For the first time, a Medicare review has proposed extending bulk-billing incentives to nurse practitioner consultations, but only to MyMedicare-registered practices.
The Australian College of Nursing (ACN) is urging the federal government to review MyMedicare and its accreditation requirements so nurse practitioners can access the same MBS rebates as GPs.
In its submission to the Medicare Benefits Schedule Review Advisory Committee’s draft report, the ACN warned that the current proposal risked “locking out” NP-led practices, which cannot join MyMedicare without a GP.
The ACN supported extending the incentives to NPs but opposed limiting them to MyMedicare-registered practices, calling for accredited NP-led practices to be recognised.
The committee’s 15th recommendation also proposed replacing MBS items for services provided outside consulting rooms with consistent fee-loading items, available only to patients registered with the practice provider via MyMedicare. It also recommended the loadings apply to NP consultations.
But the nursing college said NPs would be at a financial disadvantage compared with GPs, as practices must meet the RACGP’s Standards for general practice to join MyMedicare, and those standards did not recognise nurse-led models of care.
The college said including NPs in the proposed after-hours loading for home and aged-care visits was “a step in the right direction”, but tying loading items to MyMedicare registration would only create further access barriers.
“People in residential [aged] care facilities often struggle to access GP care. We think there’s an opportunity for NPs to deliver some of that care, but it won’t be eligible for MBS funding because of these draconian measures,” ACN CEO Adjunct Professor Kathryn Zeitz told The Medical Republic.
She said the current funding model was “disincentivising” new ways of delivering care, and that talk of a “two-tier primary care system” ignored a health system already struggling with fragmentation.
“We have to enable the community to decide the type of care they want to access, the time it takes to access that care, and the practitioner who delivers the care,” she said.
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While the draft report maintained the limitation would support “safety and continuity of care”, the ACN “strongly refut[ed]” this position, citing a lack of evidence, particularly given that accredited practices already had to demonstrate robust safety and quality standards.
“It creates a perception that nurse – or NP-led practices are unable to deliver safe, high-quality and continuous care independently,” the submission read.
The nursing college also argued the limitation would restrict consumer access to affordable and timely primary health care and favour traditional business models.
MBS benefits should be increased not only for prescribed medical practitioners but also for NPs who provide equivalent services within scope and competence, the college said.
Increasing rebates for longer GP consultations while leaving NPs behind would mean they “continue to be underutilised and unable to work to their full scope of practice”, the ACN warned.
With only 70% of nurses reportedly working to their full scope of practice, the college said the approach was also “out of step” with the government’s own National Nursing Workforce Strategy.
Professor Zeitz told TMR NPs were often essential to providing care in low-resource, rural and remote communities.
“We know that as demand on the general practice workforce increases, GPs are shrinking geographically and migrating closer to major metropolitan centres, leaving rural communities in some settings under the care of an NP,” Professor Zeitz said.
The college supported the committee’s recommendation to modernise data collection to inform primary care policy, planning and reform. But it said recording services provided by nurses who were unable to claim MBS rebates was essential, as existing datasets rendered their work “invisible”.
“The absence of comprehensive nursing workforce activity data limits the visibility of the substantial contribution nurses make to primary health care delivery and may result in workforce planning, funding and policy decisions which do not reflect the scope and value of nursing services,” the submission read.
“ACN is very hopeful the review committee will take on board the feedback from ACN, followed by a strong implementation strategy and government commitment to implement,” Professor Zeitz said.
