WA News Have You Heard? April 2017
April 2017
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By the Numbers

$151,160: HBF’s biggest single payout for a Cardiac Procedure (2015-16) in WA. It was for the implantation or replacement of cardiac defibrillator (with complications)
HBF paid out a total of $94,317,404 for 8239 episodes in the reporting period.

Source: HBF

Cardiovascular Disease (CVD) in Australia

• CVD accounted for 43,602 deaths in 2013, including 19,765 from ischaemic heart disease (the most single cause of death for both men and women)
• Ischaemic heart disease was the leading cause of death for Aboriginal and Torres Strait Islander (ATSI) people in all states and territories, with death rates up to 2½ times higher than the rest of the population.
• The PBS paid about $558m for cardiovascular drugs in 1993–94 (or 31% of all benefits paid in that year). In 2013–14, about
• $1.6b was paid out (or 17% of total PBS benefits paid in that year).
• Adults 30-65 years, 33% reported having been diagnosed with high cholesterol; 32% reported having been diagnosed with high blood pressure. Rates were somewhat higher in men than in women (36% vs 28%, respectively).

Source: Australian Heart Disease Statistics 2015, Heart Foundation & Deakin University

Voice from the trenches201704-system overload

In the light of the growing disquiet of staff at PMH, in particular, but perhaps at other WA Health sites in general, and the training dilemmas discussed on P20, a comment from a doctor responding to our latest e-Poll says so much. Here is an edited version of what this doctor had to say:
“At the present time there is quiet panic in government and the department of health about the percentage of the budget that is taken up by health care, which is rightly deemed unsustainable. However, there is a tendency to put in place blunt instruments (5% staff cuts etc) rather than the more difficult, targeted approach to areas of potential waste, rorting or areas of less clinical priority (but may be high political priority).
Consequently, adequate staffing is cut leaving less time for teaching and training as everyone is too busy, and there is not the opportunity for our young apprentices to be exposed to a range of post-graduate experience which will equip them to make sound career choices and make them sound clinicians. You cannot cut staff and expect teaching and training to flourish. [It saves money in the short term] but in the long term it’s extremely costly to the community…and a tragic waste of young doctors’ potential.
Quality consultants burn out and retreat to the green pastures of retirement or the perceived better environment of private practice where they may at least feel they have some degree of control over their professional lives. We have an ageing population, an increased number of medical graduates to educate and the Baby Boomer doctor generation, who worked incredibly long hours without (much) complaint, is getting old and tired. Generation X docs are on the way to disillusionment and burn-out and cannot replace the Baby Boomer docs.
So the malaise of our health care system of too little money, an increasing absolute and relative demand from our community for exceptional health care, failure of politicians to look beyond the next election, and [bureaucracy’s] inability to look beyond money, is leaving us in a very depressing position in public hospitals. For those of us who care about teaching and training, at the moment, it is hard yakka – clinically, emotionally and psychologically.”

Way to go: Cott to Rotto201704-dr rosemary quinlivan jan17

Mt Claremont GP Dr Rosemary Quinlivan threw herself into the deep end on February 25 and found herself battling some tough conditions for the Rottnest Channel Swim but with the help of support crew skipper Dr Tony Tropiano, paddler Brendan Reed, Tony’s son Mike Tropiano (co-skipper and relief paddler) and Anne Phelan (nutrition and drinks). Dr Pam Hendry, whose Ladybird Foundation – and the ROLLIS project in particular – is the recipient of Rosemary’s fundraising efforts, reported that Rosemary finished 27th out of 63 female solo swimmers and in the top half of all solo swimmers who completed the crossing. “She was initially a bit disappointed that her time (7 hours 35 minutes) was 45 minutes slower than her previous solo time until she spoke to others in her swim squad who came in quite a lot slower,” Pam wrote. At the time of press, Rosemary had raised $9030 on the supporter’s page.

GPs bite back

On March 4, the Australian GP Alliance (AGPA) held its first meeting at the Stamford Plaza at Sydney Airport for a contingent of 75 independent general practice owners from across the country – eight from WA – seeking action and redress on a range of issues. The pathology rental issue is one but the discontent courses over MBS reform, the PIP redesign and practice management issues. The deputy chair of the alliance is Kalamunda GP Dr Sean Stevens who told us that 46 actions were voted on across nine topics. How they will push for change will be explored in later issues. The meeting attracted attention outside of the AGPA membership. We believe both the AMA President Dr Michael Gannon and RACGP president Dr Bastien Siedel addressed the meeting calling for unity.

