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Australian Health Officials Visit Northern New York Hospital

CVPH Medical Center entrance (file)
WAMC/Pat Bradley

A group of Australian clinicians were 10,000 miles from home in Plattsburgh this week as part of a study tour assessing patient delivery and payment systems.   
The Australian commonwealth budget is being handed down on May 15th and officials have indicated that pending changes to the funding model to the nation’s health care system are unsustainable for the future. Australian Association of Practice Managers Director Gary Smith explains.   “In Australia we have a universal health care system similar to your Medicare and our physicians are fee-for-service. The government’s wanting to move away from the fee-for-service and move to what’s called a blended payment system where we receive our income from a various range of other income streams. The challenge we’ve got, of course, is that in Australia that we have a very high percentage of people who are on some form of health care card or government benefit. So there’s a social justice component  we now have to start to address in relation to how we manage our patients’ health in relation to a funding model.”

One model would adopt a patient-centered medical home concept. The nation has gone from a fee-per-service system to a block funding process, which according to Smith is being tested in this region.   “This particular area here AHI  (Adirondack Health Institute) has run a pilot on the patients at a medical home for the last six years. One of the reasons why we’re here, and in Ottawa as well, is to actually study how the patients at a medical home actually works and look at the funding models and the delivery of health care to the patients in their area.”

The Australians are scrutinizing the Adirondack Medical Home Initiative and its partners’ focus on patient-centered health care management.  They are also analyzing funding, something that Adirondack Health Institute Director of Medical Home Initiatives Bob Cawley says is a huge issue on several levels.  “The funding stream primarily for medicine in the U.S. is called fee-for-service. And basically it means that a provider, a doctor, a nurse gets paid based on the number of services they provide. And so that provides kind-of a perverse incentive to just provide as many services as you can.  We’re trying to battle that and institute a process where the emphasis is on quality and proper care for the patient. The way we’ve addressed that so far with the medical home started out with what we call a per-member per-month payment. We use that money, along with some grants that we were able to achieve, to fund the care management services as well as the information technology infrastructure.”

University of Vermont Health Network Champlain Valley Physicians Hospital CEO and President Stephens Mundy finds that how you use limited resources is key.   “They have a different health care system for how it’s paid for. But we’re all human beings and we all have health care needs and the biology’s  the same where ever you go. That leads to similarities in care. Funding, the key is how you use your resources. We’ve been extremely fortunate with the funding that we’ve gotten. But how do you use those in a way that doesn’t waste a penny? I think we’ve been incredibly judicious and really are starting to see some big impacts across our communities.”

Smith believes that based on his early observations, concepts in Australia will need to change.   “Looking at both systems in relation to the Canadian system and your system, although your funding models and funding streams are different, the concept of where the patient becomes the center of the health care, where in Australia currently it is physician led and not patient led. So the goals have to change.  We have to start to think of the patient rather than the physician. Canada and yourself have moved to this patient-centered model whereby the patient is the center and everyone works around them. Where in Australia we’re still physician-centric indeed.  Although in Australia we find ourselves thinking we’re patient-centered. But we’re not really because the funding model doesn’t lead that way.”

The Australian clinicians are also visiting venues in Ottawa including the University of Ottawa Heart Institute and the Canadian Patient Safety Institute.

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