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Paul Hayes

19 Dec 2018
News

MBS Review Taskforce publishes recommendations in general practice report

Paul Hayes

19/12/2018 4:16:56 PM

The Taskforce has released its report from the General Practice and Primary Care Clinical Committee.

The General Practice and Primary Care Clinical Committee made 18 recommendations for general practice.
The General Practice and Primary Care Clinical Committee made 18 recommendations for general practice.

The Medicare Benefits Schedule (MBS) Review Taskforce (the Taskforce) this week released its report from the General Practice and Primary Care Clinical Committee (GPPCCC).
 
The GPPCCC’s work forms part of the Taskforce’s review of the entire MBS, considering individual items as well as the rules and legislation governing their application.
 
The recommendations in the report do not constitute the final position on these items, which is subject to:

  • stakeholder feedback
  • then, consideration by the MBS Review Taskforce
  • then, if endorsed, consideration by the Minister for Health and Government.
Here are some of the GPPCCC’s 18 recommendations for general practice.
 
Introduction of an MBS item for consultations lasting 60 minutes or more
GPPCCC recommendation:
New item – Level E consultation item: Create a new item for consultations of 60 minutes or more by a GP.
 
The RACGP previously called for the Taskforce to recommend a consultation item to support patients in consultations with the GP for 60 minutes or more.

The RACGP has again called for the Federal Government to support GPs to be able to spend more time with their patients. President Dr Harry Nespolon told the Sydney Morning Herald that the Medicare system is failing to address the burden of mental health on the profession, while rewarding doctors who rush patients through consultations.
 
Change to Level B item descriptors to set a minimum six-minute consultation length
GPPCCC recommendation:
Change the [Level B] descriptors to state that the consultation length should be a minimum of six minutes.
 
The RACGP has previously advocated for a focus on quality medicine rather than time-based medicine. Mechanisms to support the provision of safe and high quality medicine is the focus of the RACGP’s Vision for general practice and a sustainable healthcare system.*
 
Move to a patient-centred primary care model supporting GP stewardship
GPPCCC recommendation:
A new model for primary care funding should be developed to support high-quality, patient-centred primary healthcare and GP stewardship of the health system.
 
The RACGP has also advocated for greater support for high quality, patient-centred primary healthcare and GP stewardship, and for alternative funding arrangement to support general practice in its Vision for general practice and a sustainable healthcare system.*
 
Facilitating patient enrolment
GPPCCC recommendation:
There should be a new fee for practices and GPs for enrolling a patient. Consumers should be able to enrol with a practice, and nominate a GP within that practice, with flexibility so patients can see other providers within the practice. The fee should be weighted by relevant patient characteristics, such as rurality, Indigeneity, risk, etc.
 
The RACGP has advocated for patient enrolment as mechanism for encouraging continuity of care in its Vision for general practice and a sustainable healthcare system.*
 
The RACGP supports voluntary patient enrolment, which creates a formal link between a patient and a general practice, making it a key enabler of health service coordination and continuity of care.
 
Support for flexible access, including non-face-to-face access
GPPCCC recommendation:
The Committee recognises that many members of the community, including those living with disability and/or with transport issues, and people living in rural and remote communities, face challenges in attending general practices. This recommendation focuses on increasing access to care. The Committee recommends that flexible access, including non-face-to-face access (eg telephone, email, videoconsulting, telehealth, etc), be supported through voluntary patient enrolment.
 
The RACGP has long called for more flexible and modern access to care, raising the need for greater access to telehealth as a recommendation to the Taskforce.
 
Changes to chronic disease management items
GPPCCC recommendation:
Combine GPMPs [general practice management plans] and team care arrangements [TCAs] into one item.
 
GPPCCC recommendation:
Equalise the value of the schedule fee of items 721 and 732, and strengthen the descriptor of item 721 to enhance quality.
 
Changes to health assessments
GPPCCC recommendation:
The Committee calls for changes to health assessments, including:
 
  • the deletion of health assessments lasting less than 30 minutes (item 701)
  • expanding eligibility to new at-risk populations and modifying existing populations to better align with clinical and service needs.
The RACGP has previously made a recommendation to the Taskforce regarding expanding health assessments.
 
The RACGP will provide a submission to the Taskforce in response to the GPPCCC recommendations and will shortly be calling for member feedback to inform our response. The Taskforce will consider the RACGP’s submission, along with those of other stakeholders, prior to making final recommendations to the Federal Government.
 
