Health Insurance Act 1973 - Declaration of Quality Assurance Activities under section 124X (QAA No. 2/2009)

EXPLANATORY STATEMENT

ISSUED BY THE AUTHORITY OF

THE MINISTER FOR HEALTH AND AGEING

HEALTH INSURANCE ACT 1973

DECLARATION OF QUALITY ASSURANCE ACTIVITIES

UNDER SECTION 124X

QAA No.  2/2009

Part VC of the Health Insurance Act 1973 (the Act) creates a 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 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 the section 124X.

The Declaration is a legislative instrument for the purposes of the Legislative Instruments Act 2003.  This Declaration has effect from the day after registration on the Federal Register of Legislative Instruments.  Section 124X(4) of the Act prescribes that, unless sooner revoked, this determination ceases to be in force at the end of 5 years after the instrument of declaration was signed. 

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

1. Royal Australian and New Zealand College of Psychiatrists (RANZCP) – Practice Visit Program (Item 1) and;
2. The Royal Australian and New Zealand College of Psychiatrists (RANZCP) –  Peer Review Groups (Item 2)

The activity at Item 1 of the Schedule was previously declared in 2003 (QAA 3/2003) and has the purpose of providing the opportunity for psychiatrists to participate in a practice visit, which includes receiving feedback and critique of their work, to gain support and to allow for opportunities of improvement to enhance outpatient care.

The activity at Item 2 was also previously declared in 2003 (QAA 3/2003) and has the purpose of encouraging best possible evidence based practice by psychiatrists, by facilitating visits from other psychiatrists to review their clinical practice, service systems or procedures and other aspects of providing psychiatric assistance.

An overview of the activities for which the Declaration pursuant to section 124X 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 activities at Items 1 and 2 meet the requirements of paragraph 124X(3)(a) in that the persons engaged in these Activities are authorised to do so by the Royal Australian and New Zealand College of Psychiatrists, 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. The criteria relevant to the activities are in regulations 23C, 23D and 23E or 23F.

The activity at Item 1 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. Outcomes of the Activity include regular reporting to the Department of Health and Ageing and internal reporting to RANZCP. Reports are also circulated to medical councils and government departments as required.
• 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.
• Regulation 23F applies as the activity has previously been carried out in Australia and is a re-declaration of activity QAA 3/2003 . The Minister’s re-declaration will continue to encourage 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 to the benefit of establishing and improving quality assurance.
• 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 practicing rights.

The activity at Item 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. Outcomes of the Activity include regular reporting to the Department of Health and Ageing and internal reporting to RANZCP. Reports are also circulated to medical councils and government departments as required.
• 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.
• Regulation 23F applies as the activity has previously been carried out in Australia and is a re-declaration of activity QAA 3/2003. The Minister’s re-declaration will continue to encourage 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 to the benefit of establishing and improving quality assurance.
• 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 practicing rights.             

CONSULTATION

Consultations regarding the applications for re-declaration were undertaken in June 2009. This included obtaining advice on the potential value of re-declaring the 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 declaration, in particular those criteria relating to whether it is in the public interest to re-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 re-declaration of these activities will not result in any direct or substantial indirect

effect on business.

The Declaration comes into operation on the day after registration on the Federal Register of Legislative Instruments.

As provided by subsection 124X (4) a declaration ceases to be in force at the end of 5 years after the instrument of declaration is signed, unless revoked earlier.

QAA No. 2/2009

ATTACHMENT

OVERVIEW OF THE ACTIVITIES

1. PURPOSE OF ACTIVITIES

The purpose of the activity at Item 1 is for RANZCP Fellows to provide a practice visit for a host psychiatrists who is visited by a peer trained as a practice visitor, who conducts a review based on the College Guidelines for Outpatient Psychiatric Practice. During a practice visit clinical cases, service issues and other aspects of work are discussed and feedback is received on all aspects of their work. The practice visit is a peer review activity designed to allow the host, and also the visitor, to reflect on their practice and review the way in which they provide care to patients.

The objectives of the activity are to:

• Review the host practice against the College Guidelines for Outpatient Psychiatric Practice;
• Facilitate discussion between the host and visiting psychiatrists about avenues for practice improvement;
• Formulate goals and engage in collaborative planning for implementing agreed improvements to practice; and
• Review progress on goals formulated in the first visit in a follow up visit.

The purpose of the activity at Item 2 is for RANZCP Fellows to provide the opportunity and incentive 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.

The objectives of the activity are to:

• Provide the opportunity and incentive for psychiatrists 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.
• To encourage psychiatrists to seek the advice and assistance of their peers and to work together to improve their practice and outcomes for patients.