Sports med one step closer to higher rebates

MRAC is reconsidering whether to allow fellowed sports doctors to bill group A4 MBS items.

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Sport and exercise physicians may finally catch a break, as the government considers whether to reclassify them as consultant physicians rather than specialists. 

It’s a change that the Australasian College of Sport and Exercise Physicians has been pushing for since initially being given specialist recognition about 15 years ago. 

According to the latest Medical Board data, there are less than 200 sport physicians in Australia; given the smaller size of ACSEP, it’s been somewhat of a David and Goliath battle to get attention from the department.  

Proof, perhaps – should it be successful – that the Department of Health and Aged Care does listen to clinician voices.  

If the change goes ahead, ACSEP fellows will be able to bill A4 consultant physician items 110 (initial attendance) and 116 (subsequent attendances).  

These items are remunerated at $168.60 and $84.35 respectively; almost double what their patients would currently receive under A3 specialist items 104 (initial attendance) and 105 (subsequent attendance).  

“We’ve got plenty of support from our organisational physiotherapy and allied health colleagues, but importantly we’ve also got full support from our medical colleagues [and colleges],” ACSEP president Dr Corey Cunningham told The Medical Republic.  

“We have tried this process for a number of years and this is by far the furthest we’ve ever gotten.” 

Both the AMA and the Council of Presidents of Medical Colleges, Dr Cunningham said, have written submissions in support of the change.  

The ACSEP president stressed that it wasn’t just about getting more money from the higher rebates, but would better reflect how modern sport and exercise physicians practice.  

“Sport and exercise physicians deal with patients who are complex and multifactorial,” he said.  

“In most cases, it’s a lot more than just elite professional or Olympic sports, and the nature of the consultation is physician style, rather than specialist opinion – as in, it’s management of patients rather than a procedure.”  

Smaller rebates necessarily create pressure for patients who can’t afford the gap.  

“Not all doctors are charging very high consultation fees, but … a doctor’s not going to spend 45 minutes with a complex case for $75, in most cases,” Dr Cunningham said.  

“Obviously that happens for kids or for follow up … but you can’t run a business doing that as a consultant or specialist medical practitioner.” 

In its submission to the consultation, the AMA said it concurred with ACSEP’s concerns about access block.  

Most patients that present to sport doctors have not improved in primary care, the association said, meaning they are complex by definition. 

“The nature of [sport and exercise medicine physician] services typically acquires a high proportion of patients with chronic or ongoing issues, which requires patients to see a physician over time for multiple treatments,” it said.  

“The current MBS structure does not accommodate the preventative treatment [they] provide to a range of chronic conditions because the expense actively discourages patients from utilising them.” 

If the bid for A4 rebates is successful this year, it would likely be left until the 2025 May budget to be introduced, according to Dr Cunningham. 

It’s frustrating, but he’s willing to wait. 

“We want sport and exercise medicine to be seen as attractive specialty to future registrars and trainees,” he said.  

“As in, [young doctors should] see sport and exercise physicians as consultant physicians alongside cardiologists, neurologists, rheumatologists and renal physicians.”