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Boosting GP stewardship through block funding


Doug Hendrie


17/12/2020 9:58:43 AM

The MBS is set for a shake-up, with the Review Taskforce recommending more use of block or blended payment models rather than fee-for-service funding.

Practice building on green background
What changes for general practice will come from this review?

The Medicare Benefits Schedule (MBS) Review Taskforce this week handed down its final report, with more than 1400 recommendations.
 
These came after trawling through and evaluating more than 5700 MBS items over the past five years.
 
‘The Taskforce has made a conscious decision to be ambitious in its approach, and to seize this unique opportunity to recommend changes to modernise the MBS at all levels,’ the report states.
 
‘Medicare and the MBS were designed in the late 1970s and early 1980s to meet the needs of a very different population. Australians are now older, living longer, and with more complex and chronic health issues, and the fee-for-service approach of the MBS needs to adapt and evolve to meet those needs.’
 
Partly shifting to block funding by expanding the voluntary patient enrolment program to the whole population has been recommended as one way to strengthen GP stewardship, particularly for patients with ongoing chronic and complex health needs.
 
‘The Taskforce frequently found the fee-for-service model was not always the most appropriate way of funding some health services,’ the report states.
 
The Federal Government has so far accepted 520 of the recommendations.
 
There are positive signs for general practice, particularly the recognition of GPs as health stewards and leaders of a supported multidisciplinary teams, as well as support for patient-centred care and encouragement of patients, family and carers as active health participants.
 
Dr Michael Wright, Chair of the RACGP Expert Committee – Funding and Health System Reform (REC–FHSR), told newsGP many of the recommendations are ‘very reasonable’ and reflect the need for the MBS to be updated.
 
‘This review started before the pandemic. We now have telehealth and are planning a system where patients can enrol with a GP and get additional services,’ he said. ‘These have happened since the review started.
 
‘So finding out where these reform processes align will be really important in working out whether it is good for general practice.’
 
But Dr Wright said the recommendation for a six-minute minimum for a Level B consultation could be controversial, and could act as a penalty for experienced GPs.
 
‘Some might say making a six-minute minimum is a good thing to reduce quick throughput, but if removing that funding makes practices unviable, then that would be a disaster,’ he said.
 
‘We need to understand where funding is going to shift. If you change Level Bs, you’d need to increase funding for longer consults to keep money in the system and encourage longer, high-quality care, which would align with our vision.’

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The MBS is projected to hit $31 billion in spending within two years, up from $20.2 billion in 2014–15.

The rapid roll-out of telehealth during the pandemic has offered a good opportunity to test what works in real time, Dr Wright said.
 
‘By necessity, there was rapid change to funding for GP services,’ he said.
 
‘It was essential to keep GPs and patients safe, but it has also allowed us to test how GPs have responded. It has shown GPs can responsibly use additional funding [through telehealth] without placing excessive strain on the health budget.
 
‘While many recommendations are reasonable, we need to ensure we don’t impact the viability of general practice. Now more than ever, we need GPs to keep their doors open as we roll into COVID vaccinations.
 
‘The last thing we need to do is make practices unviable through potentially short-sighted changes.’
 
The MBS is projected to hit $31 billion in spending within two years, up from $20.2 billion in 2014–15, a sign of an ageing population and the impact of multimorbidity.
 
Other recommendations relevant to GPs:

  • New Level E consultation item for attendances of 60 minutes or more by a GP
  • Increasing schedule fees for home visits
  • Combining GP Management Plans (GPMPs) and Team Care Arrangements (TCAs), and strengthening GPMPs
  • Proposed mandatory requirement for providers to complete training before approval for an MBS provider number
  • Establishing appropriate data collection and sharing mechanisms to inform service planning, resource allocation, evidence-based clinical practice, patient consent, and continuous quality improvement
  • Provide transparent, publicly available data on the cost and quality of MBS services to allow consumers to more easily make informed choices about their care in discussion with their GP at time of referral
  • Proposal to support and expand the use of clinical decision-support tools at the point of care to integrate MBS item descriptors and enable appropriate use of health services
  • Developing and supporting GP stewardship, including training, financing and research on a set of quality data metrics, to improve patient outcomes and health system efficiencies
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