Item numbers part of red tape burden
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.