An incoming MBS item for menopausal women will be worth less than a Level D consult.
When health ministers met on Sunday to announce a $573.3 million investment in women’s health, it was touted as “life changing”. But, when it comes to menopause, women may still be short-changed.
The funding package included new PBS listings for menopausal hormone therapies and oral contraceptives alongside updated long-acting contraceptive insertion rebates and a pilot for pharmacists to write PBS-subsidised prescriptions for certain medicines.
Assistant Health Minister Ged Kearney called the package – which has bipartisan support – “life changing”.
“For every menopausal or perimenopausal woman who has had flooding periods, night sweats or brain fog, for women who haven’t been able to afford their choice of contraception, for women who’ve had agonising pelvic pain and been told that it’s all in your head or just suck it up, that women should be in pain, and for women who have had to agonise through the awful pain of a urinary tract infection because they couldn’t get timely treatment – this package is for you,” she said.
“The Albanese Labor Government has heard you, we believe you and we are acting for you.”
From 1 July there will be a new item on the MBS specifically to cover menopause health assessments, a move that Minister for Women Katy Gallagher said “reward[ed] and supported” GPs to provide menopause care.
A spokesman for the Department of Health and Aged Care confirmed with The Medical Republic that the rebate for this item will be $101.90.
The item descriptor and any specific requirements the health assessment might entail have not been made public yet.
Compared with time-based items, the new item is worth more than a Level C (>20 minutes) consult, which is $82.90, but less than a Level D (>40 minutes) consult, which is $122.15.
Compared with the time-based health assessments set, the new item would be worth more than the “brief” health assessment (<30 minutes) under item 701, which is $67.60, but less than the “standard” health assessment (30 to 45 minutes) under item 703, which is $157.10.
Australian Menopause Society board member Dr Marita Long, a GP in Victoria, told The Medical Republic that she typically took 45 minutes to do a full initial menopause review with her patients.
Billing under a time-based long consult item, the government contribution works out to $2.71 per minute.
Under the new menopause-specific item, Dr Long would receive $2.26 per minute in government funding for the same consult.
With the item details still under wraps, Dr Long questioned whether there was space for a two-tiered rebate scheme similar to mental health advanced skills training.
“We wouldn’t want that [new] item number to be only accessible by GPs with menopause skills training, because don’t want … a GP to say, ‘I’m sorry, I can’t do that because I haven’t done the skills training yet’,” she said.
“But an incentive for more GPs to take up the education, which is on offer and is funded for GPs through Jean Hailes … maybe that’s a way of introducing some incentive. It’s food for thought.”
Related
RACGP women’s health spokesman Associate Professor Magdalena Simonis also told TMR that a thorough menopause health check, in her opinion, would likely take between 45 minutes and one hour.
“It would include a whole of person approach to their wellbeing,” she said.
“So that’s looking at what their symptoms are, taking down a full history regarding their menstrual pattern, what’s happening in terms of their menstrual cycle, where they are in terms of their reproductive cycle, life cycle and lifespan, where they are gynaecologically, whether or not they’ve had any underlying diseases affecting their gynaecological tract, whether or not they’ve got any chronic health conditions or predisposing conditions that might be become problematic, such as if they’ve had polycystic ovarian syndrome, whether or not that might predispose them to diabetes and heart disease and blood pressure as they grow older, whether or not they’ve had gestational diabetes and whether or not that predisposes them, at this stage, to diabetes again.”
Then, there’s the process of doing physical examinations, recommending particular tests and having a conversation about how to proceed.
An MBS rebate of $101.95 does not necessarily address that complexity.
Professor Simonis also pointed out that it’s not known whether the item will be restricted to once-per-year billing or if it might be available for billing at every menopause-related consult.
“It is a positive step forward, we can’t say that it’s not,” she said.
“It’s an acknowledgement that this is a significant stage in a woman’s life and that it’s an opportunity to undertake preventative care, which is what we, as general practitioners, are really good at
Adjunct Professor Karen Price, RACGP past president, told TMR that the idea of a menopause health assessment item spoke to the government’s attempts to impose a simplistic structure onto a complicated topic; menopause symptoms do not manifest in a single organ.
“[GPs are] welcoming of investment into complex healthcare and we’re welcoming of investment into spending longer with our patients to be able to assist them with un-straight forward presentations,” she said.
“Perimenopause, menopause, reproductive health, mental health; it’s all wrapped up together.
“And I think dividing it off into ever increasing numbers of item numbers is a fool’s errand.”
