ANALYSIS by Geir O’Rourke: The AMA has released its official response to the proposed revamp of Medicare’s general practice items
The MBS Review Taskforce’s draft plan for general practice should be used as the basis for a major funding boost but bigger reform is needed to address Medicare’s problems, the AMA says.
In its official response to the draft recommendations of the review’s general practice and primary care committee, the AMA says it supports the general direction being proposed, although it has real problems with many of the individual changes.
It also says its GP members are worried that many of the recommendations are seeking to reduce existing rebates at a time when practices face shrinking margins and growing administrative challenges.
“What general practice has been crying out for is a significant injection of funding, not just a redistribution of the existing funding pool,” it says.
“More funding is needed to enhance patient access to their GP and to support the management of increasingly complex patients in primary care, where they can be cared for more cost effectively.”
However, the AMA said the recommendations should be seen as a starting point for further discussions on reforming the specialty.
It also expressed concerns about a number of the individual proposals:
1. Introduce a new voluntary patient enrolment fee
The committee called for the introduction of Health Care Homes-style payments to practices that would support flexible care including telehealth and electronic repeat prescriptions or referrals.
It did not suggest a value for the new payments, but said they should cover the cover the costs of non-face-to-face care and should be weighted depending on the patient’s health and location.
But the AMA was worried about the scope of the proposal. While it supported the idea of patient enrollments, MBS funding should be limited to a $40 administrative fee, it said.
2. Reform GP management plans
The committee called for a major revamp of GP management plan (GPMP) items, including new rules specifying medical teams must spend a minimum of 40 minutes drawing up a GPMP.
Under the proposals, the items for team care arrangements would be deleted and Medicare-supported allied health referrals would instead be made through a GPMP. It also said the Medicare rebates for creating and reviewing a GPMP should be of equal value, to encourage more GPs to do reviews.
AMA president Dr Tony Bartone has previously supported the introduction of a minimum time limit for GPMPs, but the AMA’s official response rejected the idea.
“The use of time as a measure of effort or quality is incongruous with the stated principles of the [committee’s] recommendations,” it said.
It endorsed the idea to combine team care arrangements with GPMPs along with the concept of equalising the rebates for creating and reviewing the plans. However, that support was predicated on there being no reduction in the total available rebates for the items.
3. Delete health assessments under 30 minutes and expand the eligible patient base
The committee criticised the evidence behind the use of health assessments and said those that take less than 30 minutes should not be funded by the MBS.
However, it suggested that the other health assessment items should be expanded to include children in out-of-home care and discharged prisoners.
The AMA supported both proposals. It said it was clear that fewer doctors were making claims for health assessments under 30 minutes and the evidence showed it should take at least that long to perform the work involved at any rate.
However, it was concerned about plans to consolidate assessments for diabetes and chronic disease.
4. Introduce a six-minute minimum time for level B consults
The committee claimed short attendances “may not always constitute high-value care” and therefore those under six minutes should not be funded as level B consults.
But the AMA said it was “uncomfortable” with the idea of a new administrative burden.
“Not only does this effectively formalise six-minute medicine, it disregards the breadth and quality of care that an experienced GP can provide in a short period of time for a patient they have long provided cared for,” it said.
5. Introduce a new level E consultation item at 60 minutes or more
The AMA supported the proposal for a new super-long attendance item, but argued it should have the same per-minute rate as a level D consultation, which would make the minimum acceptable fee of $160.72.
6. Link Medication Management Reviews to GPMPs and reduce the schedule fee
The committee said the items for Medication Management Reviews (MMRs) should be updated to say they must be claimed at the same time or within a year of a GPMP for patients at risk of medication issues.
It said the schedule fee should be “substantially reduced”, with the savings reinvested into other areas of general practice.
But while the AMA said it had no objection to moves that would improve the targeting of MMRs, it could not support any reduction in their fees for GPs.
“These items support proactive care and better medication management and their use should facilitate savings where medications can be reduced and potentially preventable hospitalisations can be avoided by reducing the risk of adverse drug event,” it said.
“The GP has a number of responsibilities under this item and that should not be devalued.”
