Monday, 22 February 2010
Health Insurance Amendment (Diagnostic Imaging Accreditation) Bill 2009
Debate resumed from 25 November 2009, on motion by Ms Roxon:
That this bill be now read a second time.
The Health Insurance Amendment (Diagnostic Imaging Accreditation) Bill 2009 seeks to broaden the existing accreditation scheme for diagnostic imaging to cover practices offering non-radiological procedures. Radiology services were required by earlier legislation to seek accreditation from July 2008. Diagnostic imaging is an expanding sector of health care and an important means of detecting and aiding the treatment of many health conditions. Differing imaging techniques are being used by a widening range of health practitioner groups in an array of settings. Around two-thirds of services are provided by private practices, with the remainder carried out in public hospitals. It is estimated that approximately 70 per cent of services are funded by Medicare. That amounts to several billion dollars of expenditure annually for around 20 million diagnostic imaging services.
Accreditation ensures that organisations meet defined safety and quality standards in the delivery of services. It allows for a process of external review of an organisation’s performance. It is recognised as a way of assisting the healthcare industry to improve systems to support the delivery of safe and high-quality health care through a continuous improvement process. It provides a mechanism through which government can be assured that services supported by Medicare are being provided by organisations that are performing against those standards. Accreditation schemes are widely accepted through the health sector as a method of reviewing and improving healthcare arrangements.
The coalition introduced legislation in 2007, the Health Insurance Amendment (Diagnostic Imaging Accreditation) Bill 2007, to amend the Health Insurance Act 1973 to establish the Diagnostic Imaging Accreditation Scheme. This scheme covered the providers of radiology services who were required to seek accreditation under a process begun in July 2008. At the time, the then health minister, Tony Abbott, foresaw that accreditation would eventually be extended to other diagnostic imaging procedures, and the legislation was designed to allow for the introduction of accreditation schemes for other diagnostic imaging services. The current government has decided to proceed with further legislation, and this bill will amend that 2007 legislation.
This bill will extend the reach of the accreditation scheme to all diagnostic imaging services provided to the Australian community. The initial stage of accreditation covered 2,700 practices providing radiology services which accounted for 80 per cent of diagnostic services covered by Medicare. This extension will bring another 1,400 or so practices under the scheme—those that provide non-radiology services such as obstetric and gynaecological ultrasound, cardiac ultrasound, angiography and nuclear medicine imaging. These practices account for another 16 per cent of imaging services covered by Medicare payments.
The extension coincides with the commencement of stage 2 of the Diagnostic Imaging Accreditation Scheme from July this year, although arrangements for stage 2 are yet to be finalised. This bill does not set out the arrangements that will apply under stage 2 of the scheme; rather it proposes transitional accreditation arrangements for those practices not encompassed by stage 1 of the scheme. The transitional arrangements proposed here are broadly similar to those adopted previously, although in this instance the time frames are shorter. Practices and practitioners providing non-radiology diagnostic imaging services will have three months, from April until the end of June, for their premises or mobile base to seek deemed accreditation and then a 12-month period, from July until the end of June in 2011, to obtain accreditation by demonstrating their compliance with accepted standards.
Stakeholder groups generally were accepting of the initial scheme and also of this move to widen accreditation across the diagnostic imaging sector. In general, they have not voiced major concerns and accept the scheme and its extension as an expected development and part of an ongoing, staged process. Through consultation processes, concerns that have been raised include the suitability of a single accreditation model across a diverse range of medical practices and worries about duplication, costs and administrative burdens. Departmental information has suggested the costs for accreditation would not be overly onerous. However, the government must take note of these concerns and maintain ongoing consultations with all stakeholders on these issues as they develop the accreditation process, particularly as many of the stakeholders captured under this bill are private specialist practices.
I note that the Minister for Health and Ageing has assured the House that the Department of Health and Ageing has consulted comprehensively with the health professions and industry and that the government will keep the burden of compliance to a minimum. The opposition seeks an assurance from the minister that, as the accreditation scheme moves into stage 2, an evaluation will be carried out to ensure that it is working reasonably and without onerous costs on providers—with a flow-on effect to consumers—and that the minister will make that evaluation available to the parliament.
