If you’re keen to offer COVID vaccinations, despite the economics, here’s a bit of detail we hope will help you prepare for an interesting journey.
If you’re keen to offer COVID vaccinations, despite the economics, here’s a bit of detail we hope will help you prepare for an interesting journey.
As the week wore on, and more and more confusion started to layer around the COVID vaccination program, TMR decided in a well earned tea break to ring one of our largest betting companies to see if they’d take an exotic bet on whether the government would meet their end of October deadline to vaccinate the entire population.
It was an interesting call.
The very nice man in customer service listened intently to the proposition and the bets we were proposing to take (see end of article) and with what seemed like an excited tone in his voice said he would to run it past management to see.
He put me on hold.
Twenty minutes later he got back and said that, unfortunately – I guess unfortunately because it could have ended up a pretty hot betting market – it was against the law to run a tote on anything to do with the government.
Hmmmmm … sounded a bit convenient. Don’t they take bets on the general election? Maybe they felt that betting on the government doing anything on time, particularly something involving a significant IT component, wouldn’t attract odds good enough to make it a market?
Before you read on, and make a decision on the odds yourself, we all want the COVID vaccination program to happen to deadline.
Really, the faster the better for everyone, for all sorts of reasons. But of course mainly for public health and the economy.
For the Liberal government, an October deadline would be a great launching pad for an end of year election, so they are certainly motivated. Of course, we aren’t saying they are not motivated by wanting to get us all protected, and get the economy opened up, and rolling again.
We promise we aren’t just being Hardy Har Har (it’s a 60s cartoon, Millennials) with the following list of issues that might make a bet on missing the deadline a good one.
We are just saying that there’s a lot of issues piling up – logistical, commercial, medical, political, ethical and otherwise – that might contrive to upset this ambitious task we have set ourselves.
Remember, vaccinations were due to start for phase 1a, in hospitals in just a week or so (that was the original deadline which has now already been moved), and phase 1b, for 6.5 million other high risk individuals, and involving GPs, just a few weeks after this.
Here’s a few problems we think the country, the government, GPs, and other healthcare professionals are likely to encounter along the way to the end of October:
Vaccine nationalism
Put simply, short of getting our act together better on hotel quarantine, no one is sick or dying in Australia, but they are in big numbers in other parts of the world including some of our neighbours, and they are all desperately short on vaccine supply.
Ten million (now 20 million ordered) doses of Pfizer vaccine used in Australia in the next two months will probably make a lot of people feel a lot safer, but probably won’t save one life, if we can keep our quarantine problems at bay for a bit longer. How many doses of that same ten million would actually save a life in a hard hit country like Italy or Indonesia?
That’s one aspect of the ethical issues we face in Australia, having secured about three times the amount of doses we need to vaccinate just once.
We now have one of the highest ratios of doses per capita globally secured and at the same time we have managed to keep a lid on the virus so people aren’t dying and health services aren’t stretched.
This has awkwardly put Australia in the sights of those warning against vaccine nationalism, as governments put their own populations (and their own political interests) ahead of the greater global good – as Ruby Prosser Scully writes HERE , and discusses on our new Tea Room podcast HERE.
Who is wrangling this cat herd of vaccine booking and inventory systems anyway?
Perhaps ironically – ironic because if you do COVID vaccinations you will likely struggle to break even doing it – as a GP you probably have one of best chances among all the vaccination outlets being planned by the government of having a reasonably smooth booking, re-booking, vaccine inventory management and AIR registration experience.
But you might end up having the best of a very bad lot of experiences.
These are some issues currently with how you will interact with the government and the public on bookings, screening and registration:
- Most GPs (maybe up to 85% even) are well served by an existing patient booking service (eg, Hotdoc, HealthEngine, HealthSite etc).
- The Department of Health has just determined that their Central Booking Service (which they had advertised broadly to GPs and pharmacists in each expression of interest program) won’t actually be a central service any more and they will instead attempt to link to all the existing booking engines in market (clever approach) to get bookings done. They will list all clinics providing vaccinations centrally on their National Health Services Directory, run by HealthDirect, and quickly build a central inventory system that talks to each of the existing booking engines to extract de-identified data on bookings so they can effectively manage the massively complex process of getting the right amount of stock to the right clinics at the right time (more on this below). Oh, and for all those clinics that don’t have a booking system, they are going to build their own just to service them (why not make everyone happy, we say).
