Looking behind the curtain

The reality of medication reviews is a program full of band-aids and add-ons, argues Karalyn Huxhagen

When Home Medicine Reviews (HMRs) were launched, we were promised interactive programs with GPs and patients to improve health care.

Those of us that took on that challenge had to upskill, spending a lot of money on becoming accredited, staying accredited and jumping through more hoops than anybody else in the profession to keep practising.

We were given pittance to perform an important role that has a lot of research behind it, to prove that we can make a difference to patient health with this service.

Every year the two payments – HMR and RMMR – gain CPI increases. It is a trickle of improvement.

Payments such as travel allowance have stayed at their original price while fuel, costs of maintaining a car and accommodation costs have skyrocketed. Some of the towns I visit can cost $200 a night or more in a poor-quality hotel, as they service the mining community and know they can charge a high fee for a substandard room. The reality is that I can rarely get a room anyway as mining comes first.

The money certainly does not entice anyone to this role. If you perform this role it is because you love the work, love the collaboration with the prescribers and feel you make a difference.

It has taken me 23 years to build my business to the level of respect and professional collaboration that I share with general practice in Queensland, from Biloela to Bowen and west to Springsure. You could fit Tasmania in my working territory.  I regularly take calls from GPs in more remote locations wanting me to visit but I am already stretched too thin.

Over a three- to four-day period every two to three months, I travel thousands of kilometres to see 20 patients in that month. The cap has ruined my business model more than anything else that the CPA program hackers have done.

When you travel these kinds of distances you can see eight patients a day and cover off on far more requests than 20 per month.

Now as the Pharmacy Programs Administrator (PPA) announces that it is starting to audit the programs and will be tough on rorters, I have taken time to ensure I have not missed any program changes because the last thing I need is to inadvertently have my claims rejected.

The review of my practice has led me to acknowledge another casualty of the cap system. When I receive an HMR request I must action that request within 90 days of the referral being written by the GP. That rule was fine when I could perform as many HMRs as I had in my inbox. That rule is no longer viable now that I can only see 20 patients a month.

On any given month I receive 20 referrals from each of the practices that I provide services for, plus referrals from at least five pharmacies who use my services. At last count I service 20 general practices which in turn multiplies to 80 GPs plus five regular pharmacies. On any given 1st of the month there are 90 referrals to be actioned in my in-tray.

I hear you say: “Share the work.” I do if I can find quality pharmacists wanting to “go west, young man” and perform the work. I share where I can, but only with those who perform the task at a standard that I am happy with.

So here is the dilemma: referrals for medication reviews last 90 days from writing. GPs are up in arms about having to redo HMR referrals that have expired simply because I could not get to the patient in a timely matter due to the 20-patient restriction. Meanwhile referrals they write for all other allied health practitioners last 12 months from the date of writing.

I hear you say: “if we make the time longer the information will be out of date” …so what? I am in the patient’s house with their latest medications and I update the information as part of my role.

Often the referral has so many discrepancies that timely access to a GP print-out will make no difference at all.

These GPs want to vent their anger at this system that has put restrictions of trade on their ability to assist their patients. They do not understand why the caps are in place. When you put restrictions such as caps on services in place, please look at the knock-on effect of the program detail.

The 90-day referral time was put in place to ensure the patient received a timely medication review. It is not the pharmacists that cannot meet the timeliness ideal situation, it is the restrictive trade practice of the caps that prevents the demand for service to be met.

Let me just add that the practices that I provide services to are not the ‘quick buck for service’ GPs. I weeded those out long ago and only provide services to practices where the GPs use my work constructively to improve their ability to provide excellent primary health care. I receive a return rate of medication management plans from GPs that is exceptional in terms of quality and timeliness.

So, a message to the CPA negotiating team: please think like a GP for a moment when you are reworking these rules once again.

Having a cap of 20 HMRs per month and 90 days to service every HMR referral is not providing the outcomes that the program is designed for. If we had an HMR pharmacist embedded in every GP practice, clinic and pharmacy across Australia then maybe it would work.

The reality is, for the pittance that we make delivering this program, there will not be a ground swell of newbies coming out to help. I am told caps are here to stay due to program funding limitations etc.

Fine, I will accept this even though it sticks in my craw – but let us relook at the reality of the other rules impacted by capping and adjust such things as the ‘timeliness’ rule.

Karalyn Huxhagen is a consultant pharmacist based in Queensland.

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