Growth of item num­bers part of red tape bur­den

The Weekend Australian - Travel - - Health - Adam Cress­well Health ed­i­tor

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

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