To the Editor: The care of patients at the time of hospital discharge and on returning home is often neglected, and has implications for those needing multidisciplinary care. Research has shown that discharge planning can produce better health outcomes, facilitate the patient’s and the general practitioner’s involvement with discharge care, and improve communication between hospital and general practice services.1-3

To encourage GPs to be involved in discharge care planning for patients with chronic diseases, there are Enhanced Primary Care (EPC)-specific Medicare Benefits Schedule (MBS) Items for contributing as a team member to EPC discharge care planning (Item 728), and for review at 3 months post-discharge (Item 724).4 However, the fact that < 1% of claims for EPC care plans are for discharge-related items has been attributed to barriers to GPs’ involvement in discharge planning, or their unwillingness or inability to initiate such a process rather than simply participate.5 Further, little evidence exists that, given the opportunity, GPs are willing to be involved as a team member in this process.

In a recent study of ours investigating EPC discharge care planning for chronically ill patients,3 we required GPs to comprehensively review and comment (in writing) on discharge plans developed by the hospital. GPs also performed a follow-up consultation within 7 days of discharge and completed a questionnaire. We found that 90.1% of 91 GPs in the intervention arm of the study willingly contributed to discharge care planning for their patients, indicating that, when offered input into planning discharge and post-discharge care, GPs are willing to fulfil such a role. Further, this finding, in addition to the high questionnaire response rate of trial GPs (80.6%), indicates the importance of this issue to GPs and the belief that GPs are not sufficiently included in discharge processes.

Additional results from a follow-up survey, at 28 days post-discharge, of those GPs who participated in discharge planning (n = 91, 70.3% response) showed that only 42% of GPs claimed the MBS Item 728 ($39.80 in 2002, at the time of the study). Results from a subsequent survey (n = 91, 45.1% response) suggested that even fewer (about 15% of respondents) claimed reimbursement for a 3-month care plan review (Item 724, $98.20), although we do not have data on the number of 3-month reviews performed.

The reasons given for not claiming these Items included poor understanding of the Item and claiming procedures, and a belief that excessive administration was required to claim the increasing number of MBS items. In the light of sanctions for administrative claiming errors, this may explain the low claim counts for these Items. However, the most common response was that input into the discharge care plan was, in their opinion, not sufficient to justify reimbursement, even with the extra time required for care plan review and post-discharge follow-up. This suggests that GPs do not simply view EPC discharge care planning as a revenue raising exercise, but rather as quality patient care. Further, it may indicate an undervaluation by some GPs of their role in hospital-driven processes.

Considering the evidence in support of discharge care planning for improving quality of care, focus should be directed towards ways of encouraging this process, other than simply providing a financial incentive.