RACGP sees room for improvement in changes to GP rebates in RACFs

Morgan Liotta

28/02/2019 3:41:56 PM

Changes to MBS rebates for services provided in residential aged care facilities have come into effect, but the RACGP is calling for increased funding.

The RACGP is calling for increased funding for GPs providing services to patients in RACFs.
The RACGP is calling for increased funding for GPs providing services to patients in RACFs.

In the 2018–19 Mid-Year Economic and Fiscal Outlook (MYEFO), the Federal Government announced it would provide $98 million over four years towards Medicare Benefits Schedule (MBS) rebates for services provided by GPs attending residential aged care facilities (RACFs).
The current arrangements will change from 1 March.
The RACGP has been advocating for changes to the current structure, identifying the diminishing Medicare rebate per patient as a barrier for GPs supporting their patients in RACFs. The RACGP has also called for acknowledgement of the significant amount of unremunerated services provided by GPs for patients in RACFs.
The college has welcomed a new rebate structure that partly recognises the costs of attending an RACF for GPs; however, it is the RACGP’s understanding that the change results in a net reduction in funding if GPs are seeing 17 patients or more during a single RACF visit. The RACGP is seeking clarity on this issue. If correct, the change does not remove the barriers for GPs who provide services in larger RACFs.  
‘Although the changes coming into effect are a good start, there is still a long way to go to adequately represent GPs providing services to RACF patients,’ RACGP President Dr Harry Nespolon told newsGP.
‘It does try to cover some of the non-consulting costs for GPs, such as paperwork and travel, so it’s a step in the right direction, but certainly nowhere near where it needs it to be.
‘It is improved but not fixed.’
Dr Nespolon acknowledges the position GPs are in when their patients are transitioned to RACFs.
‘We do want to see GPs working in RACFs and out of loyalty to their patients, but some may feel a great sense of loss due to their patients being moved to RACFs and unable to see them due to economic or geographic reasons,’ he said.
From 1 March, RACF items 20, 35, 43 and 51 will be replaced with new attendance items (90020, 90035, 90043, 90051), which will have a stable fee amount, as per attendances in consulting rooms.
MBS rebates for services provided in RACFs are currently calculated based on the number of patients that the GP sees – by dividing an integrated call-out fee by the number of patients seen.
This rebate structure results in patients receiving different rebates on different days, depending how many patients the GP sees.
As part of the change, the Government will introduce a one-off $55 Medicare payment to cover travel time and other additional costs for GPs attending RACFs (item number 90001). GPs currently receive $47.40 per visit to cover these costs, which is integrated into the base rebate – so the new payment represents an additional $7.60 per RACF visit.
The change separates the currently integrated flag fall fee from the base rebate, simplifying the rebate structure.
The RACGP supports the non-integrated flag fall fee, but will be calling for an increase to base rebates to provide appropriate support for GPs and their patients in RACFs.
The RACGP believes the funding change ultimately does not meet its intended purpose of providing further support to GPs providing care in RACFs, and this will be further exacerbated by the removal of the GP Aged Care Access Incentive, scheduled for 1 May as part of the changes to the Practice Incentives Program.
Dr Nespolon said the removal of the GP Aged Care Access Incentive is another concern.
‘This is contrary to supporting GPs – it seems to be giving with one hand and taking with the other,’ he said.
The RACGP will continue to call for increased funding for GPs and their patients in RACFs and will be undertaking advocacy in relation to this issue.
The new GP items for RACFs and their descriptors are available on the RACGP website and the Department of Health website.

aged care MBS items RACF residential aged care facilities

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Tas Karakaidos   1/03/2019 6:39:33 AM

It would be interesting examining how the government came up with the figure of 98 million. Is it all new funding? The numbers don't add up.

Wayne Herdy   1/03/2019 8:27:31 AM

I am one of those few GP’s who have 150+ pts in RACF. The change in flagfall rebate will represent a lower average fee for most of my RACF visits, and I lose $5K a year from ACAI PIP. So I am $6-7K a year worse off. Thanks for the lower tax bill.

Graham Lovell   1/03/2019 9:08:48 AM

The cold hard facts are :
1. GPs visiting weekly gain $7.60 a week = $380 /50weeks -ie per year
2. GPs lose $5000 /yr on 1st May
= net loss of $4620/ year for those doing 1 round/week
3. If 4x 90035s are charged at $37.60 =$150.40+$55 for 90001=$205.
Now for realistically an hours work & then add travel and billing time, that in our outer metropolitan area can all up mean an additional 1/2hr
=$137/hour !! -ie around 50% of what I generate in a GP clinic.
4. From the 1st of May you are supposed to believe there was some generosity for the 1st of March $7.60 a whole round at an RCF when they take away $100($5000/yr divided by 50.)
=1/3 REDUCTION !!! (Was: $100/week +$47.60 +4x$37.60=$298 vs now $205)
5. The figures don't add up for any GP who needs to generate a reasonable income .
6. Only semi-retired GPs and deputising services end up attending RCF
7. GP exodus from RCFs will accelerate due to this .

