Growth of item numbers part of red tape burden
THE number of separate Medicare rebates for GPs alone has nearly quadrupled in the past 10 years, health department figures show. While the telephone-book-sized Medicare Benefits Schedule carried 53 separate ‘‘ items’’ for unreferred attendances in 1996, in the latest edition of the book, published last month, that number had soared to 191.
The increase explains the enthusiasm in medical circles for Labor’s promised overhaul of Medicare to make it simpler. The increase has been fanned by a proliferation of new items for after-hours services, services by GP nurses, enhanced primary care services such as care plans and health checks, and disease-specific items.
But these 191 items for unreferred attendances are themselves just a fraction of the 5632 separate items in the MBS book, covering consultations with specialists as well as operations, pathology tests, imaging services and anything else Medicare funds.
The need for doctors to know their way around this maze, or at least the corner of it that they walk each day or week, is behind the increasing clamour for something to be done about what one medical leader this week called a ‘‘ red-tape nightmare’’.
For those lucky enough not to have to deal with the MBS book, it works like this: every time a doctor provides a service to a patient, they have to work out which items correlate to that service. Each item is allocated a ‘‘ schedule fee’’ on which the Medicare rebate is based, and each item also gets a few lines in the book, outlining the essentials of what must be done to qualify for the Medicare fee.
Ironically, the previous modelling work on which Labor has already declared it will partly base its planned simplification of Medicare would increase rather than cut the number of GP items.
This work, carried out from 2002 to 2004 by something called the Attendance Item Restructure Working Group, proposed increasing the incentives for GPs to spend longer with patients by ensuring the rebate structure paid more money for those who did so.
At the moment, there are only four basic levels of rebate for most GP consultations: Level A, which is a short and simple visit and carries a rebate of $15; level B, which lasts up to 20 minutes ($32.80); level C, lasting 20-40 minutes ($62.30), and level D, lasting over 40 minutes ($91.70). Each of the levels also carried more complicated ‘‘ descriptors’’ Continued inside - Page 19