I rise to speak in favour of the Health Insurance Amendment (Diagnostic Imaging Accreditation) Bill 2009. The bill amends the Health Insurance Amendment (Diagnostic Imaging Accreditation) Act 2007 to provide transitional arrangements to allow practices with, firstly, non-radiology services—for example, ultrasound—and, secondly, a combination of non-radiology and radiology services not accredited under the Diagnostic Imaging Accreditation Scheme, known as ‘the scheme’, to register for deemed accreditation in the three months prior to the commencement of the stage 2 scheme, which will commence on 1 July 2010. Registering through the transitional arrangements for deemed accreditation from 1 April 2010 will ensure that Medicare eligibility continues from 1 July 2010 when, for the purpose of Medicare, all diagnostic imaging services listed in the Diagnostic Imaging Services Table of the Medicare Benefits Schedule need to be rendered from a site accredited under the scheme.
Stage 2 of the scheme is being developed and implemented within the existing departmental program budget, and the cost update to the Medicare Australia payment system for 2009-10 to 2013-14 is $649,000, GST exclusive. The cost of participating in the stage 2 scheme and registering for deemed accreditation will be met by practices providing non-radiology services, as was the case for stage 1.
The department has consulted with all relevant government agencies, including the Office of Parliamentary Counsel, the Attorney-General’s Department, the Department of the Prime Minister and Cabinet and Medicare Australia. Around 1,400 practices providing non-radiology services will enter the stage 2 scheme through the transitional arrangements by registering for deemed accreditation from 1 April 2010 up to and including 30 June 2010. The bill will need to be passed and receive assent during the 2010 parliament. This will ensure a smooth transition for the 1,400 practices into the scheme.
This scheme will be very beneficial to the people of Dawson, where X-ray imaging and diagnostic services are at a premium. The impact of the stage 2 scheme on families in rural and regional areas will be positive, as a standard level will be assured for a diagnostic imaging service irrespective of where or by whom the diagnostic imaging service is provided. Back in February 2008, Mackay was hit by the most dramatic floods in 90 years and the local bulk-billing X-ray service was completely knocked out. I would like to put on record the fact that this government moved swiftly and effectively to enable other private practice X-ray facilities in the area to provide bulk-billing for those services, greatly helping families on minimal incomes. That was very important assistance.
It is important that we have continuity in this area. Section 16EA coupled with the provisions in division 5 part IIB of the Health Insurance Act contain the overarching legislative framework for the Diagnostic Imaging Accreditation Scheme, which is being implemented in two stages. The stage 1 scheme commenced on 1 July 2008 and covered only radiology services. This stage 2 scheme, which will commence on 1 July this year, will cover all diagnostic imaging services—that is, both radiology and non-radiology services—listed in the Health Insurance (Diagnostic Imaging Services Table) Regulations 2009, the DIST. This means that from 1 July, for the purpose of Medicare, all diagnostic imaging services in the DIST will need to be carried out at an accredited or deemed accredited practice to be eligible for Medicare benefits.
The bill will amend the DIA act to provide transitional arrangements that will allow practices providing these non-radiological services and a combination of non-radiology and radiology services not accredited under the scheme and in operation before 1 July 2010 to register for and enter into stage 2 of the scheme. As from 1 April 2010, the transitional arrangements proposed in the bill for unaccredited practices that provide non-radiology services will provide: firstly, a registration period which will operate for around three months, from 1 April to 30 June, giving practices deemed accreditation for a period of 12 months; and, secondly, an application process to allow 12 months, from 1 July 2010 to 1 July 2011, for a deemed accredited practice to submit documentary evidence and for an accreditation decision to be made by an approved accreditor.
The stage 1 scheme was introduced on 1 July 2008 to ensure that Medicare funding was directed to radiology services that are safe, effective and responsive to the needs of healthcare consumers. The stage 1 scheme only applied to sites rendering radiology services. These sites accounted for around 84 per cent of the total number of diagnostic imaging services performed annually under Medicare. Non-radiology services such as cardiac, ultrasound, cardiac angiography, obstetric, gynaecological ultrasound and nuclear medicine imaging services accounted for around 16 per cent of diagnostic imaging services performed annually under Medicare. These were not included in stage 1 of the scheme.