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‘Not adequate’: RACGP seeks update on antenatal rebate discrepancy


Matt Woodley


13/09/2022 5:13:06 PM

The college has again asked why pregnant people cannot access Medicare rebates for longer appointments.

GP conducting antenatal consultation.
Currently, patients can only receive a maximum of $42.40 from Medicare for antenatal consultations.

Six months ago, the RACGP wrote to then Federal Health Minister Greg Hunt to call for MBS amendments that would better support longer consultations for antenatal care.
 
The letter pointed out that unlike other reasons for seeing a GP, people seeking antenatal care are only able to access a rebate of $42.40 (via item numbers 16500, 91853 or 91858), regardless of how much time they might need with their doctor.
 
To resolve this issue the RACGP recommended that the rules be amended ‘as a matter of priority’ to allow GPs to bill MBS Level C and D time-based attendance items (36, 44, 91801, 91802, 91894) for antenatal attendances that extend beyond 20 minutes.
 
Minister Hunt responded two weeks later and ‘resolved’ to work with the college to better understand the issues raised in the letter and determine whether current MBS funding is ‘fit for purpose’.
 
However, with the status quo remaining, and a new Federal Government in power, RACGP President Adjunct Professor Karen Price has written a follow-up letter.
 
Addressed to the Assistant Secretary of the MBS Reviews Unit within the Department of Health and Aged Care, Louise Riley, the letter states the lack of support for longer antenatal consultations remains a ‘significant concern’ for college members.
 
‘Funding for antenatal care provided by specialist GPs … is currently not adequate to achieve the best outcomes for patients,’ Professor Price wrote.
 
‘GPs are well placed to provide holistic, individualised care in line with the Department of Health’s Pregnancy Care Guidelines; however, they must be financially supported to do so.
 
‘The RACGP has previously discussed this matter with you … [and] we are keen to ascertain if there have been any developments in this space, and how we can work together to improve access to care and health outcomes for pregnant women.’
 
The letter also cited the results of a recent newsGP weekly poll, conducted during Women’s Health Week, which indicates that the vast majority of antenatal care appointments conducted by GPs do not generate adequate Medicare rebates.
 
Of the nearly 1500 respondents, 57% said more than three quarters of their antenatal consultations last longer than 20 minutes. Meanwhile, nearly a quarter of voters said 50–75% of consultations extend beyond 20 minutes.
 
Around 1.3 million antenatal item numbers were billed between July 2021 and June 2022, meaning potentially hundreds of thousands of pregnant people may have been denied rebates appropriate for the level of care they received.
 
Professor Price said allowing patients to access higher rebates for these longer consultations would be a ‘simple and positive step’ that would support women, children, and families.
 
‘Advances in science and technology have seen the provision of antenatal care evolve significantly over the years. We now have much higher expectations of care provision and a greater awareness of mental health issues and the health impacts of domestic violence,’ she wrote.
 
‘They are often complex consultations and can extend well beyond 20 minutes. This is particularly true among vulnerable and disadvantaged patient groups.
 
‘Patients should be able to access a higher rebate if a consultation is longer or more complex, just as they can for other consultations or conditions.’
 
The letter also cited a private survey conducted last year by Chair of RACGP Specific Interests Antenatal and Postnatal Care Dr Wendy Burton, which received more than 1000 responses.
 
When asked whether the Medicare rebate was sufficient for an antenatal attendance, 99.2% of respondents selected ‘no’. Moreover, 89.4% of respondents said antenatal care has become more complex over the course of their medical lifetime, while 99.1% believe GPs should be able to co-claim time- or complexity-based Medicare rebates for elements of antenatal attendances.
 
Meanwhile, ongoing workforce shortages across Australia’s healthcare system, combined with the pressure applied by the COVID-19 pandemic, means it is ‘more important than ever’ to have well-resourced GPs available to provide antenatal care, Professor Price says.
 
‘GPs who provide antenatal care play a pivotal role in areas where there is a lack of other specialists due to workforce shortages, as well as reducing demand on busy hospital outpatient departments,’ she wrote.
 
‘During the pandemic, many patients who previously received antenatal care in a hospital setting have instead accessed this care through the primary care sector. GPs have augmented the work of hospital-based doctors and must be appropriately supported to deliver this critical care.
 
‘It is critical that MBS policy and funding keeps up to date with evidence-based care to ensure the best health outcomes for patients.
 
‘I would welcome the opportunity to discuss this matter further – particularly the rationale for not allowing pregnant women to access Medicare rebates for longer appointments as they would be entitled to if they were seeking GP care for any other concern.’
 
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Dr Michael Charles Rice   13/09/2022 9:09:27 PM

The descriptor for Item 16500 ("Antenatal Attendance") may be the briefest in the whole MBS but those consultations certainly are anything but brief.

The 2-word descriptor has not changed since I achieved my Diploma in 1991; and the care I provide has changed HEAPS Genetic carrier screening comes on top of early anatomy scans, aneuploidy screening by NIPT that has followed amnio and CVS and the old triple-test - and that's just booking and first-trimester!

"Antenatal attendance" doesn't cut the mustard and nor does a $42 rebate


Dr Michael Lucas Bailey   14/09/2022 8:48:33 AM

As I understand it, there is no restriction on billing an item 36, 44 or equivalent for an antenatal attendance. That is not to say these rebates are adequate but that is a different argument.

If we argue, as a profession, that we do mental health consults regularly without billing mental health item numbers, 2713 etc, then it is disingenuous to argue the opposite about antenatal care. Unless expecting higher rebates for antenatal care than for other general practice.

Focusing on increasing overall rebates rather than fragmentation of item numbers would seem to make more sense.


Dr Peter James Strickland   14/09/2022 2:22:39 PM

I agree with Michael Bailey. There are too many Item Not on the Medicare schedule. A consultation is a consultation for pregnancy, mental care, fractures, general health etc. The first thing to tackle here is get the rebates themselves at a decent level ==Item 23 should be about $60 now, Item 36 about $100 etc. Solution easy billing for everyone to understand in the practices, at Medicare itself, and the whole wasted monies of hospital EDs would drop dramatically for routine medical cases.


Dr Marc Houghton Heyning   15/09/2022 9:00:09 AM

I also agree with all the above - the amount of content that needs to be covered in an antenatal consultation has exploded and they do not resemble those antenatal clinical that I attended as a ersident and registrar that were sausage-machines. So, I agree, they meet level C/D descriptors due their complexity and duration. Charging those item no's in place of 16500 is not defrauding Medicare and is very similar to what we do when mental health issues are covered during a consultation involving someone's chronic pathology etc. The rebates still do not cover the time and expertise so we have to bill over and above buit at least the patient gets a more decent rebate.