DAME Newsletter - December 2000
Contents
Acknowledgment
Distribution
Update to DAME Handbook
New procedures for obtaining medical examination stationery
Update on Medicare rebates for CASA-required examinations
and reports
Return of DAME Seminars in 2001
Confidentiality and appropriate handling of medical
information / reports
Two important reminders
Seasons Greetings
Acknowledgment
DAMEs / DAOs should confirm receipt of this Newsletter, notating their DAME stamp number, per return email to <urban_ma@casa.gov.au> Alternatively, please fax confirmation of its receipt to CASA AvMed at (02) 6217 1640.
Distribution
DAMEs / DAOs should read and digest the contents of this Newsletter, retain it for future reference, and make relevant sections of it available to locums or to other staff members who have dealings with CASA on behalf of practice principals.
Update to DAME Handbook
As foreshadowed in the last DAME Newsletter (October 2000), a complete revision of the Cardiology section of the Handbook has been completed. This should be available through the CASA website by the end of the year - please check regularly!
New procedures for obtaining medical examination stationery
CASA Aviation Medicine Section’s move towards a paperless office continues apace. Although it now appears that it will be the second half of 2001 before on-line lodgement of medical examinations and reports is finally available to DAMEs and DAOs, the Authority will discontinue supply of form 97 (Medical Questionnaire and Examination Form - R), form 98 (Medical Questionnaire and Examination Form - O) and form 99 (Eye Examination Report - V) from the end of January. Thereafter, DAMEs / DAOs will have to order these forms directly from the supplier in packs of ten forms. Note that the supplier will charge for these forms, which charge individual DAMEs / DAOs presumably will recover from their examinees.
To place orders, DAMEs / DAOs should access the CASA website as follows:
· <www.casa.gov.au> then select, in order
· <regulation of Australian aviation>
· <forms and procedure manuals>
· <CASA forms>
· <order paper forms>
Initially, it will be necessary to down load an order form and to fax it, with credit card details, to the supplier. However, plans are in hand to allow on-line ordering from the supplier as soon as possible.
This change results from CASA AvMed’s limited budget and reducing workforce. Long-time DAME Liaison Officer Margaret Urban will be leaving her position on promotion for a different part of CASA very shortly, so I decided to take the opportunity to reduce the unnecessary clerical workload for a new appointee to the position.
Update on Medicare rebates for CASA-required examinations and reports
I recently met senior medical advisors from the Health Insurance Commission to discuss again the vexed question of applicants’ access to Medicare rebates for investigations / referrals required by CASA in connection with applications for medical (re-)certification. The result may not be popular, but it certainly is clear.
The HIC’s Medical Director has confirmed that anything the DAME does as part of completing the medical certification process is not billable to Medicare. To try to make the borders identifiable, HIC considers that until all investigations necessary for the CASA report have been completed and the report dispatched, anything done is not billable to Medicare. The full text of the relevant advice follows.
I write concerning the payment of Medicare benefits in the context of health screening measures and the relative status of services rendered, and tests ordered, by Designated Aviation Medical Examiners(DAMEs) on their pilot or air traffic controller examinees, where such services are performed in accordance with CASA protocols or other air safety legislative requirements.
The Health Insurance Act 1973, which prescribes the conditions under which Medicare benefits are payable, is very specific in this regard. Under the Act, unless the Minister for Health otherwise prescribes, Medicare benefits are not payable for health screening services. A health screening service is defined as a medical examination or test that is not reasonably required for the management of the medical condition of the patient. Services covered by this proscription include all examinations and testing of fitness to undergo vocational activities, and specifically, compulsory examinations and tests to obtain [or maintain] a flying licence, whether that be for commercial or recreational purposes.
Under this proscription, the Health Insurance Commission takes the view that any and all examinations and tests in any way related to the acquiring or renewal of a pilot’s licence are not eligible to be claimed for reimbursement under the Medicare program. Even where such examinations or test lead to the need for further, more detailed examinations or tests being required in order that the required licensing protocols are fully met, the HIC would take the view that such episodes have resulted from screening services and are simply further stages in that process and therefore similarly would have no entitlement to Medicare benefit.