Local grads stay bush

With the start of the new academic year and a new era in medical training dawning with the opening of the Curtin Medical School, scrutiny around graduate and post-graduate training has intensified. Our e-Poll correspondent (see Voice from the Trenches) and the story on P20 will attest the need for some serious and creative rethinking in the way doctors are equipped to meet their own needs and the health needs of the community wherever they may be. WAGPET CEO Dr Janice Bell told Medical Forum that new data shows that the nett increase in GPs in remote and very remote areas over the past five, 15 and 30 years have been Australian medical graduates (AMGs) not international medical graduates (IMGs). It certainly blows away the idea that only IMGs are prepared to practise in far-flung locations. Having safe and quality locations to live and work is making a difference and Janice says a lot of the credit for that must go to the Rural Clinical School. “The RCS has created these quality places in which to teach medical students and that has attracted registrars and consultants to areas that would otherwise be overlooked,” she said.

Fees and performance

Health consumer advocates are calling for action around transparency of specialist fees after the publication of an analysis of Medicare billing data by Melbourne University’s Gary Freed and Amy Allen, which shows significant variations in out-of-pocket costs. Costs of initial consultations were particularly under scrutiny – the pair found fees could vary more than five-fold in some specialties. The most expensive initial consults, which could result in out-of-pocket costs of more than $128, were in immunology/allergy. The CEO of the Consumers Health Forum Leanne Wells wants to see an “independent and authoritative” website to list fees and ultimately data on the performance of specialists. Rob Bransby suggests on p12 this is only a matter of time. AMA President Dr Michael Gannon told MJA InSight that where patients were charged gap fees for private services, it was often because insurers paid substantially less than the AMA recommended fee and disagreed with the contention that Australia had “a massive problem of excessive specialist fees”. He also warned that the push to publish individual specialists’ performance data could backfire. “If, for example, we were to start publishing reports on rates of wound infection or venous thromboembolism after surgery, you would very likely see surgeons refusing to provide care to obese patients,” he said.

Putting on the squeeze

We received an email from Brisbane-based Pericoach, which is offering $50 to practices or practitioners for each patient referred by them who purchases its perineal exercise device. This PeriCoach Professional Referrer Program has resulted in about 15 WA physio practices registering on its website. It has cast its net wide with GPs and specialists within Australia, the US, Canada and UK registering. If it sounds like a kickback, the $50 is in form of a ‘credit’ paid by PeriCoach to the practitioner’s charity of choice.

PBS’s dazzling numbers

Based on PBS and RPBS prescriptions for the 2014-15 year, the NPS has released its ‘Top 10’ count. Atorvastatin is top of the list for daily doses consumed (combined or alone) and script counts (7.8m) but doesn’t even rate in the top 10 for cost to government. Instead, still under patent protection at the time, adalimumab (with 176,000 prescriptions) was the most costly ($312m) to government. The top 5 expensive drugs (relatively high cost with low script numbers) were all on patent at the time without generics available. Rituximab, classed as an antineoplastic and immune-modulating agent (injectable for treatment of non-Hodgkin’s lymphoma), was arguably top among these with just 46,763 scripts at a cost of $156.6m.

Future Fund, future research

Given the scale of Labor’s landslide victory at the WA election and perhaps the budget shocks to come, election promises might be a bit rubbery. Along with Medihotels, the now Premier Mark McGowan committed his government to a $1.1b Future Health Research and Innovation (HRI) Fund. The proposal would ‘repurpose’ the current WA Future Fund’s annual interest of $35m to health research, particularly research into cancers, child health and “other diseases in which WA has an international standing”. An actuarial board would be appointed to oversee it. Not surprisingly, Prof Peter Leedman, from the Perkins Institute, and Prof Jonathan Carapetis, from Telethon Kids, welcomed the news. Now to see it come to fruition!

Definitions under scrutiny

Also on the subject of research, Dr Ray Moynihan, from Bond University, has been awarded a four-year NHMRC fellowship to investigate expanding disease definitions and over diagnosis. He cites three areas – the expanded definitions of gestational diabetes, chronic kidney disease and ADHD – that will form part of his examination.