27 March 2019

How the new aged care rebate works

Aged Care Clinical

GPs who see up to 17 patients per visit to a residential aged care facility (RACF) will fare better or no differently under changes to the MBS rebates that came into effect this month, the Health Department says.

Only when the GP sees more than 17 patients in one visit will the new flat flagfall fee start to fall behind the previous rebate, which was calculated on a sliding scale based on the number of patients seen.

The single callout fee is $55 for vocationally registered GPs and $40 for non-VR GPs; the latter will have to see 33 patients in one visit before they are worse off under the new fee model.

“This arrangement encourages quality practice,” a department spokeswoman told The Medical Republic.

She said only 4.6% of VR practitioners who attended an RACF in 2016-17 saw more than the threshold number of patients per visit.

“Under the new arrangement, the large majority of GPs are expected to be better remunerated for visiting RACFs to see patients compared to the former derived fee arrangements, and all GPs are better remunerated than if they saw these patients in consulting rooms.”

The change was announced in last year’s Mid-Year Economic and Fiscal Outlook, with a cost of $98 million over four years.

It has come into effect five months before the existing General Practitioner Aged Care Access Incentive is removed from the Practice Incentive Payment scheme in August, along with the incentives relating to asthma, quality prescribing, cervical screening and diabetes.

Funding from those five incentives will be rolled into one, the Practice Incentives Program Quality Improvement, which the spokeswoman said would “provide reports to general practices to assist them in understanding their patient population and identify ways to work to improve patient health outcomes”.

Under the ACAI, individual GPs who provided 60 eligible services in a year received a payment of $1500, on top of consultation fees; those who provided 140 services received $3500.

Eligible services included attendances in RACFs, contributions to care plans, and residential medication management reviews.

RACGP President Harry Nespolon has said the new payments are a step in the right direction but still don’t adequately reimburse GPs for their costs, and with the removal of ACAI they amounted to “giving with one hand and taking with the other”.

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Donald Rose
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1 month 24 days ago
What are the changes hoping to achieve? After the long freeze the new rebates are hardly exciting being a few dollars either way regardless of how many you see so is the plan to try and force visiting doctors to charge a gap? It is extremely difficult to charge gaps at RACFs so currently it is a loss making venture compared to mixed billing at a surgery. Because the DOH has not explained the change, has implied sessional GPs seeing more than 17 residents are doing the wrong thing and used weird terms like flag fall and call out item… Read more »
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