Who'd have thought requiring GPs to reduce the contents of a consult to a single item number would muck up the data?
General practitioners may have written more than 1.2 million mental health care plans in 2020, but official data suggests that only one in three plans were reviewed in that time.
Of course, that’s just the official data – when those statistics were published in a recent MJA Insight+ article, GPs were quick to point out that there are myriad reasons why the numbers don’t add up.
First and foremost, mental health consults are becoming a routine part of general practice workload; a survey of 846 GPs found that about 40% of consults in a typical week would relate to at least one aspect of mental health.
Of these, just 13% were about mental health alone and 25% were on mental health along with other issues.
70% of GPs included in that survey also said that, when an appointment includes both physical and mental health issues, they don’t tend to bill the mental health component as the MBS system does not make provision for this.
In fact, many doctors were actively discouraged from co-billing mental and physical health consults when the Department of Health conducted a compliance letter campaign on the issue in early 2020.
“The very fact that most mental health consults include non-mental health and the government PSR [Professional Services Review] frowns on co-billing is extremely disheartening,” one respondent said.
Let’s make this more real. Consultations done last week: 90% involved MH work. 10 patients a day. Most very complex. Number of consultations billed using MH item numbers? One. A week. Patients prefer normal item numbers. Patient centredness matters. Billing doesn’t = care
— Louise stone (@GPswampwarrior) July 26, 2022
Governments goes after GPs co-billing of attendance and MH items and then argues that GPs are not using MH item numbers means care is not being delivered?
— Todd Cameron, COVID Vax UTD?? (@TcameronTodd) July 27, 2022
Tells me these clowns know nothing about GP?????? https://t.co/C1zWxPxVa2
The fact that mental health is now just part of general practices is something that University of Sydney mental health policy researcher Dr Sebastian Rosenberg, one of the authors on that Insight+ article, readily admits.
“Mental health is becoming is an everyday part of most GPs’ daily workload, so the question really is how best can we capitalise on the opportunity of people visiting and discussing their mental health care with their GP, in light of people’s different needs, different complexity, the need for multidisciplinary care as well as for effective short-term interventions like cognitive behavioural therapy?” Dr Rosenberg told The Medical Republic.
“On top of all of that is how do we effectively monitor and be accountable – not just to the individuals and their families for their changing mental health care needs and mental health, but also as taxpayers – that we are using our mental health resources optimally?”
Essentially, even though GPs are doing the work and following up with patients who have mental health conditions, it doesn’t necessarily show up in the data.
And data is what helps drive and justify funding decisions.
Without knowing more, Dr Rosenberg said, it is difficult to gauge whether the system is pulling in the people it was intended to pull in.
“We have been raising these issues around program design, whether the plans have been reviewed adequately and whether the program is being used by people who may well need mental health care, but maybe not in the way the program is designed,” he said.
Clinical Associate Professor Louise Stone, a GP with special interest in mental health, also flagged the disconnect between data and real life.
“Structurally we need to think more broadly, and we need some [MBS item] numbers for the doctors, but also for the patients, because we are not capturing the breadth or depth of what GPs do just by looking at what they charge,” she told TMR.
The real twist of the knife is the fact that because mental health consults like Item 2713 attract a slightly lower patient rebate than a Level C consult, which is the same length of time, more GPs choose to bill a Level C.
But because more GPs choose to bill that way, there is less data showing how much mental health work is really going on, and the government is not incentivised to put more money into funding mental health.
The cycle continues from there.
“If I see a patient and they’ve got a psychologist, I’ll just bill them a consultation item number and they can keep seeing their psychologist,” Professor Stone said.
“That is then not counted in the MBS statistics, so the government always underestimates the number of mental health patients that I’ve seen, because they count the item numbers.”
I can’t bill that under a 2713, I used a 36 but BULLSHIT I’m not checking in regularly on my patient’s mental health.
— Geepee (@GilliantheGP) July 27, 2022
There are also misconceptions about how the mental health funding which does exist is distributed.
“There’s a bit of sleight of hand going on,” Professor Stone said.
“The government says that it gives x amount of dollars to GPs by giving them all these other numbers, right.
“But if those didn’t exist, I’d still be seeing patients … so it’s not actually [new] money.
If Professor Stone saw 10 people in one day and charged them all Level C consult fees, that would be part of her normal, everyday practice.
But if she saw those 10 people and charged them an Item 2713, they would be counted as mental health consults even if she is delivering the same care.
“When other specialists or colleges say, ‘Oh, look, they’ve given all this money to general practice [for mental health]’, they actually haven’t really – they’ve just given us another way to bill it,” Professor Stone said.
“It’s the same cost.”
