1 February 2019

In case you missed it – MBS taskforce recommendations

KnowCents MBS

If you’re just getting back into the swing of things, and haven’t caught up with the recommendations of the MBS Review Taskforce released just prior to Christmas, we have reproduced them below.

  1. Move to a patient-centred primary care model supporting GP stewardship
  2. Introduce a new voluntary patient enrolment fee
  3. Introduce flexible access linked to voluntary patient enrolment
  4. Combine GP Management Plans (GPMPs) and Team Care Arrangements (TCAs) and strengthen GPMPs
  5. Link allied health items to GPMPs
  6. Equalise the rebate for GPMPs and GPMP reviews
  7. Increase access to care facilitation services for patients
  8. Activate and engage patients in their own care planning
  9. Rebate participation in case conferencing for non-GP health professionals
  10. Build the evidence base for Health Assessments and ensure that the content of Health Assessments conforms to appropriate clinical practice guidelines
  11. Delete Health Assessments less than 30 minutes and expand the at-risk groups who are eligible for Health Assessments
  12. Link Medication Management Reviews (MMRs) to GPMPs and reduce the schedule fee
  13. Increase the rebate for home visits for patients with a GPMP
  14. Introduce a six-minute minimum time for a Level B consultation item
  15. Introduce a new Level E consultation item at 60 minutes or more
  16. Increase access to primary health care in Residential Aged Care Facilities
  17. Update language across the MBS to better reflect the role of registered and enrolled nurses
  18. Amend the specialist consultation telehealth items to make clear that GPs are able to claim the items

The full report is 146 pages so relatively digestible, but if you just read the executive summary (which we’ve also reproduced below) you will get the picture. There are some very big sleepers in here for the future of general practice.

In a letter to Australian Doctor last week, Dr Steve Hambleton, Deputy Chair of the MBS Review Taskforce, seem to make this abundantly clear when he stated that: “The funding system must align with and support the best practice model of care. This will underpin the needed cultural shift in GP practices – and better align good quality care with a sensible and relevant billing system.”

We’ve asked Dr Hambleton what he thinks that “cultural shift” involves, and where is the line is between GPs changing their ways, and the funding system “being aligned” correctly as such a shift takes place, so GPs aren’t further put upon in the process.

We asked in part because Dr Hambleton also says in his letter that: “There is now currently virtually no evidence that Health Assessments offer value for very large investment and we need to work with our medical profession colleagues to build the evidence required.”

Watch this space.

Full report available here

Initial RACGP response to report here

Australian Doctor report here

Executive summary below:

The Medicare Benefits Schedule (MBS) Review Taskforce (the Taskforce) is undertaking a program of work that considers how more than 5,700 items on the MBS can be aligned with contemporary clinical evidence and practice and improve health outcomes for patients.

The Taskforce will also seek to identify any services that may be unnecessary, outdated or potentially unsafe. The Taskforce is committed to providing recommendations to the Minister for Health (the Minister) that will allow the MBS to deliver on each of these four key goals:

  • Affordable and universal access
  • Best practice health services
  • Value for the individual patient
  • Value for the health system.

The Taskforce has endorsed a methodology whereby the necessary clinical review of MBS items is undertaken by clinical committees and working groups. The General Practice and Primary Care Clinical Committee (the Committee) was established in October 2016 to make recommendations to the Taskforce on the review of MBS items in its area of responsibility, based on rapid evidence review and clinical expertise.

In Phase 1, the Committee reviewed prioritised items for services rendered, referred (e.g., secondary or tertiary care services, such as Consultant Physician attendances) and requested (e.g., Diagnostic Imaging and Pathology services) by GPs; and to develop recommendations on supporting GPs as stewards of the healthcare system.

The Phase 1 interim report outlined the Committee’s recommendations regarding mechanisms that could support GP stewardship, MBS items covering services referred and requested by GPs, and an initial set of MBS items covering services rendered by GPs. The Committee prioritised 111 MBS items1 for review in this first phase of work, which in the 2014/15 financial year accounted for approximately 29 million services and $1.6 billion in benefits.

In Phase 2, the Committee was asked by the Taskforce to review the general consultation items, chronic disease management items, health assessment items, and medication management items. The Committee prioritised 60 MBS items for review in this second phase of work. In the 2016/17 financial year, these items accounted for approximately 118 million services and $5.1 billion in benefits. The Committee was also asked by the Taskforce to consider the issue of consumer concerns around access to referrals and repeat scripts, raised by the Minister. The recommendations from the clinical committees are released for stakeholder consultation. The clinical committees consider feedback from stakeholders then provide recommendations to the Taskforce in a Review Report. The Taskforce considers the Review Reports from clinical committees and stakeholder feedback before making recommendations to the Minister for consideration by Government.