The move to align MBS rebates will raise the fees for 31 minor procedures performed by GPs
Medicare rebates will be introduced for GPs to do aftercare checks on patients following surgery, and GPs will command the same rebates as other specialists for procedures in new reforms taking effect from November.
The next round of MBS reforms will also add mental-health checks and more support for women during pregnancy and after childbirth.
Among cutbacks announced, chiropractors will lose the right to order whole-spine X-rays and bone-density tests for elderly patients will be made less frequent.
The government says it will invest $37.7 million over five years to provide a mechanism for GPs to bill routine services for patients in the recovery period following surgeries and some other procedures undertaken by other specialists.
“Any GP consultation within the aftercare period will now attract MBS rebates (unless the GP performed the procedure),” the Health Department said.
To date, aftercare is covered by the MBS item for the procedure, on the assumption both are performed by the same doctor.
“The aftercare rule will still apply when the follow-up care is provided by the practitioner (specialists and GPs) who performed the procedure (as is normal practice).”
The changes will be especially beneficial for patients who live a long way from the specialist who performed their surgery.
“These are sensible and welcome reforms that better recognise the important role of GPs in providing follow-up care after surgery,” Dr Ewen McPhee, President of the Rural Doctors Association of Australia, said.
The move to align MBS rebates will raise the fees for 31 minor procedures performed by GPs, including vasectomy, repair of skin wounds and removal of simple cysts. The step is designed to encourage GP procedural work and avoid unnecessary referrals to specialists.
“This change will benefit patients, who will receive increased MBS benefits if a GP performs one of these minor procedures,” the department said.
Currently, GPs provide about 30,000 such services a year, with scheduled fees routinely some $40 to $50 less than what Medicare pays if a specialist provides the same service.
The fee for a vasectomy performed by a GP (MBS item 37622), for example, is $193.20. The same procedure by a specialist (item 37623) is $229.85. The fee for repair of a skin wound by a GP is $144, compared with $185.60 if done by a specialist.
The taskforce’s Principles and Rules Committee said the so-called “G&S differential” was unfair and a relic of the long-gone hospital “honorary” system, under which specialists were in effect reimbursed for only 40% of their time and had to make up the shortfall through MBS revenue.
To improve obstetric care, the government is adding a new MBS item to provide a home visit in the weeks after birth by a registered midwife, GP or obstetrician.
It will also invest more to ensure women receive a mental-health assessment during pregnancy and in the early postnatal period.
“This will improve early detection of and intervention for anxiety and depression, which research suggests up to 10% of pregnant women and 16% of postnatal women experience.”
The rebate associated with planning and managing pregnancy for private patients will be increased by 15%, reflecting an expectation that providers must be continuously available during a pregnancy and should also conduct a mental health assessment for private patients, the department said.
The removal of chiropractors’ ability to order whole-spine x-rays reflects a judgment that routine imaging of the lower back lacks clinical benefit and can lead to unnecessary radiation.
In 2014-15, about 130,000 such X-rays were performed.
In its report last October, the MBS Review Taskforce originally recommended withdrawing the ability to request MBS-funded whole-spine X-rays from all allied health practitioners.
Chiropractors were singled out because they order most of these services. They will still be able to order one- and two-region X-rays of the spine, and requests from other allied health practitioners will be monitored.
Among other changes in November, bone densitometry screening for patients over 70 with mild to moderate osteopenia will be eligible for repeat testing every five years. Those assessed with moderate to marked osteopenia will be eligible for repeat testing every two years, instead of one.
Changes to colonoscopy services will take effect next March, with 20 new items created to describe the indications for initial colonoscopy and ensure “appropriate surveillance intervals” of patients at increased risk of colorectal cancer.
The revised schedule will also include a block on co-claiming of MBS items for subsequent attendances with items for surgical operations that have an MBS fee of $300 or more.
