A discussion paper for VMOA
There is a perception, that The Canberra Hospital Administration is “changing the rules” for the determination of remuneration for on-call, call-back, and ward rounds,ward administration and general administration such as results documents and letters in the hospital Intray. The practice of internal medicine is replete with communication with the numerous players in patient management. Hitherto the TCH never baulked at claims for this important part of medical management.
a) Ward Rounds – Schedule 2 of the contract refers to services provided “as reasonably required for appropriate management of the VMO’s patient case load. As far as possible these must be conducted during the normal working hours of the hospital”.
In the case of many Physicians, ward administration, or patient management as distinct from actual bedside management is a common mode of practice.
For example, in the Renal Unit, a physician would liaise with almost 106 people in managing dialysis and transplant patients across the precinct.
In recent times claims for “ward administration”, has either been diminished or scratched out without any explanation.
b) Call-Back – The relevant section is Section 6.3 (subsection 6), which says “for call-backs, the name and/or designation of the person requesting the call-back, an appropriate entry by the VMO in the medical or dental record of the relevant attendance and/treatment and…”.
In the past, a request written in the notes has been sufficient to indicate the treating team has “called back” the consultant for an opinion.
Ms Rosemary O’Donnell has interpreted this differently. She says of a call-back: “this is an explicit request made by a medical officer asking you to attend to a patient’s clinical need, to distinguish it from a daily review visit which would occur routinely on a part of patient care during the course of a hospital admission.”
In practice, even if the on-call consultant did not previously know the patient, did come back to see the patient, wrote in the notes in response to the written request , administration are knocking back payment for these“call-backs”, on the basis that they could not find “an explicit request”.
Either the administration doesn’t understand usual medical practice, that is a note has been written in the file requesting the call-back or a registrar has already attended as a fist response to the request and phoned the consultant asking that the consultant make a specific review and notation in the notes about the patient, or it is a deliberate way of undermining the call-back process. The remunerative loss is substantial if a call back is termed “Post Hoc”, a ward round
There are also other new rules coming in, for example, some physicians, and no doubt surgeons and anaesthetists as well, are given compulsory administrative tasks, such as filling out forms, reviewing notes, talking to staff, which also fell into the category of “ward administration”, which seem to be censored and not paid for.
The net result is either the physician, surgeon or anaesthetist does the work free of charge, or takes the churlish view of simply not participating which would be to the disadvantage not only of patients and staff, but a disadvantage for physician/surgeon/anaesthetist.
