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VMODETERMINATIONSIN PUBLICHOSPITALS: THECASEFORREFORM
AMA(NSW)ispreparingforarbitrationtoupdateandmodernisetheNSWPublicHospital VisitingMedicalOfficerDeterminations
ThelasttimetheVMO Determinationswerethesubjectof asubstantivereviewwas2007,and thelasttimeaworkvaluecase wasrunforVisitingMedical Officerswastheearly1990s Recent NSWGovernmentWagesPolicy hasrestrictedtheabilityofAMA (NSW)andunionstoseekreform oftheindustrialinstrumentsthat applyintheNSWPublicHospital System.
WhatisAMA(NSW)roleinthe NSWIndustrialRelationssystem forVisitingMedicalOfficers?
AMA(NSW)istheregistered industrialbodyforVisitingMedical Officers(VMOs)inNSWunderthe IndustrialRelationsAct1996(NSW).
UndertheHealthServicesAct,AMA (NSW)hastherighttoseekthe appointmentofanarbitratorto determinethetermsand conditions(including remuneration)forVMOs ASMOFis theregisteredindustrialbodyfor employeddoctorsintheNSW PublicHospitalSystemunderthe IndustrialRelationsAct1996
WhathasAMA(NSW)beendoing toprepareforarbitration?
PriortotheCOVID-19pandemic, AMA(NSW)hadcommenceda reviewofVMOarrangements,and inparticulartheworkbeingdone fromoutsidetheHospitalforwhich VMOsarenotpaid.
TheformerNSWGovernment’s WagesPolicy,inplacefrom2011
untilthechangeofGovernmentin 2023,cappedremunerationincreases butperhapsmoreimportantly, placedsignificantrestrictionsonthe capacityforindustrialorganisations toseekchangesintermsand conditions
SessionalVMOs(whoare remuneratedatanhourlyrate) receivedincreasesinmostyears undertheWagesPolicy Fee-forService(FFS)VMOswhoare remuneratedbyreferencetoservices providedandremuneratedbasedon theCMBS,didnotreceivethesame increases.
BecauseofthethenFederal Government’sMedicarerebatefreeze, AMA(NSW)andtheMinistryreached agreementforincreasesforFFSVMOs over5years.Undertheagreement, VMOswereentitledtoindexationof 25%eachyearforfiveyears,provided theMedicareItemNumbersclaimed werenotchangedbecauseofthe MedicareReview Assuch,forVMOs whoseitemnumberswerenot changedbytheMedicarerevieware nowpaidabaseremunerationrateof 113.1408%oftheCMBS.Forthoseitem numbersthatwerechanged,theydo notreceivethebenefitofthe indexationandarepaidabaserate of100%oftheCMBS.
TheFFSagreementexpiredon30 June2022 AMA(NSW)andthe Ministryengagedindiscussions regardingchangestotheFFS Determination,includingthatall VMO’spaidbyreferencetothe currentCMBS(asindexedfromtime
totime)(desiredbytheMinistry) andotherchangestothe Determination.Ultimately, agreementcouldnotbereached, withtheMinistryadvisingthat Treasurywouldnotprovidefunding formanyofthechangessoughtby AMA(NSW).
In2023AMA(NSW)accepteda remunerationincreaseforSessional VMOsthatmeantarbitration proceedingscouldnotbepursued forSessionalVMOsuntilJuly2024 Intheinterestsofefficiency(both timeandcost)adecisionwas madetoseekarbitrationforboth SessionalandFee-for-ServiceVMOs atthesametime
In2024AMA(NSW)hasbeen meetingwithVMOsatMedicalStaff Councilmeetings,andmeetings specificallyfocusedonreformofthe Determinations,todiscussthe changesAMA(NSW)hasidentified andtoheartheirviewsonwhat needstochange
Shortly,wewillbesurveyingVMOs andtheresultswillformpartofthe evidenceinsupportofthecasefor change.
WhatchangeswillAMA(NSW)be seeking?
AMA(NSW)seekstosecure changestotheDeterminationsso thattheybetterreflectmodern workingpracticesandformpartof asuiteofmodernindustrial instrumentsthatofferconsultants genuinechoiceonhowtheyare engagedtoprovide
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servicesintheNSWpublichospital system
Thearbitrationwillalsoreview currentratesofremunerationand whethertheyreflectthecurrent valueoftheworkperformedby VMOsworkinginthepublichospital system.
