Time to end needless repeat referrals to specialists

Tuesday, September 29, 2020

‘It’s high time that Australia’s referral system to specialist care was brought up to date—in the interests of patients and to meet management requirements for today’s ongoing chronic health conditions’, says Alison Verhoeven, Chief Executive of the Australian Healthcare and Hospitals Association (AHHA).

Ms Verhoeven was commenting on today’s release by the AHHA’s Deeble Institute for Health Policy Research of an Issues Brief, Optimising health care through specialist referral reforms.

‘When the Medicare referral rules were put in place in the 70s, most referrals related to acute conditions that could be managed within a 12-month period.

‘Now referrals are typically for management of an ongoing chronic condition—around 50% of Australian adults live with an ongoing health condition’, Ms Verhoeven said.

‘So the standard 12-month referral will expire during your ongoing course of treatment and you will be asked to go back to your GP to get another referral if you want the specialist appointment to be Medicare-rebatable.

‘If a patient is seeing more than one specialist, keeping track of the validity of all referrals can be a nightmare.

‘The reason often given for repeat referrals is “to keep the GP involved in your care”—but most specialists report back to the patient’s GP on the care being provided to the patient. And a GP can ask to see a patient when there is a clinical need for it.

‘Using a repeat referral to trigger GP involvement is not an optimal use of the medical workforce. And, typically, the appointment with the GP for a repeat referral will not change care provided by the specialist in any significant way.

‘After a patient sees their GP, and pays any gap fee applied, they go back to the specialist—and, because the rules are ambiguous, many specialists will charge a higher ‘’initial consultation” fee with a higher gap payment because it is a ‘new’ referral.

‘Our Medicare system is something to be proud of, but it is not a bottomless pit—so why are we paying professional fees for what in many cases is a mini-lap of the health system that is of little value to the patient, and over which the patient has little control?

‘A similar situation applies to specialist-to-specialist referrals, where the standard period of referral is three months. It’s easy to see how, say, a cancer patient receiving both radiation and chemotherapy treatment will have regularly-expiring specialist-to-specialist referrals.

‘A curiosity of the referral system is that while referrals from GP to specialist last for a standard 12 months, indefinite referrals are permitted, with regulations only requiring practitioners to consider the general “need” for such a referral.

‘In short, the rules requiring patients to obtain repeat referrals have remained unchanged since the 1970s. There are many arguments for changing these rules to having no time limits on referrals to specialists, expanding referral rights, collecting better data on referrals and referral pathways, regular reviews of the rules, and decoupling specialist billing from referral status—all as part of enabling better-coordinated continuous care.

‘But above all, it is high time there was an independent, evidence-based review of the whole referral system, to properly examine its costs and benefits, and bring it up to date to better suit consumer needs’, Ms Verhoeven said.

The Issues Brief can be accessed here.

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: Alison Verhoeven, Chief Executive, AHHA 0403 282 501