NEWS 5
ausdoc . com . au 2 JUNE 2023
NEWS 5
Rate the importance of tripling bulk-billing incentives for GP care .
20 %
Very bad Neutral Very good
Rate the idea of removing team care arrangements from the MBS in terms of the impact on GP care .
30 %
Very bad Neutral Very good
The Federal Government is limiting level B consults to a minimum of six minutes — rate the reform in terms of its impact on general practice .
50 %
Very bad Neutral Very good
increase in the metro areas is not going to be sufficient .
“ In a few years , we will need to introduce gaps again .”
A GP in the Northern Rivers region in NSW said : “ This will further disadvantage patients with no concessional status and will create a more fragmented system that disadvantages the working poor .
“ Failing to move the rebate by more than $ 0.75 is a failure of the highest order and will not be understood by patients .
“ How do you explain to the single working mother that you can bulk-bill her kids , her pensioner parents but not her when she attends all three appointments looking after her family but will be unlikely to afford to look after herself ?
“ The November implementation is also a long way away for many practices currently going backwards .”
What about the other budget pledges ? There are a few lines in the budget papers promising to save $ 300 million by revamping the MBS items for chronic disease care in line with the Medicare task force recommendations .
None of this has been confirmed , but it will probably mean scrapping the team care arrangement item ( with a $ 120.85 rebate ) and allowing the care plan to trigger access to subsidised allied health .
The savings from doing this are expected to be reinvested in the rebates for the care plans and , more significantly , to increase the current rebates for reviewing them in order to ensure a full cycle of care is delivered by the patient ’ s usual GP / GP practice .
The budget papers also said a minimum time will be introduced for a standard consult .
Again , it was a policy in the MBS Review task force recommendation , one designed to prevent the level B rebate being claimed for sausage-machine medicine .
But it has always been controversial .
We asked whether consults lasting less than six minutes can meet the complexity requirements of a level B .
If you have stopped bulk-billing concession card holders and / or children , will you now go back ?
Yes 13 % No 77 % Don ’ t know 10 % n = 224
Will increased incentives ensure the vast majority of children / concession card holders are bulkbilled over the next five years ?
No , the increases are not sufficient
Yes , but only for the short term
Will you sign up patients to the voluntary patient registration scheme ?
Yes , it will improve care of my patients
I don ’ t know ; there are still too few details on what patients get in return
It depends on the level of additional funding for patients
No , it will lead to capitation and / or pay-for-performance
43 %
25 %
Yes , definitely 11 % Don ’ t know / other 21 %
9 %
46 %
14 %
26 %
Other 5 %
Some 30 % of doctors said yes , 34 % said yes but only in a small number of cases , and 32 % said no .
“ All level B consultations should be 12 minutes-plus . Let ’ s stop bulk-billing clinics seeing more than five patients per hour ,” was the view of one Adelaide doctor . “ I feel it ’ s poor medicine .” The RACGP certainly had a very good budget . It pitched the idea of tripling bulk-billing incentives .
Federal budget 2023 — main points
• Bulk-billing incentives triple A GP who bulk-bills an eligible patient for a standard consult in a metro area will receive an increased incentive of $ 20.65 instead of $ 6.85 .
In very remote areas , it will increase to $ 39.65 , instead of $ 13.15 .
It will only come in November , and the incentive increases don ’ t apply to level A consults .
• Revamped care plan items Little information in the budget , but the changes are meant to be in place in November 2024 .
It is expected to result in the loss of the team care arrangement item , with the care plan being used to access Medicare-funded allied health .
The team care arrangement rebates are meant to be reinvested in the other care plan items — including the all-important review item . Just how that will be done is unknown .
• A minimum six-minute time on level B consults The budget papers say it will cut Medicare spending by $ 250 million over five years .
• New level E attendance items Worth $ 184 , this is for consults running beyond 60 minutes .
Some , me for instance , thought the cost would be too big in these hard times and believed the Minister for Health and Aged Care , Mark Butler , too much when he suggested increasing investment in fee-for-service was no longer a policy with a future .
So , it is worth mentioning the other win for the college : it was the creation of a level E consult — one lasting over an hour to deal with issues like end-of-life care , refugee health and complex mental health cases .
Again , GPs are on balance generally in favour of what has been delivered , saying it would be good for patients , although some 40 % remained neutral .
Lastly , the longest-lived undelivered policy in Australian healthcare history : voluntary patient enrolment .
It was announced ( as it has been many times before ) in the budget .
The big pitch is that it can be used
Minister for Health and Aged Care Mark Butler .
• Voluntary patient enrolment system It will be open to all patients . It will not be a requirement for patients wanting access to care plan funding , although that could be a future reform .
The only benefit of enrolment currently being sold is signed-up patients regaining Medicare rebates for longer telephone consultations — level C and beyond . However , the government is spending almost $ 100 million over four years for wraparound care for 13,000 fre quent flyer patients they expect will sign up — that is , those who go to hospital 10 or more times each year .
• Other stuff Funding for eight more GP urgent care centres , taking the total to 58 .
Rebates for nurse practitioners will be raised by 30 % and the legal requirement that they must collaborate with a medical professional to prescribe PBS drugs will be scrapped .
And another $ 429 million over two years will be poured into My Health Record to keep it running and improve its usability for doctors and patients .
And yes , the one policy the Pharmacy Guild of Australia hates : GPs will be able to write scripts allowing 60-day dispensing .
for signing up hospital frequent flyers ( 10 attendances or more in a year ), with the potential of triggering block payments for their care . What do GPs think ? Well , someone needs to give a little bit more information about how it will work in practice rather than how it will work in principle .
To defend Mark Butler , he has stressed that patient enrolment will be an evolution , not a revolution .