AMA(NSW)strategytopursue arbitrationisinformedbythe feedbackprovidedbyVisiting MedicalOfficers.Whileremuneration isrelevant,theissuesthatthey wouldliketoseeaddressedinclude: VMOsarenotpaidforservices providedfromlocationsother thanthehospital, Recognitionthatincreasingly non-emergencyworkis undertakenafter6pmandon weekendsyetthereisno recognitionofthevaluebutalso inconvenienceofsametoVMOs doingthatwork,andneedfor remunerationarrangementsto change;
Thelackofanon-callallowance forFee-for-ServiceVMOs; Alackofflexibilityintermsof remunerationforservices providedwhenon-call(in particular,shouldFFSVMOshave theoptiontoremuneratedat sessionalrates); Paymentforcancelledcasesas opposedtolistsindefined circumstances; Thefailuretoindexthe ProfessionalSupportPaymentfor regionalVMOsandtheneedto reconsiderthequalifyingcriteria foraccesstothepayment; Privatepatientsinpublic hospitalsandthechallenges associatedwithalackof communicationbyhospitalsto VMOsregardingpatient classification
Whenwillarbitrationcommence?
AMA(NSW)hasaskedtheNSW governmenttochangethe legislationregardingwhocanbe appointedasarbitrator
AMA(NSW)ispressingforthese changestobemadeassoonas possibleandwillthenfileits application
AMA(NSW)wantsthelegislation changedtoprovidethatajudgeof theIndustrialCourtmaybe appointedasarbitrator.Duetothe previousgovernment’swagespolicy thereareveryfewpeopleinNew SouthWaleswhohavethenecessary knowledgeandexperienceinthe applicationofrelevantindustrial principles Twoofthemost experiencedindustrialpractitioners wereappointedtotheIndustrial Courtearlierthisyear
In2016,thethenNSWIndustrial Courtwasabolishedbythethen StateGovernment Untilthistime,the HealthServicesActprovidedforan arbitratortobeappointedfromthe NSWIndustrialCourt Followingthe abolitionoftheCourt,thelegislation wasamendedtoprovidethe arbitratorwouldbeaformerJudge oftheNSWSupremeCourtoralegal practitionerofatleast7years experience.
TheIndustrialCourthasbeen re-establishedandwhilequestions
ofinterpretationregardingthe Determinationshavebeenreturned totheIndustrialCourt,theprovisions regardingthequalificationsofthe arbitratorhavenotchanged
WillthecaseforVMOsbenefitthe system?
AMA(NSW)anticipatesthatthe caseitrunswillbenefittheNSW PublicHospitalSystem.Modernising industrialinstrumentswillassist NSWtoretainitsexistingworkforce andattractadditionalworkforce
Themattersforwhichweseek changearenotuniquetoVMOs, andifwearesuccessful,we anticipateitwillstrengthenthecase forthemodernisationofother industrialinstrumentsintheNSW PublicHospitalSystem
DominiqueEgan.
ContacttheAMA(NSW)Workplace Relationsteamifyouhaveany furtherquestionsaboutthese changes.Youcancontactour teamon(02)94398822orvia workplace@amansw.com.au
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WHATYOUNEEDTOKNOWABOUTAIIN
MEDICALNOTE-TAKING
TheintegrationofArtificialIntelligence(AI)intonote-takingprocessesinmedicalpracticesis rapidlygainingmomentum.AInote-takingprogramsareemergingaspowerfultoolsfor medicalpractitioners,offeringenhancedefficiency,accuracy,andoverallqualityofmedical documentation.ThisarticleexploresAIinmedicalnote-taking,howthesetoolsworkand factorsyouneedtoconsiderbeforeimplementingsuchtoolsinyourpractice
AIinmedicalnote-taking
Manymedicalpractitionersare oftenoverwhelmedwith administrativepressuresincluding creatingcomprehensiveand preciseclinicalnotes Traditional methodsofmedicalnote-taking involvemanualdataentryandthe transcriptionofpatientinteractions, whichcanbetime-consuming AInote-takingtoolsoffer assistanceformedicalpractitioners balancingthedemandsofabusy practice Theyseektostreamline documentationprocessesand allowmedicalpractitionerstofocus moreontheprovisionofpatient care Thisshiftcouldimproveboth efficiencyandtheoverallqualityof medicaldocumentation
HowAInote-takingtoolswork
AInote-takingtoolsoperateby recordingthedialoguebetweenthe medicalpractitionerandthe patientduringaconsultation.Using advancedtechnologies,thesetools extractrelevantinformationand generatecoherentclinicalnotes Overtime,AIsystemslearntomirror theuser’stoneandstyle,ensuring thattheAI-generatednotes resemblethosecreatedmanually bythemedicalpractitioner.Medical practitionerscanreviewand andamendAI-generatednotes
beforefinalisingthem Thisallowsfor theinclusionofpersonal observations,additionalnotes,and testresults,ensuringthenotesare accurateandcomplete
Keyconsiderations
WhileAInote-takingtoolsoffer promisingbenefits,practicesand medicalpractitionersthatwishto utiliseAInote-takingtoolsneedto considerseveralimportantfactors:
Privacyandsecurity
Practicesshouldreviewprocedures formanagingpotentialbreachesof patientprivacyanddatasecurityto ensuretheycoverandaddressthe useofAIinthePractice
Giventhesensitivityofmedical information,stringentdataprotection measuresareessentialWhen selectinganAInote-takingprogram, practicesshouldreviewthefollowing: DataEncryptionandStorage: Understandhowpatientdatais encrypted,storedanddestroyed DataProcessingLocation: Determinewhetherdatais processedorstoredinAustraliaor overseas.
