While they were certainly a poor measure of GP involvement in mental health work, the MBS mental health items were also the only measure of GP involvement in mental health work.
Mental health consultations will be axed from the MBS come November; but while few are mourning the items’ demise, there are questions as to how else the government will measure GP input on mental health.
As confirmed in a Department of Health, Disability and Ageing fact sheet last week, GP mental health treatment plan review items (MBS items 2712, 92114 and 92126) and related GP mental health treatment consultation items (MBS items 2713, 92115 and 92127).
Instead, GPs can just bill the appropriate time-based consult item for these appointments.
One of the many quirks of Medicare is that an item 2713, which covers mental health consults 20 minutes or longer, is rebated at $83.65 – about $1 less than the rebate for an item 36, the equivalent time-based consult.
Because of this, doctors are technically likely to be slightly better off under these new arrangements.
Mental health researcher and GP Associate Professor Louise Stone told The Medical Republic that misinterpretation of MBS data had led to false assumptions about the kind of work that GPs were doing.
“It was often interpreted that the only mental health work we did was inside a 2713, so a lot of the statistics that we have about how much mental health work GPs do are grounded in how many 2713s we bill,” she said.
“And that’s obviously problematic, because we don’t always bill a 2713.”
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Without solid data to back up the level of work that GPs put into mental health treatment, it’s difficult to argue for better funding.
It also leaves the profession open to criticism; in 2022, researcher Professor Ian Hickie used data which indicated that only one third of GP mental health care plans were formally reviewed to argue that patient mental health progress was “largely unmonitored by their GPs”.
Professor Stone said there were multiple reasons that GPs underbilled item 2713, two of the big ones being that patients did not always want to have a Medicare record that indicated potential mental illness and that patients rarely presented with a purely physical or purely mental health complaint.
Billing incorrectly in this area could lead to involvement from the Professional Services Review.
At a conference last year, Professor Stone presented a mock postnatal check and asked one side of the room to count the seconds spent delivering mental healthcare and the other side to count the seconds spent delivering physical healthcare.
“It was impossible,” she said.
“We know that this is a classic one where GPs will under-bill, because it’s just so problematic to try and work out what’s what.
“And we shouldn’t [have to work that out], because people are all people; they’re not divided with their mind on the left-hand side of the consultation room and their body on the other.”
In one sense, Professor Stone said, the removal of the mental health items was a “relief” because it brought an end to the guessing game.
But the issue of how the government measures GP mental health treatment remains.
“Everyone knows what happens to someone in a hospital, because it’s coded – but [hospitals] have coders,” Professor Stone said.
“General practice is … always going to be really messy and difficult to categorise.
“They can’t count things unless they actually ask us, at this point.”
Over the years, both the RACGP and AMA have repeatedly lobbied for funding to resume the Bettering the Evaluation and Care of Health (BEACH) project.
This has been unsuccessful so far.
