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MRAC backs funding for longer consults
A major GP billing shake-up has been proposed as an MBS review backs a simpler Medicare schedule that could dramatically reshape the fee structure.
RACGP President Dr Michael Wright described the draft report as ‘a major step forward in correcting many of the biases and peculiarities in the Medicare schedule’.
Reforms are needed to address inequities in the current time-based GP fee structure, which is skewed towards rewarding shorter, less complex consultations, according to a draft report into time-based Medicare items.
Released for consultation on Thursday, the report feeds into a Medicare Benefits Schedule (MBS) Review Advisory Committee (MRAC) review into primary care time-tiered MBS items.
It identified several issues with the current fee structure including a need for time-tiered items to ‘equitably support appropriate and varied consultation lengths’.
On a per-minute basis, the difference between short and long consults was seen as being ‘too great’, found the report, which was compiled by the Time-Tiered Primary Care Working Group (TTWG).
‘The TTWG considered that this fee structure incentivises shorter consultations, and disadvantages patients who need, and practitioners who provide, longer consultations,’ the draft report states.
‘MBS data also revealed gender equity issues, as female GPs are more likely to provide longer consultations than their male counterparts.
In addition, female patients are more likely to use longer consultations than male patients, with current bulk-billing incentives exacerbating ‘the lack of financial incentives for longer consultations’.
While there are several complex ways to address the disparity, the group acknowledged increasing the fees for levels C–E ‘is the option that could be implemented fastest’ – a reform long called for by the RACGP. However, it may also ‘preclude longer term changes to the time-tiered structure’.
A further point raised is that ‘the current bulk-billing incentives structure exacerbates the lack of financial incentives for longer consultations compared to shorter consultations’.
The group recommended bulk-billing incentives ‘should be based on a percentage of the MBS fee for the service that is bulk billed to avoid furthering the disproportionate remuneration of shorter consultations when compared to longer consultations’.
Other recommendations include:
- starting the after-hours period from 6 pm (rather than 8 pm)
- current urgent after-hours MBS items be replaced with a higher rate loading item that applies between the hours of 11 pm and 7 am daily
- when providing after-hours care, medical practitioners can use the same bulk-billing incentives that are applicable when using standard attendance items
- to support system simplification, consideration be given to the progressive transition to a single set of time-tiered consultation items with an appropriate fee modifier linked to the provider’s qualifications and/or provider type to replace the current approach of creating parallel sets of items.
- bulk-billing incentives be available for nurse practitioner services when the consultation is provided to a patient who is registered through MyMedicare with the practice that provides the service.
To ensure the MBS underpins ‘contemporary and holistic care to patients’, the report also recommends the adoption of five key principles for time-tiered items:
- Condition-specific consultation items be minimised in primary care settings
- MBS benefits for time-tiered items be equitable, to support patient access to primary care services that meet their individual clinical needs
- MBS items and their requirements be consistent, unless there is a defined clinical need for variation
- MBS after-hours arrangements be streamlined and aligned across primary care
- MBS primary care items be adequately supported by non-MBS mechanisms
The RACGP says the review and its 23 recommendations, many of which back
ongoing college advocacy, will have major impacts on the financial viability of Australia’s general practice sector.
RACGP President Dr Michael Wright describes the draft report as ‘a major step forward in having this discussion to correct many of the biases and problems in the Medicare schedule’.
He said he is pleased to see much of the RACGP’s advice included in the draft report, including the need to increase funding for longer, more complex consultations.
‘We know that the disparity in long consultations is impacting more and more GPs as the care we provide becomes more complex, and that the brunt of this disparity is placed on female GPs,’ Dr Wright told
newsGP.
‘It also discusses a principle of focusing on general item numbers rather than disease-specific items, which the college has consistently called for, because we really need to be providing support for holistic, comprehensive care rather than piecemeal, single-condition items.
‘There’s a recommendation that the bulk-billing incentives should be a percentage, so they actually go up for longer consultations, and that just makes sense so that the existing disparity in the MBS payment for long consults is getting reinforced by those incentives.’
But the ‘devil will be in the detail’, he cautioned, with further information needed to better understand the impact on GPs.
‘There are no numbers to say what the new rebates might be, but the committee has looked to remove a lot of the disparity and some of the complexity within the MBS,’ Dr Wright said.
The review, which aims to ensure the MBS framework for primary care time-tiered MBS items remain fit for purpose in a contemporary clinical context, is now open for consultation until 15 October.
According to the report, implementing all recommendations could reduce the number of time-tiered attendance items to under 100.
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