- The good news here is that your favourite booking engines jumped the DoH on this process and are already developing specialised booking modules for your patients which will handle booking, scheduling, pre-screening, and the timely process of consent. We have a story later in this newsletter announcing what HotDoc is developing.
- The bad news is that this doesn’t actually mean the government will manage to create a system that can talk to these bookings systems and provide good inventory management nationally. It’s a not insignificant job to talk to all the versions of all the systems and collate that data properly. Remember, such a system has to talk to lots of other systems which are servicing hospitals, hospital hubs and pharmacies. OK, but at least a GP can do the booking right? Yes, but if the government can’t co-ordinate supply, you might not be able to get the vaccine stock you need to meet the demand of your bookings. That’s a problem because you could upset a lot of your patients.
- Slightly worse news on this front: for some reason – we think a cross between panic, mistrust of the federal government in a federated system, and a genuine need for for some sort of state based capability to manage the vaccination process – every state and territory has decided to write their own separate booking, inventory management and logistics system as well. We have no information at this stage on whether the federal system is going to talk to the state systems (feels a little like the rail gauge problem we had pre-Federation at this stage), and having viewed a few of the tender specifications for the state systems we can confidently at this stage say:
- The state governments have specified a system in each state (eerily similar between documents, but of course different multinational corporations winning the job in each state so likely very different solutions) which in any normal IT project cycle might take two years to complete. Some of these tenders went out as early as November last year and have been awarded, but we aren’t aware of any of the systems being near completion. We showed one specification to one of our most successful local tech vendor companies, who are particularly agile at software development and they guffawed spontaneously before composing themselves and saying it was a great set of ideas which would take a very long time and a lot of money to realise.
- The tender documents, though long and complex, and with lots of wish list stuff in them (much of which hasn’t been managed to be developed in advanced digital health economies like Denmark yet) actually don’t make mention of talking to any of the existing booking systems that the federal government has now decided to distribute most of it work too, or any of the major patient management systems that GPs use. It might be that these state systems are only intended to service hospitals, but they look much bigger and more expensive than that. If you don’t know, talking to the PMS systems is a major undertaking as they have lots of versions you would need to integrate too. All the current major booking systems do talk to the major PMS systems, so GPs will be able to quickly list their vaccinations on the Australian Immunisation Register (AIR) as required. But that spec isn’t in the state based systems we saw. We gather they might be adding it though.
- As a sort of summary: these state based systems, though well intended surely, are uncoordinated with each other or the federally planned system for the vaccine rollout. No one is saying anything yet but we think there is a good chance of there being a be a pretty big bottleneck as all these systems converge and start trying to talk to each other, and various governments seek data to run their various systems. It could even be a fairly large train wreck if they all meet at the same crossing at the same time – vaccine distribution time. Just spit balling here everyone. But be prepared for work arounds and the very real possibility that your booking does not align with actual stock delivery for you to vaccinate your patients.
- That the state governments are spending a lot of money on big overseas software and consulting companies on at least five systems that are set to do pretty much the same thing can’t be a good sign for the overall co-ordination and management of this vaccine rollout. Why in a big meeting of all the major health tech vendors with the DoH to discuss the logistics of roll out is there no mention of what the states are doing and how they fit in? At this point of time we are aware that some of the state system tender winners are likely to have been Microsoft, Salesforce, Oracle and Accenture. But there will be a lot more subcontractors involved we guess. This is only relevant to know if this all blows up because that’s a pretty disorganised and wasteful approach if it does.
- If you are interested, here’s some more morbid detail on the booking systems issues.
- One other possible problem for everyone is that if you can’t co-ordinate between all these systems then you are very likely to encounter patients doing multiple bookings at multiple clinics offering vaccinations. This happened in a significant way last year with flu vaccinations as patients, panicking that they might miss out, booked everywhere they could. The result of course is inventory and stock mayhem, and a lot of waste, as patients don’t turn up who are booked. There is talk of solving this issue so the government is well aware of it, but there are a lot of systems that need to co-ordinate on one unique ID for every Australian if this isn’t going to happen.
Back to the economics and the emotion
We have written a fair bit on the economics of a GP and a pharmacy trying to make money by doing COVID vaccinations. David Dahm has written a good article HERE on what you need to consider when planning. There is some on how pharmacy might benefit HERE. Dahm surmises that you might be able to make money if you really plan big, get scale and throughput, and somehow manage the issue of pumping a whole lot of extra people through your practice while doing your best not to disturb your business-as-usual patients.
