Tuesday, November 02, 2010

Broadband Nurses to Lower Medicare Cost

From 1 November 2010 patients can claim on Medicare when
examined by suitably qualified nurses
. The nurse can examine a patient on their own (without a doctor), write some prescriptions and referrals.

What might be useful is nurse practitioners linked to doctors by broadband. A nurse practitioner could record the patient history and make an examination. Then, where necessary, the nurse could contact a doctor online. The patient details would appear on the doctor's screen along with live video. The doctor could then make a quick assessment. In most cases they would simply confirm the nurse's diagnosis. But they could request further tests, write a prescription, or ask the patient to come in person.

As the nurse practitioners can now set up practice for themselves, this could change the balance of power in the medical profession and lower costs. Most visits to the doctor would be eliminated. The nurse would be the one the patient goes to see and so the nurse would decide if patient needs to see a doctor and which doctor they will see.


Unknown said...

And how exactly does the doctor get paid for offering the service to the nurse and patient in the scenario you describe?

Tom Worthington said...

Blogger Rob said November 03, 2010 9:33 PM:

>... how exactly does the doctor get paid for offering the service to the nurse and patient in the scenario you describe?

Most of the doctor's consultations would be less than a minute and for these it would likely be covered by the Nurse paying the doctor on contract.

Longer consultations would be covered by current Medicare arrangements. There is now provision in Medicare for doctors to examine patients online. So the Patient (and Medicare) would be charged for two medical consultations: one by the nurse and one by the doctor.

If more medical practitioners were called into the video conference, for example a specialist, they would also be paid.

That may sound complex and expensive. But the data and billing could be done online and having the doctors being able to quickly confer on the patent's case could save a lot of necessary lengthy separate consultations.

Unknown said...

Your claim that Nurse Practitioners will lower health costs is one that is open to debate. Some papers have shown that the cost saving of the nurse's lower salary is offset by the fact that they perform more tests, refer more and see less patients.

Your other claim that NP's will take over most medical consultations is somewhat optimistic and not the experience overseas.
NP's, by definition, have a restricted scope of practice, and can only manage problems in a narrow focused area (eg wound care, Diabetes).

They certainly may contribute to increasing capacity in the health system, especially in some need areas (eg rural, aged care). And rebates for online consultations may increase their effectiveness. But their numbers (about 400 odd) in Australia mean this will be limited, especially as most NP's are currently employed in tertiary hospitals in major cities.