The rising number of tests and scans at major clinics and medical centres is under investigation by the Federal Department of Health, according to a report in The Australian. It will focus on whether the cause is inappropriate financial arrangements. The department will look at compliance and whether GPs are getting unlawful kick-backs to request pathology services, especially where the services are co-located.

The department says that whereas Medicare services per head went up from 14 to 15.9 between 2003-04 and 2015-16, pathology services shot up from 3.7 per head to 5.5.

The department wants to use data-analytics tools to highlight irregularities in rent or referral rates.

It has taken a preliminary look at data and identified “outliers” who will be asked for more information about financial arrangements.

Commercial influences on pathology tests could be unethical and “compromise patient outcomes and lead to over-servicing”, the department says. They could be illegal, with fines up to $126,000 for individuals and $1.26 million for corporations.

The department said, “We will also conduct ongoing audits of lease and other arrangements. Our compliance efforts may be escalated and involve coercive regulatory tools … where attempts to secure voluntary compliance are unsuccessful or where there is evidence of a deliberate intention to contravene the Prohibited Practices Provisions.”

However, Choosing Wisely Australia, the professions-led initiative aimed at cutting over-servicing, suggests the reason for the pathology and scanning blow-outs depends on who you ask. A consumer survey said 84 per cent thought they had tests because the health professional recommended them. But clinicians blamed patient expectations.

The pathology rent issue cropped up in the 2016 election. The Coalition agreed to help pathology companies get cheaper rent for collection centres in major clinics and medical centres and Pathology Australia agreed to stop campaigning against the Coalition plan to remove bulk-billing ­incentives. But in government it dumped both the plan to remove bulk-billing incentives after Senate opposition and the commitment to regulate rents.

The department’s website says, “Changes to the laws prohibiting inappropriate commercial relationships between requesters and providers of pathology services came into effect on 1 March 2008.

“Rent or other benefits may, in certain circumstances, breach the prohibited practices provisions of the Health Insurance Act 1973 . Those provisions prohibit the offer or acceptance of benefits that would be reasonably likely to induce a requester of pathology services to request those services from a provider.

“Concerns which relate to the use or occupation of pathology approved collection premises can be made by: emailing pathology.rents.section@health.gov.au or calling the Pathology Rents Section on 02 6289 7591.
Indications of suspected inappropriate practices may include:
• extremes in rent paid
• inducements associated with rental agreements
• inducements offered to providers of pathology services or requestors of these services
• vacant or unused rented space for the use of pathology services within 60 days of the lease agreement.”