Item num­bers part of red tape bur­den

The Weekend Australian - Travel - - Health -

From Health cover in­di­cat­ing the min­i­mum clin­i­cal con­tent of the con­sul­ta­tion. A range of vari­ants, each with its own MBS item, at­taches to each of th­ese four lev­els to cover con­sul­ta­tions at a hospi­tal, or nurs­ing home, or other place, while other items dic­tate the fees payable af­ter-hours and in other spe­cific cir­cum­stances.

Be­cause the same $32.80 re­bate is payable to a bulk-billing doc­tor who sees a pa­tient for five min­utes as one who sees a pa­tient for 19 min­utes, the sys­tem makes it much more prof­itable for doc­tors to churn’’ pa­tients quickly. A doc­tor who sees 12 pa­tients for five min­utes each per hour can claim $393.60 from Medi­care, as op­posed to $98.40 for a GP who sees three pa­tients each for 20 min­utes.

Med­i­cal groups have long sought to fix this. The AIRWG pro­posed leav­ing the level A item un­changed, but split­ting lev­els B, C and D into two new items each, which would be more nar­rowly de­fined: one pro­posal was to make the level B 6-12 min­utes, a new level B1 12-18 min­utes, level C 18-28 min­utes, C1 28-40 min­utes, D1 40-60 min­utes and D2 over one hour.

AIRWG chair­man Justin Beilby — now ex­ec­u­tive dean of the fac­ulty of health sci­ences at the Univer­sity of Ade­laide — told Week­end Health he was pleased that AIRWG’s pro­pos­als were likely to be dusted off by La­bor, af­ter the pre­vi­ous Lib­eral Gov­ern­ment showed lit­tle in­ter­est.

I would think that this model should be re­ex­am­ined,’’ Beilby said. It is a good model and when 90 per cent of all GP and pa­tient in­ter­ac­tions are in con­sul­ta­tions, it seems the best way to im­prove pa­tient care — to have cor­rect fund­ing lev­ers aimed at more time for GP-pa­tient in­ter­ac­tion.’’

Beilby sug­gested that split­ting the level B item alone — cur­rently by far the most com­monly used GP at­ten­dance item — would be a good start’’ as a tran­si­tional step to­wards more wide-rang­ing re­form. But prob­a­bly we also need a whole-of-MBS re­view — there are too many item num­bers,’’ he said.

In 2005 pro­fes­sor Beilby said the AIRWG had been given no clear di­rec­tion on its role’’ by the then fed­eral Gov­ern­ment.

How­ever, whether La­bor in­tends to cut the to­tal num­ber of MBS items, or pur­sue the promised sim­pli­fi­ca­tion by other means such as cut­ting el­i­gi­bil­ity re­quire­ments, re­mains un­clear.

In its pol­icy doc­u­ment is­sued in June the ALP said it would re-ex­am­ine and up­date’’ the AIRWG’s work — and also sug­gested the changes would be cost-neu­tral. The Aus­tralian Med­i­cal As­so­ci­a­tion has sup­ported the sim­pli­fi­ca­tion drive but warned against cuts to level A or B re­bates to pay for in­creases to longer con­sul­ta­tions.

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