7 April, 2020

Nurse practitioners, doctors and Medicare payments analysed

The collaborative arrangements that nurse practitioners are required to have with medical practitioners in order to receive Medicare-subsidised payments are analysed in the latest issue of Australian Health Review (AHR), the academic journal of the Australian Healthcare and Hospitals Association.

An author team led by Professor Mary Chiarella from the University of Sydney sought to clarify the arrangements in relation to collaboration, control, supervision and any reported difficulties in establishing and operating the mandated relationships.

‘Nurse practitioners are master-degree-qualified with a minimum of 3 years experience at advanced clinical nursing practice level’ said Australian Health Review Editor-in-Chief Dr Sonĵ Hall.

‘They are endorsed to prescribe medications, initiate pathology and diagnostic imaging, and refer patients to other healthcare practitioners. They often work in specialised areas such as emergency departments, cancer care, diabetes and heart failure.’

In 2009 the Federal government introduced limited access to Medicare and the Pharmaceutical Benefits Scheme for nurse practitioners, but only if they entered into a collaborative relationship with a medical practitioner or an organisation that employs medical practitioners.

The driving force behind the arrangements was to boost autonomous qualified medical services in under-served populations.

‘The authors report instances of doctor resistance to entering such relationships, for scope-of-practice reasons, as well as many doctors believing, wrongly, that the arrangement was supervisory with attendant legal responsibility’, Dr Hall said.

‘In addition, the clinical record-keeping requirements for nurse practitioners were seen as complex overkill, with little evidence that the records are audited in any way.

‘The available research literature shows nurse practitioners to be universally highly effective, with negligible patient complaints. The authors agreed with the Medicare Benefits Schedule Review’s nurse practitioner reference group that the collaborative relationship requirements should be scrapped.

‘This would seem to be the best way to solve the barriers and difficulties experienced, especially in our current COVID-19 pandemic where flexibility of medical services is at a premium’, Dr Hall said.

Other AHR articles published today include:

  • Serious misconduct of health professionals in disciplinary tribunals under the National Law 2010–17 (University of Technology Sydney)
  • Culturally safe and sustainable solution for Closing-the-Gap-registered patients discharging from a tertiary public hospital (Princess Alexandra Hospital, Queensland Health)
  • Priorities for improved management of acute rheumatic fever and rheumatic heart disease (University of WA, Charles Darwin University, University of Sydney)
  • Incident haemodialysis and outcomes in the Top End of Australia (Charles Darwin University, Royal Darwin Hospital, Flinders University Darwin, Northern Territory Department of Health)
  • Analysis of sponsor hearings on health technology assessment decision-making (Amgen Australia, Wonder Drug Consulting)

The April 2020 edition of Australian Health Review can be accessed here.

More information on AHHA is available at ahha.asn.au. This release is available online.

The Australian Healthcare and Hospitals Association is the national peak body for public and not-for-profit hospitals, Primary Health Networks, and community and primary healthcare services.

Media enquiries: Dr Sonĵ Hall, Editor in Chief, Australian Health Review 0427 613 587