before I had stood on any more landmines.

Abel MacDonald:

I think it’s important to remember that radiotherapy is a Medicare funded service and does not attract… is not related to health insurance claims because it is traditionally offered as an outpatient service. I think the other component is that chemotherapy is offered as a day patient and/or an in hospital service and so can sometimes have the billing arrangements associated and attracting private health insurance arrangements. But I think part of what Michael is saying is it’s how those two different modalities are offered in a way that is seamless to the patient.

Assoc. Prof. Michael Poulsen:

It is ironic that there are different operations at two sites. But I guess, to be fair to Queensland Health…

Norman Swan:

That’s an unusual phrase that I don’t hear very often but anyway.

Assoc. Prof. Michael Poulsen:

The calls for tender for Toowoomba were for… it was always going to be a private operator there. For Cairns it was sort of open for all comers.

Question (unidentified female)

Dr Poulsen, can you tell us how in Toowoomba patients are acting under the model that you described there – patients are able to access the full gamut of the services that they require for their whole treatment journey. So, you talked about the luxury of allied health…

Assoc. Prof. Michael Poulsen:

Yes.

Question (unidentified female):

What about the allied health and the whole fabric of support that patients, as we’ve heard in the conference reiterated many times, patient require.

Assoc. Prof. Michael Poulsen:

So there are two scenarios that come to mind. The first scenario is the patient who’s had their preliminary management through the base hospital and they will be referred for radiation oncology. They will continue their ongoing support, allied support, psychosocial support through the base hospital and we liaise with them.

The second scenario is patients who are referred privately and haven’t gone to the base hospital and usually what we would do with extra things there, we would liaise with the GP and implement an extended care program so that they could access things like speech pathology, physiotherapy, dietician support and that would be done through the private sector and rebated through health funds and so forth.

So they’re the two scenarios and once again this sort of gets back to the communication. It is often challenging with, you know, it’s often a sort of phone call and liaison with the public hospital and that always doesn’t… we’ve got to physically enter that into our system so that it’s recorded and can be accessed by everyone.

Question (unidentified female):

So, just going back to your costing model there that showed that the private sector looked cheaper than the public sector – is that perhaps not correct because you’re sending your patients back to the public sector to get the other component of their care so the public sector actually is part of the cost of providing that care and is bearing that cost?

Assoc. Prof. Michael Poulsen:

Yeah, there are all sorts of potential criticisms that can be made with this thing…

Question (unidentified female):

No I don’t make it as a criticism. We have to compare apples with apples.

Assoc. Prof. Michael Poulsen:

It is quite complex but the area that we compared it to in the public sector didn’t include things like ward costs, pharmacy costs, radiology costs because they’re all outsourced to the Mater Hospital. So in that way it was comparable. Where it’s not comparable is in the allied health thing that we’ve got limited allied health support even in the public sector but it is funded in that funding model. In the private sector you’re absolutely right, that is not costed it is outsourced to the other, and as I said that may be accounted for in part that gap.

Question (unidentified female):

But is it correct to say that the private sector can do it cheaper?

Assoc. Prof. Michael Poulsen:

It is. There’s absolutely no doubt when you look at the total cost which is the community costs if you look at what patients pay, State pays and Commonwealth pays, there is a difference and the big saving is for the state governments.

Norman Swan:

And that includes Registrar training?

Assoc. Prof. Michael Poulsen:

Yep.

Norman Swan:

Elizabeth:

Question (Elizabeth):

Mike, integration is one of the keys for, you know, for us and many of us are involved in regional services and expansion of regional services. Cairns is not a tertiary hospital and I think we’re very interested in how Cairns integrates with a tertiary hospital. How your practice integrates with a tertiary hospital?

Norman Swan:

Yeah. So it’s a follow up to that previous question. So this is primarily Townsville you’re talking about.

Assoc. Prof. Michael Poulsen:

Townsville or Brisbane.

Question (Elizabeth):

Townsville or Brisbane.

Assoc. Prof. Michael Poulsen:

Yep. Well there will be some patients that have to be referred on and that would be done doctor to doctor as per any other referral. The integration there is no better or worse than if I was to refer a patient to Roger for Iodine 131.

Norman Swan:

And your data is transparent to QOOL?

Assoc. Prof. Michael Poulsen:

Yes. For the MDM’s. Any of the patients within MDM’s are entered into QOOL.

Norman Swan:

In Toowoomba as well as Cairns?

Assoc. Prof. Michael Poulsen:

Correct, yeah.

Norman Swan:

And just, you’re ownership structure is what?

Assoc. Prof. Michael Poulsen:

The ownership, there are three directors who direct the company. There’s a board of governors who meet four times a year but there are other shareholders within…

Norman Swan:

So you’re not a corporatised practice?

Assoc. Prof. Michael Poulsen:

There’s a unit trust… Once again it gets complicated. There’s a unit trust in Toowoomba and there’s a company structure in Cairns.

Norman Swan:

Right.

Assoc. Prof. Michael Poulsen:

But they’re different organisations.

Norman Swan:

So, what happens when the venture capital company comes to you and offers you the big bucks to buy you out but says you’ve got to maintain your income in order to, you know, to continue your salary. Such as happened to, you know, 80 cardiology practices now in the Heart Care Group. That’s fine to buy it out, you get your money but you’ve got to maintain your income through your earnings and that could pervert your noble cause.

Assoc. Prof. Michael Poulsen:

Within the contract with the Commonwealth there are clauses in there with who can sort of buy in…

Norman Swan:

Oh so you have limitations on your corporate structure?

Assoc. Prof. Michael Poulsen:

Yeah.

Norman Swan:

Any other questions or comments? That’s fascinating Michael, thank you very much indeed.

(applause)
Top of page

prev page| TOC |next page