THE IRISH Medical Organisation (IMO) sought the Government to establish a €30 million compensation fund to assist GPs affected by the decision to establish a new single capitation rate for treating patients aged 70 and over.
In its unpublished submission to the process for establishing the new fee rate, the IMO said it was looking for a “transition fund” to deal with the significant adverse implications of the move to a single capitation rate for the group of GPs who had a very high proportion of over-70s who received their medical card automatically on age grounds under rules introduced by the Government in 2001.
“Many of these GPs have relied on the continuation of existing payment rates when making decisions to invest money in the provision of infrastructure in line with the aspirations of the primary care strategy,” the submission said.
“The IMO would seek that this fund be in the order of €10 million per annum for a period of three years and that a joint committee be recommended between the IMO and the Department of Health and Children/
HSE to devise a methodology for the application of the funding,” it added.
The IMO proposed that the single capitation rate should be set at €369 per patient per annum.
The new fee rate for medical card patients over 70 which was recommended by the independent process and accepted by the Government was €308.76. The new fee, which includes an increase under the national pay agreement, came into effect from the beginning of January.
A Department of Health spokesman said that no transition fund was to be established as part of the new process.
The abolition of previous payment arrangements and the introduction of a new single capitation fee for GPs emerged following the controversy surrounding the Government’s decision in the budget in October to scrap the automatic entitlement to a medical card for everyone over the age of 70.
The new single payment replaces what was effectively two sets of fees paid to GPs for treating patients over 70 with medical cards: an average of €161 paid in respect of those who qualified for the medical card on grounds of low means prior to the 2001 deal; and an average of €640 per annum paid to GPs for medical cards awarded on the grounds of age following the 2001 agreement.
In its claim for a single capitation fee of €369 per annum, the IMO argued that patients over 70 had significantly higher medical needs and, consequently, higher visitation rates than younger patients. It said this needed to be reflected in a “realistic capitation rate for this high workload age group”.
“There is no authorative database of visiting rates in Ireland. However, a verifiable computerised audit carried out recently in Ireland’s largest general practice [25,000 patients] found a visitation rate of 10.54 visits per over-70 patient per annum [1,754 patients of 70 and over]. We believe this visiting rate to be an accurate reflection of attendance rates by over-70s patients across the country.”
The IMO argued that its claim for a fee of €369 per annum was fully justified in light of the huge workload associated with patients over the age of 70, the very low capitation rates payable for all other patients under the GMS and the significantly increased costs associated with general practice in recent years – both administrative and infrastructural.