Kon Exarhakos   1/03/2019 9:58:39 AM

Totally agree with Wayne, GPs with large numbers in RACFs who do rounds will be significantly worse off on the rebate change alone. Normally if you saw 15 residents you would get $6.77 travel per resident. As of March 1, the 15 residents would get $3.77 (55/15) travel allowance each. How does this help?

Dr Felix Bisterbosch   1/03/2019 1:16:43 PM

This is terrible.
I am planning now to stop my weekly visit to the local nursing home.

Magdy Shamaly   1/03/2019 1:26:59 PM

What about the after-hours items for aged-care visits?

Dr Susan Margaret McDonald   1/03/2019 1:43:24 PM

The new rates are laughable. We are worse off.
I have been doing nursing home visits for 40 years, as a community service and because I didn't pay uni fees but was on a scholarship.
This insult is the last straw!
I look after 40 patients and the nurses are always begging me to take on more as no GP's will take them. The ones who do are mostly over 60.
Medicare is an ASS. The RACGP and AMA should box their ears and kick their proverbial.
Good GP care SAVES money !!

Robert Menz   1/03/2019 1:51:16 PM

Another barrier to our providing high quality care to our RACF patients is the we can only claim for the time physically with the patient and that time completing medication charts, or speaking with nursing staff or other specialists or patients’ families in the nurses station does not count

Dr Nicholas A. Cooper   1/03/2019 7:24:54 PM

So I see 6 residents at 2 different Nursing Homes over 3 hours. Old system $683.50 + PIP Payment, currently worth $14,000 per year to me, new system = $561.20 + no PIP payment. Same time at the Surgery over 3 hours could bill approx $600 - 800. I currently provide care for 30 Nursing Home patients and feel that it is my duty to provide cradle to grave care. This new deal is an insult

Robert Hoffman   1/03/2019 10:27:42 PM

I and two other doctors I know, only found only found out about this change this afternoon when Australian Doctor dropped into my email. I have completed my billing based on the "old" item numbers. The tree of us have full time aged care practices and between us see about 500 residents. Why weren't we advised by the health Department about this change.

In addition, Best Practice does not seem to recognise the new item numbers. I am up to date on all the downloaded updates. Too late to talk to Best Practice today.

This looks like poorly implemented change, one with no communication to us GP's - a letter would have been nice.

Dr John William Lehmann   1/03/2019 11:01:50 PM

1 fragment of good news. The bulk billing incentive item numbers can be used with the new flag fall item nos. As the large majority of RACF recipients are pensioners who usually are bulk billed, then the flag fall fee works out to be $55 + Item 10990 /10991.
Sadly it still wont be enough to turn around the exodus of GPs doing Aged Care visits.

Sam Bouwer   2/03/2019 8:27:23 AM

How come we support the RACGP/AMA
Exciting "New Incentive"?
An incentive to get more GP involvement in RACF’s.
Short implication of what RACGP negotiated on our behalf:
You get $7.60 more for the first patient. For any other patients you see in one session you get less:
For the first 7 patients $64.95 less than before,
after that first 7 $3.35 per patient less.
For every 15 patients you get $ 95-10 less, for a busy day it means $190-00 less.

Bad Maths or Forked tongue from our leaders?
Who will add a pt in a RACF for 7.60 (to cover his travel time and cost) more than gp consult in the convenience of your rooms.
How can RACGP allow negotiate a fee that’s worse off for us who are already involved in aged care? A slap in my face.
Aged care sold out again by our representative bodies!
How will you attract the next generation?
Just to rub in- congratulations on informing soft ware providers. No electronic claims on this items at least for next 2 weeks!

Simon Torvaldsen   2/03/2019 10:33:48 AM

I sit on the State RACGP Council and both State and Federal AMA Council of GPs. I can’t speak for Federal RACGP but I can tell you that the AMA has been aware of this issue for some time and has been putting in a lot of work behind the scenes. It was discussed at our AMA Council of GP meeting 2 weeks ago and President Bartone (a GP) is discussing it with Minister Hunt, along with retention of the Aged Care PIP. I am personally following it up also. So action is being taken, pre-election is always a strange time but I remain hopeful of getting a good result. GPs and Aged Care are a priority and are being listened to. Please don’t give up on your RACF visits!

Dr Felix Bisterbosch   2/03/2019 6:55:09 PM

Dr Nespolon said :
"Although the changes coming into effect are a good start, there is still a long way to go to adequately represent GPs providing services to RACF patients"
How can it be a good start: losing 5000 dollar per year and not really getting paid more for our visits to the nursing home; it would be good that the RACGP would do some case scenarios like some colleagues did( see above) ; this would make it clearer for us what the financial implications are of the MBS changes.