AMA calls for overhaul of time-based items

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Will GPs be better off under the proposed RACGP or AMA reforms?


The AMA will push for a comprehensive redesign of GP time-based MBS items ahead of the election this year, despite RACGP just asking for a raise.

According to the association’s pre-budget ‘modernise Medicare’ campaign, which was released today, the path to sustainable general practice begins with changing the Level A, B, C, D and E item structures.

Under its proposed replacement system, there would be seven time-based Medicare rebate levels instead of five.

These would start at five minutes or less and go up from there in graduations of 10 minutes, with everything after 60 minutes covered by a $260.80 rebate.

It differs from the RACGP’s big ask for Medicare rebates, which it has confirmed will be a 40% increase to the rebates for Level C and D consults.

According to the RACGP’s 2024 Health of the Nation survey, the average GP consult last year went for around 19 minutes.

Under the current rebate structure, that would be classified as a Level B consult and draw a patient rebate of $42.85.

Because the RACGP is only asking for an increase to the Level C and D consults, if the government followed its reform plan, then the average patient would still be receiving a $42.85 rebate for that appointment.

The proposed AMA system, however, would classify a 19-minute appointment as a Level 3, worth $78.25.

“Where we share goals [with the RACGP] is that we’ve all made it clear that general practice needs significant investment and that we need to be supporting longer consultations,” AMA president Dr Danielle McMullen told The Medical Republic.

“We’ve got slightly different ways of going about getting there, and we do think that the underlying Medicare structure needs reform, but the two organizations are united in our desire for funding for general practice.”

One of the benefits of a complete time-based consult overhaul, Dr McMullen said, would be to “smooth” the rebate curve.

In turn, this would have the run-on effect of alleviating the Medicare gender pay gap, whereby female GPs tended to take on longer appointments which have a lower per-minute remuneration on Medicare.

“Under our seven-tier structure, there’s a real smoothing of that curve so that even at the longer end, you can afford to keep your doors open and see those patients for the more complex consultations,” the AMA president said.

Of course, big change came with a big price tag; the AMA estimated that the reforms would cost $4.5 billion over four years.

Dr McMullen said the AMA had done extensive economic and behavioural economic analyses and tested it with real GP and patient data in a variety of different practice settings, and was confident that it would work in practice.

The AMA’s other headline asks were equalising pay and conditions for GP registrars, increasing the number of GP rotations, removing caps on the Workforce Incentive Program, restarting a general practice data collection scheme and offering an extra 500 GP training places yearly by 2027.

When asked why additional places on the Australian GP Training Program would be needed, given that 2025 is the first year since 2015 that all 1500 places have been filled, Dr McMullen said it was important that the AMA’s reforms went together as a suite.

“We’ve seen a full subscription to GP training places this year, but to boost that going forward, we need reform of the employment conditions for registrars,” she said.

“They shouldn’t have to take a pay cut to enter general practice training, so we want to see equalisation of pay and conditions with their hospital-based counterparts.

“And we also want to increase the exposure in pre-vocational training so that junior doctors have the opportunity to come in and try general practice, do a placement in the community, meet our patients, work in our clinics and understand how rewarding a career in general practice can be.

“Then once we’ve lured in all those new GP [registrars], we need the capacity to train them.”

At the time of writing, the date for the federal election had not been set. It will be held on or before 17 May 2025.

While the AMA’s asks are technically part of a pre-budget submission, it’s worth noting that the May budget is not scheduled to be handed down until after the election, making it likely that any big-ticket items could be wheeled out as election promises.

Current structure
Level A (item 3)<6 minutes$19.60
Level B (item 23)6 – 20 minutes$42.85
Level C (item 36)>20 minutes$82.95
Level D (item 44)>40 minutes$122.15
Level E (item 123)>60 minutes$197.90
AMA proposed structure
Level 1<5 minutes$19.60
Level 26 – 15 minutes$45.00
Level 316 – 25 minutes$78.25
Level 426 – 35 minutes$111.75
Level 536 – 45 minutes$149.00
Level 646 – 59 minutes$186.30
Level 7>60 minutes$260.80

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