Declaration of Quality Assurance Activities under section 124X of the Health Insurance Act 1973 – QAA 1/2015

EXPLANATORY STATEMENT

ISSUED BY THE AUTHORITY OF

THE MINISTER FOR HEALTH

HEALTH INSURANCE ACT 1973

DECLARATION OF QUALITY ASSURANCE ACTIVITIES

UNDER SECTION 124X

QAA No. 1/2015

Part VC of the Health Insurance Act 1973 (the Act) creates a scheme (known as the Commonwealth Qualified Privilege Scheme) to encourage efficient quality assurance activities. Those activities help to ensure the quality of health services that are funded by the Government, including through Medicare benefits, the Pharmaceutical Benefits Scheme and/or Health Program Grants. The scheme encourages participation in such activities by protecting certain information from disclosure, and also by providing some protection from civil liability to certain persons engaged in those activities in good faith, in respect of those activities.

In order for Part VC of the Act to apply to an activity, the Minister must make a Declaration pursuant to section 124X of the Act, that the activity described in the declaration is a quality assurance activity to which Part VC applies. Regulations
23C to 23G of the Health Insurance Regulations 1975 (the Regulations) set out the public interest criteria that must be met by quality assurance activities in order to be declared under section 124X of the Act.

This Declaration under subsection 124X(1) applies to Part VC of the Act to the following activities:

1. Practice Visit Program (Activity 1); and
2. Peer Review Groups (Activity 2).

An overview of the activities for which the Declaration pursuant to section 124X of the Act is made is contained in the Attachment.

Before the Minister can make a Declaration, certain requirements must be met:

• Firstly, the Minister must be satisfied that the persons engaged in the activities are authorised to do so as described in paragraph 124X(3)(a) of the Act.
  
  Activities 1 and 2 meet the requirements of paragraph 124X(3)(a) in that the persons engaged in the activities are authorised to do so by the Royal Australian and New Zealand College of Psychiatrists (RANZCP), which is an association of health professionals.

• Secondly, paragraph 124X(3)(b) of the Act provides that the Minister must be satisfied that it is in the public interest to have Part VC of the Act apply to the activities. In doing so, the Minister must have regard to criteria prescribed by the Regulations.
  
  Activity 1meets the criteria as follows:
   
  • As required by regulation 23C, the activity includes the disclosure of
    non-identifying information that concerns the quality of service assessed, evaluated or studied. Information from this activity will include by RANCZP annual reporting to the Department of Health, internal organisational reporting and circulation (as relevant and as required) to medical councils and government departments.
     
  • Regulation 23D does not apply as the activity will be engaged in more than one State or Territory.

• Regulation 23E does not apply as the activity has previously been engaged in in Australia. The activity was previously declared to be a quality assurance activity to which Part VC applies in 2003 (QAA 3/2003) and 2009
  (QAA 2/2009).

• Regulation 23F applies as the activity has previously been carried out in Australia. This is a re-declaration of QAA 3/2003 and QAA 2/2009. The Minister’s re-declaration will continue to encourage full participation in the activity by persons who provide health services and by providing participants with a greater degree of confidence and security that their participation is solely for the benefit of ensuring the continuation and enhancement of a valuable quality improvement strategy for psychiatrists in practice and improved outcomes for the community in mental health care.

• Regulation 23G does not apply as the activity does not include the assessment or evaluation by a person of the services, skill or performance of a health practitioner for the purpose of determining the health care practitioner’s clinical practising rights.
   

Activity 2 meets the criteria as follows:
 

• As required by regulation 23C, the activity includes the disclosure of
  non-identifying information that concerns the quality of service assessed, evaluated or studied. Information from this activity will include by RANCZP annual reporting to the Department of Health, internal organisational reporting, and circulation (as relevant and as required) to medical councils and government departments.

• Regulation 23D does not apply as the activity will be engaged in more than one State or Territory.

• Regulation 23E does not apply as the activity has previously been engaged in Australia. The activity was previously declared to be a quality assurance activity to which Part VC applies in 2003 (QAA 3/2003) and 2009
  (QAA 2/2009).

• Regulation 23F applies as the activity has previously been carried out in Australia. This is a re-declaration of QAA 3/2003 and QAA 2/2009. The Minister’s re-declaration will continue to encourage full participation in the activity by persons who provide health services and by providing participants with a greater degree of confidence and security that their participation is solely for the benefit of ensuring continuous quality improvement in psychiatric practice, to achieve and to support the best attainable quality of psychiatric and mental health care.

• Regulation 23G does not apply as the activity does not include the assessment or evaluation by a person of the services, skill or performance of a health practitioner for the purpose of determining the health care practitioner’s clinical practising rights.

Consultation

Consultation regarding the applications for declaration of these activities was undertaken in September 2014. This included obtaining advice on the potential value of declaring these activities as quality assurance activities for the purposes of the Act, the methodology used to conduct the activities, and whether the applications met the criteria required for declarations to be made, particularly the criteria relating to whether it is in the public interest to declare the activities.

Those consulted included members of the Qualified Privilege Advisory Group, which includes an external clinician; a legal expert; a quality manager working in the field of health care quality assurance; and a consumer representative.

The Declaration of these activities will not result in any direct or substantial indirect effect on business.

The Declaration has effect from the day after registration on the Federal Register of Legislative Instruments. This Declaration ceases to be in force at the end of 5 years after it is signed.

The Declaration is a legislative instrument for the purposes of the Legislative Instruments Act 2003.

         ATTACHMENT

1. PRACTICE VISIT PROGRAM

Purpose

This activity involves psychiatrists (trained as practice visitors) visiting host psychiatrists in order to conduct a review based on the College Guidelines for Outpatient Psychiatric Practice. Participants are encouraged to review and further develop their professional practice so that their knowledge, skills and performance standards are maintained and that the provision of adequate and safe medical care is optimised.

Objective/s

The primary objective of this activity is to provide context where participants may discuss clinical cases, service issues and other aspects of the work they do and to receive feedback on all aspects of their work.

This activity also involves:

• facilitating discussion between host and visiting psychiatrists about avenues for practice improvement;
• formulating goals and engaging in collaborative planning for implementing agreed improvements to practice; and
• reviewing progress on goals formulated in the first visit in a follow up visit.

2.      PEER REVIEW GROUPS

Purpose

This activity provides psychiatrists, working in small groups, the opportunity to review their own work and receive feedback on their work, with the aim of continuous improvement of the quality of their practice and improving outcomes for individual patients.

Objective/s

The primary objective of this activity is to provide context where participants may present clinical cases, service issues and other aspects of their work and receive feedback on difficulties or concerns about their work and advice and assistance on practice improvement.

This activity also involves:

• providing the opportunity for psychiatrists to engage in a quality improvement activity looking at their own clinical practice, their service systems or procedures, and other aspects of providing psychiatric assistance to encourage best possible evidence based practice; and
• encouraging psychiatrists to seek the advice and assistance of their peers and to work together to improve their practice and outcomes for consumers.