It appears the RACGP’s wish for increased long consult rebates will be granted.
A long-awaited MBS Review Advisory Committee draft report has validated GP concerns about the inherent unfairness of the time-tiered MBS rebate structure for general practice.
The draft report, which health minister Mark Butler foreshadowed last week, concluded that “the current per-minute differences between short and longer consultations is too great”.
It recommended that the benefits for time-tiered items “equitably support appropriate and varied consultation lengths to ensure patients can access care that meets their individual clinical needs”.
The draft report also formally recognised the role of inequitable rebates in perpetuating a gender pay gap in general practice.
“MBS data also revealed gender equity issues, as female GPs are more likely to provide longer consultations than their male counterparts,” the report said.
“In addition, female patients are more likely to use longer consultations than male patients.”
The working group felt it was still “reasonable” for shorter consults to have a higher per-minute rebate attached, in recognition of a “relatively higher” administrative burden attached to shorter visits.
There were three key options identified – increasing the fee for level C, D and E consults, moving to a seven-tier structure and converting the rebates into “time blocks” with a flag fall for the initial block.
The first two options will be familiar to those who have followed the ongoing debate as the proffered solutions of the RACGP and AMA respectively.
Where the RACGP has long called for a 20% to 40% boost to rebates for level C, D and E consults, the AMA’s vision for reform involves restructuring the tiers completely, adding in two completely new rebate levels.
The MRAC draft report appeared to lean toward the RACGP’s solution.
“… Given the complexity of changing the overall time-tiered framework (for example, as per the AMA proposal), the [time-tiered item working group] acknowledged that increasing the fees for levels C–E is the option that could be implemented fastest,” the report reads.
“However, doing so would not preclude longer term changes to the time-tiered structure.”
The draft report also recommended that bulk billing incentives be based on a percentage of the MBS fee for the service that is bulk billed, rather than be a flat fee, to avoid furthering the “disproportionate remuneration of shorter consultations when compared to longer consultations”.
The working group felt that rural loadings for bulk-billing incentives were “appropriate and should be retained” under the proposed changes.
The report also noted that the staggered reintroduction of indexation to the MBS – which famously meant that items like 2713 were permanently rebated about $1 less than their time-tiered counterparts – needed to be addressed.
The MRAC giveth…
It also dealt with rebates for home visits, after-hours services and urgent after-hours services.
For each of these, the MRAC working group recommended that the existing set of items be replaced with a higher rate loading item.
The definition of after-hours would also be aligned across all care locations to begin at 6pm on weekdays.
Unsociable hours, meanwhile, would be defined as between the hours of 11pm and 7am daily.
GPs would also be able to claim the same bulk billing incentives items that would be available for a regular consult.
There’s also good news for fans of BEACH.
The working group also recommended that the government “ensure the funding of appropriate and contemporary data collections”.
“During its discussions, the [working group] recognised that data collection to inform policy could be improved. However, data collection is not a sufficient justification for separate MBS items,” the report said.
“Other mechanisms of data collection should be considered as the primary mechanism for data collection on issues such as reason for visit, prevalence of specific conditions, and the overall health and wellbeing of the population.”
… but the MRAC also taketh away
Other recommendations included in the 45-page draft report sought to standardise the language used in item descriptions and align the duration of MBS time-tiers across all relevant primary care provider types.
As a result, one of the proposed actions is to create a single set of time-tiered MBS items for all practitioners – including nurse practitioners – and simply have a fee “modifier” linked to each provider type.
In the name of streamlining, the working group recommended the following be removed, with GPs to claim general attendance items instead:
- Differential fees and items for practitioners with mental health skills training,
- Standalone items for pregnancy support counselling and antenatal care,
- Standalone items for acupuncture, and
- Standalone items for telehealth services for bloodborne viruses and sexual health services (although the existing relationship rule exemption would still apply).
Time will tell
RACGP president Dr Michael Wright told The Medical Republic that, whatever happened, the time-tiered item review was going to have a “major impact on the financial viability of general practice”.
“It was good to see in the notes where they said that the college’s proposal to increase the consult items will be the quickest way to fix the problem,” he said.
“It’s good to see that that’s been looked at.
“But the devil’s got to be in the detail, because there are no figures on what the re-aligned rebates will look like.”
As a whole, Dr Wright said the recommendations were in line with what the college has been advocating for.
“It’s good to see this work, finally, to get rid of some of the bias within the current Medicare schedule which has been there since it started,” he said.
“It provides more funding for procedures over consultations, and it then … disadvantaged doctors who were spending more time with complex patients.
“Fixing it up is a real step in the right direction.”
Work on the review commenced more than two years ago.
The draft report is open for submissions until 15 October.