Where, as a result of such examination or tests, a clinical condition is discovered which of itself requires further investigation for the sake of the ongoing management of the clinical condition of the patient, such further investigation should be performed outside the parameters of any DAME services, by the applicant’s own GP. Where the DAME is also the applicant’s usual GP, then such further tests and/or examinations should be addressed as part of a separate episode unrelated to the purposes of the GP’s examination of that patient in his/her capacity as a DAME.
For further clarification on any of the above, Dr Janet Mould can be contacted on (02) 6124 6276. Alternatively, any of the HIC’s Senior Medical Advisers in any of the mainland States’ capital city offices of the HIC can also provide further guidance.
Return of DAME Seminars in 2001
DAME appointments are subject to a number of specified conditions and all DAMEs sign an undertaking to observe these conditions. One such condition which has fallen into disuse in recent times is the requirement that DAMEs attend an approved update seminar on aviation medicine at least once in every two years. Although CASA will no longer itself provide DAME update seminars, in 2001 it will resume participation in high quality seminars organised by a number of external agencies. External agencies will have their relevant courses or seminars approved in advance by CASA for the purpose of DAME recertification and notice of approvals will be posted on the CASA website under ‘Information for DAMEs and DAOs’. At this stage, February 2001 seminars organised by the Victorian and NSW Branches of AMSANZ have been so approved, as has the 2001 AMSANZ Annual Scientific Meeting scheduled for September 2001 in Canberra. Additionally, Flight Medicine Systems Pty Ltd (headed by Dr David Newman) has been approved to conduct seminars for the purpose of DAME currency. Dr Newman intends to run a number of one-day seminars in regional centres during 2001, for the convenience of local DAMES. Details of Flight Medicine Systems seminars will be available from the company’s website <www.flightmed.com.au> and further information can be requested directly from <info@flightmed.com.au>. Obviously, DAMEs will have to pay to attend these activities, but the organisers will seek CME points from the RACGP and / or AFOM in all cases. This truly marks the entry of CASA’s DAMEs into a new era of ‘User Pays’!
Confidentiality and appropriate handling of medical information / reports
Several recent instances of mishandling of medical reports have given CASA Aviation Medicine Section cause for concern. One DAME gave an applicant his own medical examination and report form plus those of several other applicants and asked him to drop them all off to a CASA office! This is contrary to both the letter and the spirit of the requirement for DAMEs to mail examination and report forms to CASA as soon as practicable after their completion. Allowing an applicant access to his own medical is fraught with possibilities for corruption of data recorded. Giving him other applicants’ medical reports is possibly legally actionable and certainly unethical. In another case, a DAME referred an Air Traffic Controller to a cardiologist for assessment. The cardiologist then (correctly) sent his account to AirServices, but also sent a copy of his clinical report to the employer. DAMEs are requested to remind specialists to whom they send medical certificate holders / applicants for assessment that clinical reports should be sent only to the referring DAME, ideally with copy directly to CASA Aviation Medicine Section, regardless of whom they bill for the consultation and report.
Two important reminders
- When an examinee admits to current problematic usage of any substance, obtain a urine specimen from the applicant then and there. CASA Aviation Medicine has had several recent instances where it had no choice but to issue a medical certificate to an applicant about whom it held suspicions but who had returned a ‘clean’ urine specimen when the history came to attention, often weeks after the original medical examination.
- Remember to complete examination and report forms in HEAVY / DARK BLACK ink, whether written or typed, also that written comments should be PRINTED to ensure legibility.
Seasons Greetings
All staff at CASA’s Aviation Medicine Section join me in wishing all our DAMEs and DAOs compliments of the Christmas season and success in the new year, century and millennium.
Peter Wilkins
Director of Aviation Medicine /
Principal Medical Officer