What’s with the rush? The AMA would like to know.
As if simultaneous incoming changes to GP management plans, WIP and PIP incentives weren’t enough of a shake-up, the Department of Health and Aged Care is now eyeing reforms to the 11 health assessment items on the MBS.
The proposed changes – which are still in the consultation phase – were spurred by a 2023 Bond University review which found little published evidence to demonstrate the impact of general, broad-based health assessments on patient outcomes.
By DoHAC’s reckoning, MBS data shows only “modest” patient and provider engagement with health assessments, “limited” uptake by patient target groups and “marginal” repeat use for annual services.
It came up with three avenues for change.
Under the “minimum approach”, it would update clinical services to remove references to requirements that no longer align with clinical practice, like tests that are no longer performed.
It would also consider whether the availability of health assessments should be linked to MyMedicare.
The “moderate approach” would make all the changes included in the minimum approach, as well as amending the age cohorts and service frequency for chronic disease assessments.
The third and final option is the “restructuring approach”, which would replace the health assessment model entirely.
This would include considering whether existing time-tiered health assessment items (such as residential aged care) would be more appropriate as stand-alone items and whether health assessment items should simply be replaced with a general attendance item co-claiming model.
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It’s a plan bordering on overambitious, according to the AMA.
“This busy schedule of reform, including MyMedicare implementation, the streamlining of chronic disease management items, and the broad reviews of workforce incentives and scope of practice, requires time to adequately observe the impacts of policy changes to medical practice and engage in thorough consultation with stakeholders to perform adequate review of their success,” its submission read.
“GPs must also expend a great deal of energy adjusting to the changes and the implications to their service delivery.”
The association did support minor adjustments outlined under the minimum approach and said it was open to discussion on some aspects of the moderate approach.
“In particular, the AMA is supportive of the recommendation to combine chronic disease, type 2 diabetes and heart health checks into one health assessment item and looks forward to exploring this further with the department,” it said.
“Such a change could streamline the health assessment environment while still allowing patients clinically appropriate access to comprehensive assessments.”
It was also against any notion of allowing non-medical practitioners to claim health assessment items, and strongly encouraged the department to leave GPs at the centre of care.
“While the coordinated care and supportive services rendered to GPs by practice nurses and other team members are essential to the quality of healthcare general practices provide, the AMA cannot support fragmenting the provision of health assessments by broadening the scope of eligibility for health assessment provision,” the AMA said.
The RACGP was somewhat more open to change than the AMA, throwing its weight behind the moderate approach.
Specifically, it supports expanding access to health assessments to all age groups and expanding target groups for time-based health assessments to include women, children in out-of-home care and people leaving prison.
The college also backed a requirement for patients registered with MyMedicare to only access health assessments at their enrolled practice.
Unenrolled patients would continue to be able to access a health assessment at any practice.
Like the AMA, it opposed any moves to expand item availability to non-GPs.
“The RACGP encourages government to proceed with caution if and when considering expanding MBS health assessments to other providers, who may not be properly equipped or trained to deliver this service,” the college said.
“Aspects of health assessments that are particularly aligned with general practice include interpretation of family history, medications, immunisation queries and many other features.”
The first round of consultation on the changes has now closed.
