RACGP

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Reducing value disparity in the MBS

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The Specialist and Consultant Physician Clinical Committee (the Committee) released a report earlier this year as part of the Medicare Benefits Schedule Review (MBS) Taskforce investigating items relating to professional attendances for non-GP specialists and consultant physicians.
 
The report included recommendations to:

• replace items for initial and subsequent attendance items with items for time-tiered attendances
• provide a new framework for case conference items
• retain the existing specialist-to-specialist referral validity period

 The RACGP this week made a submission to the Committee, providing member-informed feedback on its recommendations.
 
Time-tiered items and value disparities in the MBS
The submission reinforces RACGP support for the recommendation of time-tiered items for non-specialist GPs instead of the current structure of initial and subsequent attendances.
 
One of its main arguments for the change is that it would remove financial incentive for non-GP specialists and consultant physicians to send patients back to the GP for additional referrals, something RACGP members have reported as a problem in their practices.
 
The RACGP also agreed that any time-tiered items adopted should be the same as those currently used for general practice. The college believes this would not only promote best and most efficient use of consultation time, but would also help address the current 18.5% value disparity within the MBS between GPs and other medical specialists.
 
The RACGP acknowledges the Committee report does not suggest fees for the new time tiers, as this is outside its scope. However, it states that once a methodology for setting fees has been determined, it must be applied to all MBS attendance items to ensure transparency in rebates and remove disparities between GPs and other medical specialists.
 
The college also recommends replacing the term ‘specialist’, which is currently used in the MBS to describe only a sub-set of medical specialists. It believes this would help to better clarify interpretation of the MBS and prevent the undervaluing of the GP role in the health system by addressing the perception that GPs are not medical specialists.
 
New framework for case conference items and complexity
The RACGP argues for the further simplification of current case conference structure for specialists and consultant physicians, calling for the same structure as general practice case conferencing items, which are related to either ‘organising and coordinating’ or ‘participating’ and are split into time-tiers.
 
While supportive of including GPs in case conferences to promote continuity of care, the RACGP does not agree GP participation should be mandated. According to the submission, case conferences can already be logistically difficult to organise, and mandating GP involvement could exacerbate this situation.  It instead suggests that, while their participation should be preferred and encouraged, GPs should be supported to review and discuss any resulting report with patients and other involved health professionals if they are unable to attend in person.
 
Specialist-to-specialist referral validity period
The Committee recommended retaining the current validity period of three months, rather than increasing it to six months, a suggestion the RACGP supports as ‘longer term management of patients is best coordinated by their usual GP and specialist to specialist referral should only be a short-term arrangement’.
 
Finally, the RACGP called for transparency and assessment of any changes made as a result of the MBS Review, suggesting they ‘be subject to rigorous monitoring, evaluation, and consultation with stakeholders, to ensure that the intended results are being achieved’.

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Case conference MBS items MBS Review Medicare Benefits Schedule specialists Time-tiered billing

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