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Performance against Portfolio Budget Statements 2018-19

Performance criteria

Table 3 outlines the quantitative key performance indicators specified for PSR in the Portfolio Budget Statements 2018–19:

Table 3: Protecting against inappropriate health care practice

Quantitative performance criteria

2018–19 Target

2018–19 Actual

Percentage of reviews by the Director of PSR finalised within 12 months

100%

100%

Total number of matters for review finaliseda

50

101

Percentage of court cases where PSR’s application of the law upheld

100%

100%

a This figure includes no further actions under s. 91 of the Act, negotiated agreements under s. 92 of the Act, final determinations resulting from a Committee hearing and cases where it was impossible to come to a final outcome. The figure excludes cases that have lapsed under s. 94 of the Act and cases considered indefinitely in abeyance.

In 2019–20, PSR will maintain the deterrent effect of the PSR Scheme by continuing to refer cases of practitioners who may pose a threat to the life or health of any other person to regulatory bodies for further action. PSR will also refer to the major non-compliance unit in the Department of Health any practitioner where a serious compliance concern is generated.

Quantitative deliverables

PSR continued to act on referrals from the Chief Executive Medicare during 2018–19, completing 101 matters.

Qualitative deliverables

The qualitative key performance indicators specified in PSR’s Portfolio Budget Statements 2018–19 are shown in Tables 4 and 5.

Table 4: Protecting against inappropriate health care practice

Qualitative performance criteria

2018–19 Reference point or target

The Director will conduct reviews of practitioners referred by Chief Executive Medicare and in appropriate cases enter into agreements.

The Director conducted reviews of practitioners referred by Chief Executive Medicare and in appropriate cases entered into agreements.

PSR Committees will be convened and will conduct hearings in a timely manner ensuring that practitioners being reviewed by their peers are afforded procedural fairness in each stage of the process.

PSR Committees were convened and hearings were conducted in a timely manner. PSR committees ensured that practitioners were afforded procedural fairness in each stage of the process.

The Determining Authority will ratify agreements and make appropriate determinations of sanctions.

The Determining Authority ratified agreements and made appropriate determinations of sanctions.

Table 5: Maintaining professional support for PSR

Qualitative performance criteria

2018–19 Reference point or target

Professional bodies are actively engaged in the process

for appointments to the PSR Panel, and PSR receive the

required number of nominees to ensure broad professional representation on the PSR Panel.

Professional bodies were actively engaged in the process for appointments to the PSR Panel, and PSR received an appropriate number of nominees to ensure broad professional representation on the PSR Panel.

As in other years, submissions made by practitioners reviewed by PSR indicate that a great majority made positive changes to their practice as a result of the review process. In most cases reviewed during 2018–19, inappropriate practice involved inadequate clinical notes, failure to comply with the particular requirements of the MBS items billed to Medicare, or prescribing concerns. Practitioners who were reviewed indicated frequently that they accepted the need to change their practices and were able to demonstrate practical measures undertaken to achieve the required improvements. This was the case for both practitioners who were referred to Committees under s. 93 of the Act and practitioners who entered into voluntary agreements under s. 92.

The AMA and other relevant organisations were consulted, as required by s. 84, 85 and 106ZPB of the Act, as part of the process of appointing the membership of the PSR Panel and the Determining Authority in 2018–19.

Performance criteria set out in the PSR Corporate Plan include:

  • timely management of cases for practitioners, who are the subject of a request to review from the Chief Executive Medicare
  • engagement with government, and relevant professional and regulatory bodies to ensure peer support and awareness
  • continuing engagement with stakeholders to ensure their understanding of PSR’s role and activities
  • reviewing PSR’s internal operations to ensure minimal burden to the health industry while ensuring the integrity of the Medicare system.

Throughout 2018–19, all cases were managed to ensure that deadlines required by the process set out in the legislation were met. The Case Management Unit within PSR met on a regular, weekly basis with the Director to review the status of all current cases, whether at the initial Director’s review stage of the process or at the Committee or Determining Authority stages.

The Director and the PSR executive team met regularly with the Provider Benefits Integrity Division in the Department of Health. These meetings enabled the Director to provide feedback and comments to the senior officials who advise the Minister for Health on Medicare issues, including inappropriate practice.

During 2018–19, PSR’s Case Management Unit added staff to ensure that it has the necessary capability to support the Director, Committees and the Determining Authority in delivering the PSR Scheme. Most case management staff members are legal officers, to enable a focus and emphasis on procedural fairness and compliance with statutory requirements in the delivery of the scheme.

PSR has sought to improve transparency in 2018-19 by publishing more details of case outcomes on its website and providing more detail of the agency’s activity in a regular newsletter to Panel members and other interested persons.