The subtle change to item 23 next month discourages bulk billing and could affect patient costs, advocates say.
The “horrific changes” to level B items are a money-saving move and don’t benefit patients or GPs, says GP advocate and Australian Socety of General Practice president Dr Chris Irwin.
On 1 November, as promised in the May budget, Medicare will receive a $3.5 billion investment aimed at encouraging bulk billing, according to the government.
But among the promises of bulk-billing incentives is an attempt to balance the books by cracking down on very short consultations billed at level B, including item 23 the most frequently billed item.
While item 23 used to apply to level B GP consults lasting anything less than 20 minutes, the November update will impose a six-minute minimum consult length.
The six-minute limit will also apply to items 24, 5020, 5023, 5028, 90035 and 91800.
According to the RACGP president Dr Nicole Higgins, this is a change that has been flagged for some time and should only affect the rebates received by a small number of patients, such as those predominantly seen by a nurse for wound care.
“The average consultation time is increasing. And it’s important that we reward those who are spending more time with patients,” she said.
“Unfortunately, the way the MBS works, the more time you spend with a patient, the less reward or the less remuneration that you get.
“And this is particularly impactful for women who have longer consultations.”
Dr Higgins said that we need “different funding models to actually recognise the work that the rest of the team are performing”.
But, according to Dr Irwin, this change signifies a “horrific” and “cynical” move by the government that could constitute a funding cut of around $5500-6200 per GP.
“I’ve always said for years – and I really want GPs and all other doctors to understand – governments of both descriptions, left-wing and right-wing governments, with regards to Medicare are solely interested in cost cutting, increasing bureaucratic control, and data mining,” said Dr Irwin.
“And if a change doesn’t meet one of those three objectives, it simply won’t happen.”
According to Dr Irwin, the introduction of level E consults has been tied to level B cuts.
While the level E consult is “making moves to recognise the expert and complex work that some GPs do, especially with disadvantaged people that need more time” the “disgustingly low” rebate for level E consults doesn’t encourage practices to treat complex, long-term patients, Dr Irwin told TMR.
Instead, the rebate for level E consultations of an hour or more, $183, constitutes a 26% cut in funding when compared to six item 23s billed in an hour, for providing arguably more complex care, he said.
“[The federal government] can pretend all it wants but this is a simple cost-cutting exercise which they’re hoping that the AMA and RACGP don’t kick up too much of a fuss about.
“The outcome doesn’t help patients and it doesn’t help GPs.
“It’s a cynical government ploy pitting so-called ‘good GPs’ who spend more time with patients against ‘bad GPs’ who have shorter consultations, while not actually fixing the funding problems that cause many GPs to practise short consultations.”
In its explanation of the cuts, the MBS said “it is anomalous that an MBS GP Level B consultation has no minimum duration when an MBS Level A item is available for short and less complex attendances”.
But Dr Irwin said that if the minimum was all in the name of rationality and alignment, there would be efforts to align vocationally registered (VR) and non-VR GPs, who are subject to different rebates for different time allocations.
Dr Irwin queried how years of training that allow for expert GPs to diagnose quickly and accurately are now valued at only $18, while other specialists may receive around $80 for similar care.
“If a patient comes to me deeply concerned about an individual, small lesion on their face, for example, through years of training, it might only take me five minutes to have a look at it, come up with an action plan and go from there.”
Dr Higgins concurred that while “the more skilled you are, the more efficient you get at a consultation and hence quicker”, as most consultations are getting longer, this shouldn’t impact the majority of consults.
“However, my concern is that they’re taking money away from general practice and this needs to be put back in.
“The money that they’re saving, needs to be reinvested into those longer item numbers.”
She added that patients might pay more as the change disincentivised bulk billing.
Dr Irwin said he expected, based on voluminous anecdotal evidence from colleagues, that GPs will be too scared to bill level E, given the chilling effect caused by DoHAC/PSR compliance activity and what he called “anaemic” responses by the RACGP and AMA.