SecondaryUseofData:Clarifyif thedatawillbeusedfor secondarypurposesbytheAI providerorthirdparties
Compliance:EnsuretheAI provideradherestothe AustralianPrivacyPrinciplesand thePrivacyAct1988(Cth)
Consent
Patientconsentisessentialwhen usinganAInote-takingprogram duringconsultations Somepatients maynotbecomfortablewithAI,soit isessentialtoobtainconsenteach timeanAInote-takingprogramis used Thisconsentshouldbe documentedinthepatient’s medicalrecord.Relyingsolelyona referencetotheuseoftheAInotetakingprograminthePractice PrivacyPolicyisinsufficientand practicesshouldestablishaclear processforseekingandrecording patientconsentoneachoccasionAI isused
Accuracyofnotes
Medicalpractitionersmustreview AI-generatednotestoensurethey accuratelyreflectwhatwassaid andobservedduringthe consultationandcorrectanyerrors beforeenteringthemintothe patient’smedicalrecord
AlthoughAIisadvancing, inaccuraciescanoccurinAIgeneratednotesduetofactorssuch asaccents,useofslang,orfailureto filterirrelevantinformation
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AInote-takingtoolswillalsonot capturenon-verbalcuesand medicalpractitionerswillneedto ensuretheseareincorporatedinto theAI-generatednotes.
Transferofrecords
AI-generatednotesmaynotalways includeessentialpatientidentifiers, leadingtopotentialissuesduringthe transferofrecordstothepractice’s systems Tomitigatetheriskofdata lossorincorrectstorage,practices shouldimplementrobustprocesses andprovidetrainingtostaffinvolved inhandlingAI-generated documentation
AHPRAguidanceforpractitioners
TheAustralianHealthPractitioner RegulationAgencyhasreleased guidanceforpractitionerswhich explainshowexistingresponsibilities inNationalBoards’codesofconduct applywhenpractitionersuseAIin theirpractice Youcanreadthe guidanceontheAHPRAwebsite ThereisnoobligationtouseAIin medicalnote-taking.However, Practicesandmedicalpractitioners whousingAIfornote-takingorare thinkingofpurchasingand implementinganAInote-takingtool intheirpracticeshouldensurethe selectedtool: meetsclinicalneeds, enhancesthedeliveryofquality patientcare;and complieswithlegaland professionalobligations
Itisrecommendedthatpracticesandmedical practitionersconsultwithanITexpert,their cybersecurityproviderandtheirMedical DefenceOrganisationwhenimplementingan AInote-takingtoolintheirPractice.
ItisrecommendedthatPractices andmedicalpractitionersconsult withanITexpert,theircybersecurity providerandtheirMedicalDefence Organisationwhenimplementingan AInote-takingtoolintheirPractice. Carefulattentiontopatient consent,dataprivacy,andthe accuracyofrecordsisessential
AsAItechnologycontinuesto evolve,itholdsthepotentialto furthertransformmedical documentation,makingthe integrationofthesetoolsa promisingsteptowardsmore efficientandpatient-centred healthcare
AnastasiaLivanovaand DominiqueEgan.
ContacttheAMA(NSW)Workplace Relationsteamforspecificadvice relatingtoyourpractice.Youcan contactourteamon(02)94398822 orviaworkplace@amansw.com.au
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PAYROLLTAXEXEMPTIONFOR GENERALPRACTICE
AMA(NSW)longrunningadvocacycampaignforanexemptionforgeneralpracticefor potentialpastpayrolltaxliabilitiesforgeneralpractitionercontractswassuccessful,resulting inanexemptionforgeneralpracticesinrelationtounpaidpayrolltaxthatmayhavebeen payable.Theexemptionisforunpaidliabilitiespriorto4September2024.
