PCA outlines essential Medicare reforms to enhance palliative care access

The growing need for palliative care threatens to overwhelm primary care settings where time and funding restrictions could result in too many people missing out on essential palliative care.

Palliative Care Australia (PCA) is urging the Australian Government to consider key solutions, which have been developed with advice from primary care experts and key stakeholder groups, to better remunerate palliative care in primary. 

PCA’s 2024 National Palliative Care Workforce Survey identified major concerns in the primary care system. 

Just 11% of respondents agreed that their practice is adequately funded to deliver palliative care while only one-in-three professionals said they had enough time to meet patients’ palliative care needs. 

PCA’s new report, The case for improved remuneration of palliative care in primary care, highlights that without better remuneration under Medicare, the burden of care will continue to disproportionately fall on acute hospital-based services.

Not only do these services tend to be more expensive than primary care, but they are poorly aligned with community preference to remain at home for as long as possible to receive palliative care. 

“These findings echo what we hear every day and align with similar findings and insights from our partners in the sector,” PCA Chief Executive Officer Camilla Rowland said.

“Primary care has a significant role to play in meeting the growing demand for palliative as Australia’s population ages. The conversations and care that happens at this time of life are distinctly different and more complex to other kinds of care offered in primary care settings.

“GPs and nurses need to spend more time with patients and carers talking through a range of sensitive matters including prognosis and treatment, advance care planning, and care coordination.

“And what our survey tells us is that the current system, which is structured around how GPs bill for specific Medicare item numbers, and incentivises short appointments, doesn’t fully embrace palliative care,” she added. 

Notably, the report also reveals that many GPs are providing palliative care out of compassion for minimal remuneration – or often none when providing end-of-life support – as they are uncomfortable with billing grieving family members. 

Respondents highlighted that ‘Medicare billing does not reward long complex consults with palliative care patients’ and that recent primary care funding reforms are not sufficiently incentivising additional palliative care activity in primary care.

“The changes effectively decrease funding for palliative care in RACF settings,” one respondent said.

The road to better access

While primary care reform is ongoing, PCA is calling on the government to ensure that cost does not remain a barrier to receiving timely palliative care. It said patients with a life expectancy of a year or less should be bulk billed for Medicare consultations, while GPs should not have to contemplate billing a dying patient or receiving inadequate remuneration.

“It’s encouraging to see those who want to form government after the election are talking about empowering primary care through a stronger Medicare,” Ms Rowland added.

“A stronger Medicare lifts us all, but our health system needs to reward good palliative care if we are going to properly care for Australia’s ageing population.”

PCA has proposed the following five reforms to deliver better access to palliative care: 

1. A new practice-level payment to remunerate palliative care (for example, advance care planning, developing goals of care, and referral to family and social supports) – covering activities undertaken by primary care multidisciplinary teams that are not currently billable to Medicare.
2. Further guidance for general practice about the use of existing longer consultation items (Level C, D and E) to be more explicit about their relevance to palliative care.
3. Additional funding for home visits, after-hours care (in-person and via telehealth), and shared care arrangements with specialist palliative care teams.
4. Creation of an expert working group to advise the Australian Government on how to best increase palliative care activity in primary care.
5. Development of a Palliative Care in Primary Care Monitoring and Evaluation Framework, to fill the gap in knowledge about palliative care provision and quality in primary care. 

Aged care concerns

Improvements to the way primary care professionals are incentivised could also enhance palliative care access in residential aged care. As highlighted by PCA, the recently-introduced General Practice in Aged Care Incentive (GPIACI) actually excludes many patients with short life expectancy. 

One GP who manages nearly 100 patients in a local residential aged care home told PCA they hold major concerns for newly admitted palliative care patients likely to pass away within 2-4 weeks.

“These patients, transferred from a hospital to nursing homes after an acute terminal diagnosis for end-of-life care, require intensive management including end-of-life support, family meetings, palliative care medications including syringe drivers, collaboration with local palliative care teams, and formulating death certificates upon their passing – often done pro bono as there is no Medicare rebate for this,” they explained.

“The new scheme’s quarterly assessment periods exclude these patients from the incentive criteria since they usually do not live long enough to meet the minimum servicing requirements of two eligible services in separate months within a quarter. 

“This exclusion means GPs like myself do not qualify for incentive payments despite providing substantial care. How will the Department address this gap to ensure that newly admitted palliative care patients receive the necessary support, and that their GPs are fairly compensated?” 

Additionally, other professionals said they struggle to treat and visit patients in their own homes due to time, geographic and cost reasons. Recent changes through MyMedicare are not enough to cover travel expenses which could lead to healthcare professionals reconsidering home care visits. 

For more insights from PCA’s report, click here.