Privately referred non-inpatient agreements

AMA (NSW) recently received several queries from VMOs and HMOs regarding Privately Referred Non-Inpatient (PRNI) licence agreements to provide private services to outpatients in public hospital clinics. It is important that proper contracts are in place to protect the VMO from any issues regarding improper Medicare billing.

The National Healthcare Agreement between the Commonwealth and State Governments does not prohibit the establishment of private patient clinics at public hospitals, provided that the following conditions are met:

• Public patients must be provided with the same access to services as private patients
• Where care is directly related to an episode of admitted patient care, it should be provided free of charge, even if the consultation takes place in private rooms
• Emergency department patients referred to an outpatient clinic must not generate charges against the MBS
• Referral pathways must not be controlled to deny access to free public hospital services, nor controlled so that a referral to a named specialist is a prerequisite for access to outpatient services.

When a patient presents to an outpatient clinic at a public hospital, and provided that they have not been referred directly from the Emergency Department, the patient has the choice as to whether they wish to be treated as a public patient or a private patient. If a patient opts to be treated privately, they must produce a private referral naming the doctor by whom they wish to be treated.

When agreeing to participate under a PRNI model, a VMO should note the following:

• Participation is purely voluntary, and the VMO may terminate the agreement by giving the requisite notice, eg 30 days’ notice
• The VMO has the responsibility of ensuring all privately referred non-inpatients are referred to him or her by name. A referral to the clinic is insufficient
• The VMO must ‘bulk bill’ the patient and the patient must not incur any out-of-pocket expenses
• Consistent with commercial arrangements, the VMO is expected to pay a facility fee for the infrastructure and resources used
• The VMO may use their own professional indemnity insurance or opt for coverage by the Treasury Managed Fund (TMF)

AMA (NSW) encourages NSW public hospitals to engage VMOs using the Standard Licence Agreement in NSW Health document GL2009_008.

Northern Beaches Hospital Inquiry

The NSW Upper House has established an inquiry into the operation and management of the Northern Beaches Hospital. Areas of review include (but are not limited to):

• The contract establishing the hospital
• Ongoing arrangements for operation and maintenance
• Standards of service provision and care
• Staff arrangements and staffing changes
• The impact of the hospital on the surrounding communities and health facilities
• The merit of public private partnership arrangements for the provision of health care

The inquiry will not be conducting investigations or reviews of individual cases. AMA (NSW)’s submission will be publicly available on the Parliament of NSW website. Hearings were scheduled to commence on 26 August 2019.

After consideration of the evidence, the Committee will prepare a report including findings and recommendations. The report will be tabled in the Upper House for debate. The Government is not required to implement recommendations but must explain what action, if any, it will take in relation to each recommendation.

Further information is available at www.parliament.nsw.gov.au/committees. Should you be invited to attend the hearing, you may wish to contact AMA (NSW) and your Medical Defence Organisation for an understanding of the process and your obligations to attend and to answer the questions put to you.