The AMA’s submission to the long-awaited MRAC paper reiterates that changes are only welcome if they do not represent a fee decrease.
Any Medicare reforms must address the level B “distortion” in time-tiered rebates and reinvest funding from items that get cut, the AMA says – while also delivering a firm warning to the department on its recent consultation tactics.
The fact that the government has now formally recognised the iniquity of Medicare’s time-based GP item structure, it said, “marks the growing recognition that the status quo is no longer enough”.
Released last month, the MBS Review Advisory Committee time-tiered item working group report acknowledged that the current per-minute differences between short and long consultation rebates was too great.
It recommended that benefits for time-tiered items be adjusted to “equitably support” appropriate and varied consultation lengths.
In its submission to the MRAC report, which was published today, the AMA continued to push its proposed seven-tier rebate structure.
While the draft MRAC report appeared to favour the RACGP’s proffered approach of increasing the rebates for level C to E items – calling it the “fastest” solution – the AMA argued that the real pain point for GPs was level B.
“Raising only levels C–E leaves the most common patient attendance item untouched,” the submission said.
“Level B consultations accounted for 66 per cent of GP services in 2023–24, yet Medicare funds a six-minute and a 19-minute consultation identically.
“A 15–19-minute consultation for a patient with several chronic conditions is where the current structure fails.”
The AMA acknowledged that increasing level C through E rebates would be a sound place to start, so long as more reform followed.
It has long proposed a seven-tier structure, which would break up level B into two separate levels: 6–15 minutes and a 16–25 minutes.
“While lifting level C through E fees is important, what we would always like to see, is to recognise the value that is already being delivered by people who see patients for a longer period of time,” AMA president elect Dr Michael Bonning told The Medical Republic.
“And that that means people in that 16-to-25-minutes category and beyond, so that there are two more time tiers.
“Otherwise you go from a relatively small increment of zero to under six minutes, and then you get just these much progressively longer [jumps of] six through to 20, 20 through to 40, 40 through to an hour, and then an hour and beyond … this is a much more graduated system, without being without being particularly complex.”
The association also took shots at the Department of Health, Disability and Ageing’s recent consultation efforts.
“Recent reforms have seen rebate structures finalised internally before the profession was consulted on item descriptors, with proposed rebates disclosed late in the process,” the AMA said.
“It is imperative that implementation follow best practice. The reforms are too important to repeat that approach.”
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The association called on DoHDA to publish the modelling for each recommendation, including the impact on total rebates, and to involve the profession in setting rebates before item descriptors are finalised.
While the AMA did not refer to a specific consultation, DoHDA did notably drop the ball on chronic disease management changes, with key stakeholders reportedly kept in the dark on what rebates would be until quite late in the piece.
The MRAC report also recommended that several standalone, condition-specific MBS items, including pregnancy counselling, acupuncture and bloodborne virus items, be axed, with doctors instead using the relevant time-tiered item.
The AMA said it supported measures to minimise disease-specific items, but noted that many of the items proposed for removal could currently be co-claimed with general attendance items.
This, it said, effectively “reduces the total rebate for complex, multi-issue consultations”.
The association called for any removal of condition-specific items to be matched by a significant increase in time-tiered rebates.
Read the full submission here.
