What do the MBS Taskforce recommendations mean for general practice?

Amanda Lyons

8/02/2019 2:07:02 PM

Dr Michael Wright, Chair of RACGP Expert Committee – Funding and Health System Reform, talks to newsGP about the recommendations for general practice and the college’s response.

The RACGP wants to know what its members think about the MBS Review Taskforce recommendations for general practice.
The RACGP wants to know what its members think about the MBS Review Taskforce recommendations for general practice.

The Medicare Benefits Schedule (MBS) Review Taskforce report from the General Practice and Primary Care Committee (the Committee), released just before Christmas last year, contained 18 recommendations for general practice.
Most of the recommendations amend current MBS items, but there are some fundamental changes, including a recommendation to introduce a fee for voluntary patient enrolment.
In order to help guide its response, the RACGP has already begun surveying its members on their thoughts about the recommended changes.
‘So far most members are supportive of the recommendations, but cautiously so,’ Dr Michael Wright, Chair of RACGP Expert Committee – Funding and Health System Reform (REC–FHSR), told newsGP.
Most of the report’s recommendations are focused around changes to the current MBS, which include:

  • linking Medication Management Reviews to patients with General Practice Management Plans (GPMPs)
  • expand the at-risk groups who are eligible for health assessments
  • increasing the rebate for home visits for patients with GPMPs
  • equalising the rebate for GPMPs and GPMP reviews
  • introducing a new Level E consultation item number for consultations of over 60 minutes.
But it is another couple of recommendation in this vein that have so far caused the most concern among RACGP members.
‘These are the proposals to remove short health assessments and one to create a minimum six-minute time before a Level B consult can be billed to Medicare,’ Dr Wright said.
The report contains other broader recommendations related to primary care, most notably:
  • move to a patient-centred primary care model supporting GP stewardship
  • introduce a new voluntary patient enrolment fee
  • introduce flexible access linked to voluntary patient enrolment.
‘These recommendations are more long-term, interlinked and likely to have the greatest impact on GPs, practices and our patients,’ Dr Wright said. 
‘They mean that GPs will have a greater role in looking at patient care in the community – not just with each patient they are seeing, but in a population health role, as a patient advocate elsewhere in the system.
‘For example, when a patient needs care away from general practice, their GP might have the role of helping them get into hospital.
‘Flexible access is about recognising that the GP’s role is greater than just treating the patient sitting in front of them. We provide a lot of care that is not face-to-face, and this recommendation might recognise the value of that care.’
Dr Wright believes the second recommendation, introducing a voluntary enrolment fee, could help further encourage continuity of care without restricting access to primary care. But he also noted some caveats in terms of uncertainty about how this would be funded.
‘The report outlines its multiple recommendations, but does not provide advice or guidance on what fees for enrolment or providing additional care might be,’ he said. ‘This will be of central importance to understand whether providing this care is feasible for practices.’
The report is currently under consultation and the RACGP is seeking member feedback to inform its submission to the MBS Taskforce, which will be coordinated by the REC–FHSR.
Dr Wright suggests some key questions to help guide members when giving feedback.
‘Do you think this a better way to be paid and provide care for your patients?’ he said.
‘Is this the type of general practice that you want to be operating in? Does this sound like a better model of care for our patients and for us than the current system?
‘The answer could be either – we just want to know what people think about this.’
Members can visit the RACGP website to provide their feedback, or email, until 15 February.

general practice item numbers MBS Review Taskforce

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Dale van der Mescht   12/02/2019 7:00:53 AM

I don’t think I would want to be part of that!

Sounds great on paper, but try see a doctor in the UK... you’ll get an appointment in 2 weeks. That’s if you are able to make one, some practices open the phone lines in the morning and only take “on the day” appointments so by 8:30 you have to try again tomorrow... the result, GP problems flooding A&E.

In my opinion, this will not work well.

