Declaration of Quality Assurance Activity under section 124X of the Health Insurance Act 1973 – QAA 4/2015

EXPLANATORY STATEMENT

ISSUED BY THE AUTHORITY OF

THE MINISTER FOR HEALTH

HEALTH INSURANCE ACT 1973

DECLARATION OF QUALITY ASSURANCE ACTIVITY

UNDER SECTION 124X

QAA No. 4/2015

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, through Medicare benefits, the Pharmaceutical Benefits Scheme, Public Hospitals 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 activity:

1. Improvement of surgeons’ operative outcomes and better health outcomes for patients through web-based self-audit and practice comparisons with professional peers (the Activity).

An overview of the Activity 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 Activity are authorised to do so as described in paragraph 124X(3)(a) of the Act.
  
  The Activity meets the requirements of paragraph 124X(3)(a) as the persons engaged in the Activity are authorised to do by Surgical Performance Pty Limited, under the auspice of Quality Innovation Performance (QIP) Limited, 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 Activity. In doing so, the Minister must have regard to criteria prescribed by the Regulations.
   

The Activity 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. Results of this study will include by Surgical Performance Pty Limited annual reporting to the Department of Health, publication of papers for journals (using de-identified data) and presentation of data and outcomes at national and/or international meetings.
   
• Regulation 23D does not apply as the Activity will be engaged in more than one State or Territory.

• Regulation 23E applies because the Minister is satisfied that the Activity is of a kind that has not been engaged in previously in Australia. The Declaration is needed to make the Activity effective by encouraging full participation in the Activity by persons who provide health services by providing participants with a greater degree of confidence and security that their participation is solely for the benefit of establishing and improving quality assurance.

• Regulation 23F does not apply as the Activity has not previously been carried out in Australia.

• 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

Consultations regarding the application for declaration of this Activity were undertaken in 2014 (September and December) and 2015 (January to March). This included obtaining advice on the potential value of declaring this Activity as a quality assurance activity for the purposes of the Act, the methodology used to conduct the Activity, and whether the application met the criteria required for declaration to be made, particularly the criteria relating to whether it is in the public interest to declare the Activity.

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 this Activity 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. IMPROVEMENT OF SURGEONS’ OPERATIVE OUTCOMES AND BETTER HEALTH OUTCOMES FOR PATIENTS THROUGH WEB-BASED SELF-AUDIT AND PRACTICE COMPARISONS WITH PROFESSIONAL PEERS

Purpose

This Activity involves web-based self audit using a software system provided by Surgical Performance Pty Ltd that provides performance feedback to health professionals, administrators and other interested parties on the outcomes of medical interventions. The software product/s allow comparison of outcomes for a health care provider with others, whether local or in the medical communities at large, with the aim of providing better health outcomes for patients.

Objective/s

The primary objective of this activity is to allow individual clinicians to compare their outcomes from treatment with the outcomes from colleagues (web-based self-audit) and to practice comparison with professional peers in a de-identifiable environment, live and online.

This activity also involves:

• promoting safe surgery and reducing surgical/obstetric adverse events;
• emphasising the importance of regular practice audit as an integral part of the quality cycle;
• achieving better patient outcomes through a reduction in surgical adverse events;
• reducing the costs for the treatment of surgical complications; and
• increasing health practitioners’ job satisfaction.