HWLEbsworthprovidethefollowingupdateontheexemption forgeneralpracticeandthebulk-billingrebateuponwhich somegeneralpracticesmaywishtorely.Itisimportantto rememberthatthebulk-billingrebateisanadditional measure,andthatonlygeneralpracticeswhomeetthe relevantthresholdarerequiredtoregisterwithRevenueNSW.
Background
On18June2024,whendeliveringthe 2024-2025StateBudget,theNSW StateGovernmentannounceda seriesoflegislativeamendmentsto thePayrollTaxAct2007(NSW)(Act) whichwereaimedatprovidingrelief frompayrolltaxformedicalcentres engagingGeneralPractitioners(GPs) asindependentcontractors.
TheCommissionerofState RevenuelaterreleasedaPractice Noteexplainingtheamendments whichwereintroducedunderthe RevenueLegislationAmendmentAct 2024No83(NSW) Theseincluded: Anexemptionforanyunpaid payrolltaxthatwaspayableon ‘wages’paidorpayabletoGP contractorsunderarelevant contractpriorto4September2024 (UnpaidPRTLiabilitiesExemption) [1]
Arebateforpayrolltaxonwages paidorpayabletoGPcontractors onorafter4September2024when certainconditionsaremet(Bulk BillingRebate)[1];and Theadditionalreliefsupplements theexistingexemptionsunderthe Act,includingthe90Day ExemptionandthePublicService Exemption[1]
UnpaidPRTLiabilitiesExemption
Anyunpaidpayrolltaxthatwas payableonwagespaidorpayable toGPcontractorsunderaRelevant Contractpriorto4September2024 arenowexemptfrompayrolltax liabilities Thismeansthatwhere payrolltaxmayhavebeenpayable inrelationtopaymentsmadeto GPsunderarelevantcontract,the medicalcentreisnotrequiredto declarethosepastpaymentsprior to4September2024aswagesfor thepurposesofpayrolltax
Arefundisnotavailablefora medicalcentrewhichhaspaid payrolltaxinrelationtopayments madetoaGPunderarelevant contractpriorto4September2024.
RelevantContractsandExemptions Ifageneralpracticehasgeneral practitionersprovidingservicesto patientsatthegeneralpractice,the firstmattertobeansweredis whetherthecontractisaRelevant ContractforthepurposesoftheAct, andifso,arethereanyexemptions whichmayapply Whilethereare severalexemptionsundertheAct, thosemostrelevanttogeneral practicesarethe90DayExemption andthePublicServiceExemption UndertheActacontractwillnot beconsideredaRelevantContract forthepurposesofpayrolltaxifthe contracteddoctorconductstheir businessatthemedicalcentrefor lessthan90daysinafinancialyear [1]Forthepurposeofcalculatingthe numberofdaysthecontracted doctorworksatthemedicalcentre, partofadaywillcountasafullday [2]Inordertosatisfythe90Day Exemption,amedicalcentrewould needtodemonstratethatthe contracteddoctorhasconsultedwith patientsforlessthan90daysatthe medicalcentreinafinancialyear.
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relevantcontract Inordertoclaimthe BulkBillingRebate,medicalcentres locatedinmetropolitanSydneymust bulkbillatleast80%oftheirGP services Whereasformedicalcentres locatedinotherareas,only70%of theirGPservicesmustbebulkbilledto attracttheBulkBillingRebate.
ThePublicServiceExemption statesthatacontractwillnotbe considereda'relevantcontract'for payrolltaxifthecontracteddoctor alsoprovides'servicestothepublic generally'[1]Toqualifyforthis exemption,thecontracteddoctor mustprovideservicesofthesame kindtopatientsofanother business,possiblybyvisitingthe localHospitalorconsulting patientsatotherpractices References:
BulkBillingRebate
From4September2024,medical centresmeetingprescribedbulk billingthresholdsmaybeentitledto claimarebateonwagespaidor payabletoGPcontractorsundera
ForthepurposesoftheBulkBilling Rebate,RevenueNSWhasdetermined whichsuburbsaredeemedtobepart ofMetropolitanSydneyandalistcan befoundontheirwebsite.Anysuburb whichisnotincludedinthelistis outsideofMetropolitanSydneyand attractthelesserthreshold
TheBulkBillingRebateisonly availableformedicalcentreswhich engageGPsandhaveregisteredfor
payrolltax Onceamedicalcentre haspaidpayrolltaxinrelationto thepaymentsmadetoGPsunder therelevantcontract,theywillthen receivearebateiftheprescribed bulkbillingthresholdismet
ScottChapman,Partner; LukeDepares,SeniorAssociate; MadeleineMurray,Solicitor.