Rimas Liubinas   12/02/2019 10:13:29 AM

Very interesting the focus on mandatory times ... funny no mention is made on time spent for no rebate yet essential for good practice ie phone calls ( the real telehealth) , paperwork , scripts for nursing homes, phone calls from nursing homes , death cftes , police reports , liasing with specialists , chasing results .... aah!!! BUT LET'S punish the gp for a 5 min 59 second consultation.
Reports are made for those who pay for them

David Rivett   12/02/2019 1:51:45 PM

Tinkering at the edges is not a solution. The MBS as it stands remains a recipe for ever lower patient rebates via non indexation and flawed indexation. Until sound indexation reflecting practice costs is introduced any changes are cosmetic.

Maureen Fitzsimon   12/02/2019 9:29:12 PM

Smoke and mirrors which appear to offer reforms, but fiddle around with trivia, while the ship is burning. Where do I start? . “ Gps helping patients get into hospital “. This is the easy bit that I’ve been doing for 40 years. The hard bit is avoiding ambulance call outs and avoiding hospital admissions. I do this by unpaid phone calls galore, home visits, nursing home visits, and staying back late after work, when I would rather be at the gym. How about a loading for seeing old and complex patients ? My cohort is very old , and I now average 5 problems per visit PLUS preventative care etc., Meanwhile, a GP who sees simple, single problems in younger healthier patients receives the same remuneration, for far less time and expertise.. There is no payment for experience. IAs we become more efficient, and more experienced, Medicare fails to reward us, unlike every other profession, and, in fact punishes us, because we have a complex case load. I dream of a 6 minute consultation. We are in an area where pensioners live in caravans and tiny, rented pensioner apartments. Charging these people a “ voluntary “ enrolment fee, will mean they have to do without , food, medicine, or electricity. Charging the richer people will create a two tier system, where those who pay, expect to be prioritised over those who don’t. We need true reform of the health system, not this rubbish.

Dr Peter Robert Bradley   14/02/2019 3:33:24 PM

Just hang in there Maureen. You are a true GP, and much like I tried to be before I retired. I suggest you read my comment/epistle to the unbelievers, in the thread under Harry's response to Heffernan of the Pharmacy Guild, to save reproducing it here as well. It might give you a small lift..?

Dr Peter Robert Bradley   14/02/2019 3:48:18 PM

Totally agree Maureen, hence my earlier post, and suggested re-direct.

Accepting that the concept I have favoured for a long time - ever since I nearly went broke serving a low socio-economic area back in NZ in the 80's actually, of a truly salaried GP service, remunerating GPs properly like the public servants they in reality are , is never going to happen, I suspect. I feel the only true reform that might work is to adopt a system similar to NZ, where there is indexed capitation, and they retain the right to charge a fee for service, unlike the UK, for instance, which is stuck with the hide-bound notion GP care must be free...!

But, and it's a mighty important but, the capitation subsidy funding must be indexed for degree of disability, AND properly for CPI inflation. This is where NZ's system is now starting to creak at the joints once again. Failure to inflation index..! Sound familiar..? Otherwise it works well. The GPs can charge a gap fee up front, but it's discretionary. So, to some extent they can protect themselves from inflation, but the issue now is that the gaps are getting a bit large in places and for some categories of patient. This then begins to be self-defeating. The health Care Homes thing touted for Australia is sort of headed in this direction, but in a Mickey Mouse sort of dysfunctional way. It needs to be commenced again from scratch based upon the above I think. That's my thoughts for today. Nothing has changed really, practically since the day I entered GP practice. Kinda pi**ed off I won't now be able to participate in it if any really good change did occur, but that's life I guess.

Dr Joveria Javaid   15/02/2019 1:13:29 PM

OK, well!! , then increase the rebate of level B consultation from 37 to 50$ if you want to cap it to 6 minutes. Because even the podiatrist and O.T. charge you more for the consultation when you go and see them. We some times feel like a plankton in the food chain of medicine.