The RACGP has welcomed the MBS Review as an opportunity to modernise Medicare and argues for better recognition and focus on GPs through the review process.
 
Details of the RACGP’s previous submissions to the Taskforce are available on the college website.
 
* The RACGP is currently reviewing its Vision for general practice and a sustainable system and will be consulting with members on the revised version in early 2019.

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A.Prof Vicki Kotsirilos, AM   20/12/2018 9:18:13 AM

Congratulations to the RACGP! These are truly positive changes to Medicare item numbers and improving quality of care for doctors and our patients.

Ning   20/12/2018 12:33:16 PM

Can any one help me to answer my questions ?
1: What is urgent item number should be used for non-VR GP in the After Hours Clinic in social hours and in the unsocial hours ?
2. Can non-VR GP refer patient to Psychologist by using chronic disease GP Management plan, as some patient has no time to see their GP during day time.
3. What item number should use to refer patient to see exercise Physiotherapist for non-VR GP in the After hours Clinic ? Such as Severe Obesity patient.

Dr Colin Hughes   20/12/2018 4:11:42 PM

Dear Chair,
As a former Chair of the RACGP and Head of Public Health East Metro Perth, I am very concerned about the rapid increase in 6 minute medicine promulgated by the large GP clinics who demand contracts from their OS trained GPS for 6 minute appointments and targets. There was a recent proposal to ensure a minimum time of 6 minutes per consultation but this is ridiculous if we are to improve the productivity and level of care to patients. It is time to change the time bands to 10 minute quintiles with minimum standards of record keeping to ensure tax payer value and improved health care. As a clinical teacher at Curtin Medical School I can assure you that our new graduates are properly trained but will avoid a low paying career in General Practice unless major changes are made. I would be happy to appear in person to any committee.

By way of background my submission can be found here (https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Health/Health/Submissions?MainContentPlaceHolder_&print=1&main_0_content_1_RadGrid1ChangePage=7_20)

Colin Hughes
PO Box 1905 Midland DC WA 6936
M 0403027323 H 08 92551661

Dr Peter J Strickland   20/12/2018 6:38:22 PM

Noe of these changes REALLY does anything apart from administrative changes for irrelevant items ( like health assessments). This committee has not got down to the nitty-gritty of general practice, e.g increasing the rebates for consultations and visits, introducing an item no. for e.g. wart treatments done mostly in GPs treatment rooms and needing LA, cautery machines, liquid n2 use etc.. Phone consultations by patients should have been an item years ago, writing and reviewing prescriptions for patients in nursing homes, or simply writing repeats for our patients --where are they? I am afraid I totally disagree with Vicki K. (above) --the real world of the GP is different to what public servants and quangos determine from time to time in their imagination --their aim is always to save money, and not related to patient treatment by doctors!

Dr Makawitage Duminika Minushi Perera   21/12/2018 10:08:22 AM

Can I get more details on when this is gonna be implemented and what the dollar value is per item number , does the fee stay the same though the timing has changed , what incentives are there for bulk billing rural doctors ?

newsGP   21/12/2018 11:05:22 AM

Thanks for your query, Dr Makawitage Duminika Minushi Perera.
The recommendations in this report are still in draft form, and members are encouraged to provide the RACGP with as much feedback as possible. The RACGP will use this feedback to form a response to the MBS Review Taskforce.
Following the review of feedback, the MBS Review Taskforce will submit a final report to the Government, which will then consider the report and make a final determination – it is at this stage that implementation dates will be advised.
The Clinical Committee has not released any details on dollar values or other incentives. Regardless, the RACGP can still provide the MBS Review Taskforce with feedback on these important issues.
Thank you.

Claire Cupitt   21/12/2018 9:29:46 PM

My concern with Medicare lies with its complexity - the rules for items 721 and 723 are complex,onerous and written in morethan 1 place in the MBS - consequently, it is rare for a GPMP or TCA to pass a Medicare audit - leading to severe penalties for doctors who are trying to practice in the best interests of their patients and to be compliant with the rules. Rules for other item numbers can also be complex, open to interpretation - if other interpretations are made, they should be added to the descriptor, in italics, so we can see an adjustment has been made, to make it easier for the majority to know the rules and not be innocently caught out.

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