One pattern that appears to be emerging already, which we guess the DoH may not end up being happy with, but which they will only have themselves to blame for, is that quite a few GP practices appear to be gearing up to vaccinate their patients after hours. This makes sense for two reasons:
- You don’t have your normal patient load in your waiting rooms so you have space and social distancing and you can plan at scale as you will just be vaccinating and nothing else
- The MBS items for after hours pay a GP more
Having put out a few warnings about how hard it is likely to be to do COVID vaccinations, we read in Australian Doctor this week that apparently 5240 GP practices have expressed interest to the DoH in doing vaccinations. That’s a lot of GP practices given we think there are about 6500 all up and there’s a lot of really small ones.
It’s against a backdrop of the DoH originally predicting that they throught 1000 GP practices would likely be doing COVID vaccination, and then an announcement from federal Health Minister Greg Hunt last Sunday (he works hard) that the EOI had received such a great response that he thought there would now be 2000 GP practices doing vaccinations.
So that’s 1000, 2000 and 5240. It looks in those figures like either the DoH thinks that a lot of practices will see the economic light and pull back from actually doing vaccinations, or a lot are simply going to miss out.
Or, maybe everyone will join in!
But that would likely amplify significantly the above booking and logistics problems that already exist, so we think the DoH is probably going to restrict numbers to some degree if it can.
Some larger practices have told TMR that despite a lot of scale planning, they will still lose up to $10-$20 per patient doing the work, but they aim to recoup that by picking up new long term patients by providing a good service.
And herein lies a dilemma for even those GP practices that have decided they can’t afford to do it. (My GP said she was going to do it, although she is in a two-GP practice, could hardly understand the EOI, and hadn’t yet done any numbers – she just felt it was what GPs should be doing).
If you don’t do it, will that big practice up the road do it and seduce a few of your loyal patients along the way?
Jeez, as if doing the numbers and applying for the EOI isn’t enough stress. Now you have to worry about marketing, customer retention and branding?
Maybe, but we think you probably don’t have to stress out too much. COVID vaccination is a short term event overall. It’s not likely to be a patient’s idea of a great time out anywhere they get vaccinated, so you’d have to doubt that simply offering COVID vaccination will result in a lot of patients deciding swap their GP. It didn’t have much impact in general practice when pharmacies took a proportion of the flu vaccinations.
The scoreboard problem
If you’re a T20 cricket fan you’ll be familiar with a scenario where the first team to bat hits the ball out of the park so much that the second team starts batting in an almost impossible position to chase the winning score. What often happens is that the tension and stress of having to hit out from the very first over causes the second team to collapse, and get all out for a very low score.
Before we start the countdown to October 31, our run rate on getting vaccinations done per day is huge. Like 200,000 per day. See this Conversation piece by Professor Raina Macintyre et al.
The point is, we are starting with a run rate so high that nothing can go wrong if we are going to chase the score down. There’s a lot of stress at the start. And if you think of what is riding on the politics of making this run chase, between both the federal and the various state governments, things are likely to get a fair bit more tense.
BTW – the Australian T20 final is on tonight.
(With apologies to the significant proportion of our readers who don’t follow cricket at all and don’t go for sporting metaphors either).
The betting (and some odds)
We publish these bets and odds as a sort of check list and reminder of what you might want to prepare for so you can better manage in your workflow and expectations as the great COVID vaccination program starts to roll out. We aren’t accepting bets
Bet 1: Australia will give up at least a third of its orders in the short term (remember we have enough coming for now to vaccinate us all three times over) to help countries in much more immediate need of the stock.
YES: 1.80
NO: 3.20
WE WILL GIVE UP SOME AT LEAST: 2.10
Bet 2: The state government built booking and inventory systems won’t talk to the federal government one in time, or the major PMS and booking systems for GPs and there will be problems (possibly big ones).
YES: 1.01
NO: 23.2
THERE WILL BE SOME EXCHANGE OF DATA BUT NOTHING MEANINGFUL: 5.20
Bet 3: The entire Australian population that can be vaccinated, and wants to be vaccinated will be vaccinated by October 31, 2021.
YES: 4.68
NO: 1.15
Bet 4: The Liberal government will either call an election before December if the vaccine rollout seems pretty well accepted by Australians, problems or not, and won’t call one if it turns out to be a public train wreck.
YES: 6.20
NO: 1.37
Please feel free to send us some exotic bets of your own.
Note: I said last week I’d continue analysing the new lobby group situation for GPs, but this felt more urgent. I’ll get back to that next* week.
* Don’t hold me to that.
