Contracted Medical Support Model Wins Favour at Atawhai Assisi Aged Care

The support provided by general practitioners to aged care facilities varies throughout Australia and New Zealand. This support may be influenced by government rules and regulations, local demography, general practitioner accessibility, general practitioner interest in aged care medicine, and or medical networking within the local community.

Atawhai Assisi Home & Hospital is situated in the rural outskirts of Hamilton in the North Island of New Zealand. It has 30 high care beds and 40 low care beds and it has a somewhat unique way of managing medical input for the care of its residents. It must be said right from the outset that the model applied at Atawhai Assisi is largely possible due to the remuneration system for GP's in New Zealand that is a mixture of both a capitation rate* and a gap fee for individual services provided. However not all facilities in New Zealand adopt this model and significant changes to the Medicare doctor payment system would be needed to make this model financially attractive to aged care facilities in Australia. It should also be noted that medical cover in New Zealand is included in contract rates, and must be met by the facility.

*Capitation is based on assigning a certain number of people to the care of a particular doctor and he is paid to look after those people.

The Model

Atawhai Assisi pays a retainer to a local GP who has over a period of time demonstrated both commitment to aged care and special skills in the area of palliative care. The retainer is based on a fee to provide:

• three two hour visits per week to the facility at the hours of 8.00 am to 10.00 am;
• to be available to the facility between the hours of 8.00 am and 6.00 pm at no extra cost;
• to be available and involved in the processes for ensuring Legislative Compliance and strategic planning;
• contracted cost effective hourly education sessions;
• and, phone advice from 7.00 am to 11.00 pm seven days per week;
• Residents are not compelled to use the retained medical officer but currently 69 out of 70 residents have chosen to use him indicating the esteem to which the medical officer is held by both residents and relatives.

Dr Steve in discussion with a resident and staff member.

Without going into the fine detail of the contractual arrangement the benefits of this system as described by CEO Judy Hindrup include:

• the GP closely aligns himself with the vision and mission of the organisation and actively participates in the decision making processes;
• as the facility is on the outskirts of Hamilton there is some distance to other medical practices and so maximising involvement of the closest medical officer is important;
• the arrangement means that the GP participates in the monthly multi-disciplinary meetings to review residents with six residents being reviewed at each monthly session;
• there is a strong level of trust and teamwork between registered nursing staff and the GP and registered nursing staff are able to call for assistance at any time within the contracted hours;
• the medical officer is able to participate in peer review of the decisions to call on the GP for a support visit;
• contractually, the GP is locked into a peer review mechanism and there is a specialist physician nominated for the CEO to contact in the event that the nursing staff or the CEO want to question a process or decision implemented by the GP. In effect this is done in a cooperative spirit of quality assurance and pursuit of best practice, and provides great confidence in the medical support provided.

Our benchmarking results indicate higher than average levels of relative satisfaction in the area of medical and therapy services.

On the specific question about medical services the relatives rate the facility at 3.60 (90%) compared to the industry average of 3.37 (84%).

As a final comment Judy Hindrup adds that nurses that come to the facility are always impressed by the level of service and the commitment of the facility GP, "it gives the nurses confidence to make decisions and to seek support when needed" and this confidence flows into both employee and resident/relative satisfaction. "Dr Steve" is in his early forties and our contractual arrangement sets us up to provide high quality consistent services into the future."