MBS review recommends time-tiered billing for specialists

Doug Hendrie

6/02/2019 4:23:16 PM

The taskforce investigating how doctors bill Medicare made the recommendations following RACGP calls for parity.

If approved, the RACGP believes a time-tiered structure would help deal with the longstanding disparity between GPs and other specialists under the MBS.
If approved, the RACGP believes a time-tiered structure would help deal with the longstanding disparity between GPs and other specialists under the MBS.

The report from the Medicare Benefits Schedule (MBS) Review Taskforce committee investigating specialist consultations recommended replacing existing fees for initial and subsequent attendance with a time-tiered attendance approach.
If accepted by the Government, the move would help deal with the longstanding disparity between GPs, who have long had time-tiered attendances, and other specialists under the MBS.
‘The Committee recommends introducing time-tiered attendance items with descriptors including activities to be performed in each time tier. These items replace existing standard attendance items and will be accessed by all consultant specialists,’ the report states.
In the RACGP’s submission to the review, the college pointed out the disparity between GPs and other specialist consultation items.
‘[C]onsultation items for other medical specialist are not time-tiered – an initial specialist consultation item could take less than 10 minutes and still attract a rebate of $85.55,’ it states.
The RACGP has long argued that consultations for other specialists are valued more highly than for GPs, leading to a significant gap in income even after adjusting for training time. The college is on record calling for a loading of 18.5% to be applied to all GP consultations to bring them in line with other medical specialist consultation MBS items.
Dr Michael Wright, Chair of RACGP Expert Committee – Funding and Health System Reform (REC–FHSR) told newsGP it is good to see moves towards more uniformity in the MBS.
‘For a long time there’s been a disparity between valuing the time of GPs and valuing the time of other specialists. So it’s good to see a move to more consistency,’ he said.

Dr Wright said a major benefit to GPs from any move to time-tiered specialist consultations would be the likely drop in specialists referring patients with ongoing conditions back to GPs in order to be able to bill the higher fee for an initial consultation.
‘[Patients] can often be referred back to GPs because the patient rebate is higher for an initial consultation, and the specialist can then bill another initial consultation each year,’ he said.
‘By moving to a timed consultation, they’re removing this incentive. That should reduce the workload for GPs in not needing to do unnecessary referrals.’
The MBS Review Taskforce committee report recommends building support among peak bodies, clinicians and patients for the principle of time-tiering before introducing schedule fees.
The report also recommended that a linear relationship be established between attendance time tiers and schedule fees, as well as recognising that each attendance also incurred non-patient-facing time.
Fee setting is outside the taskforce’s scope, and recommendations from the committee are not final.

MBS review medicare benefits schedule specialists time tiered

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David Maconochie   8/02/2019 8:53:48 AM

I am a GP and I have no problem with specialists getting a higher Medicare rebate than GPs. A specialist appt is quite different to a GP appointment in a host of ways. It is foolish for GPs to expect parity. You want a specialist rebate, then go train as a specialist and take on the extra responsibility that it entails.
Arguing for parity distracts us from the fundamental problem of the Medicare rebate being inadequate across the board.
This brings us on to why the Medicare rebate has become inadequate. A big part of this is that the finite health budget is being blown away in the billions on the white elephant of the electronic health record.

Prof Max Kamien, AM   8/02/2019 11:35:50 AM

Specialist fees are a relic of history. When I was a young doc a physician or psychiatrist set aside one hour for an initial consultation. Nowadays a cardiologist can see a patient in 10 minutes, a psychiatrist 20 minutes and an orthopaedic surgeon, 1 minute. To attract doctors to general practice there needs to be some sense of equity and fairness. This has been recognised in studies of relative value ( Mr Abbott was in favour of it when Health Minister). The problem with the implementation of such studies is that GPs gain but specialists lose. This makes any change close to impossible.

Dr Joveria Javaid   8/02/2019 2:09:43 PM

First things first, A fee of 37$ per consult for a GP is a joke. And to add injury to the insult is the fact that by every passing day, more and more item numbers are being chopped off. The most disappointing one is the changes to surgical item numbers.
I am not doing face biopsies any more and am referring them to hospital for excisions on face since the reduction in payment to the item numbers related to face biopsy.

Dr Jan Sheringham   10/02/2019 6:30:48 AM

Thanks Max, right on the money as usual! Oops, sorry about the unintended pun.

To Dr Michael Wright, the practice to which you refer of sending patients back to GPs for a “new” referral so the specialist can charge a fresh Initial Consult is just not on! If I send a diabetic to an Ophthalmologist for review of potential or actual diabetic eye disease, there is NO justification for a new referral - the condition REMAINS THE SAME - DIABETIC EYE DISEASE! Should such a patient develop a NEW EYE CONDITION, then AND ONLY THEN, is a new referral, with an associated Initial Consult, justified AND LEGAL under Medicare rules! While I agree it is good practice to provide an annual summary update for any specialist treating a patient, this does NOT constitute a new referral for a previously referred chronic condition, where the referral meets the criteria for an INDEFINITE REFERRAL. While myHR may circumvent the need for an annual summary, when/if it runs effectively and completely, some consultant specialists need to review their front office procedures for requesting “NEW” referrals - perhaps this is one effective area for the PSR group to examine. I am certain they could unearth many practitioners who routinely rort this component of Medicare, costing millions!