Three paths to fairer GP rebates

The AMA is calling for feedback on how to reform time-based item numbers to make longer consults more feasible.

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With Medicare (allegedly) moving from prioritising episodic care to rewarding ongoing care for chronic conditions, the time to push for fairly remunerated long consults could be here.

Under the current setup, time-based consults – namely items 3, 23, 36 and 44 – are rebated in such a way that the longer a consult is, the smaller the remuneration is on a per-minute basis.

Item 3, known as a Level A consult, is defined by the MBS only as a straightforward service for an “obvious problem” but is generally understood to apply to consults lasting five minutes or less.

It attracts a rebate of $18.20, or a minimum $3.64 per minute.

For Level B and Level C consults – which last maximum 20 minutes and maximum 40 minutes – assuming that a GP has seen the patient for the maximum time allowed under both those item numbers, the rebate per minute drops to a minimum $1.98 and $1.92, respectively.

Even spending the minimum amount of time, 41 minutes, on a Level D (item 44) consult would net a doctor, at maximum, $2.76 per minute, almost a dollar less per minute than the minimum rebate from a Level A.

In light of the upcoming Medicare reforms, the AMA is now taking feedback on preferred pathways to reform.

Its first option is to add an “extended Level B” consult to the mix, which would apply to appointments between 15 and 20 minutes in length.

The rebate for this new item would be set in between the current Level B and C rates, which would be $58.35 if it was set at the exact midpoint.

Assuming $58.35 was the extended Level B price, it would level out to a minimum per-minute rebate of $2.91 and a maximum of $3.89.

Item 23 would be amended to apply to consults less than 15 minutes.

The rationale for choosing this option, the AMA said, would be that GPs would be better compensated for long consults but there would be minimal change to the current rebate structure.

Option number two presented by the AMA is somewhat simpler: increase the Level C and D rebates by 20%.

This would result in item 36 having a rebate of $92.34, or a maximum $4.61 per minute rebate, and item 44 carrying a $135.96 rebate, or a maximum $3.40 per minute.

The benefit of this approach, according to the AMA, would be to equal out the “skew” toward higher rebates for shorter consults, while again making minimal changes to the schedule.

The final and most radical of the AMA proposals is to restructure all item duration tiers and base the remuneration for all on a $3.64 per minute base rate.

Two new items, a Level E and a Level F, would be created.

Under this model:

• The rebate for item 3 would stay the same, but the item descriptor would be amended to define it as lasting five minutes or less.
• Level B would be limited to consults between five and 15 minutes, priced at $54.60, or a minimum of $3.64 per minute.
• Level C would be 15 to 25 minutes and carry a benefit of $88.72, or $3.64 per minute less 2.5%.
• Level D would be 25 to 35 minutes and carry a benefit of $121.03, or $3.64 per minute less 5%.
• Level E would be 35 to 45 minutes and carry a benefit of $151.51, or $3.64 per minute less 7.5%.
• Level F would cover appointments 45 minutes and over and carry a benefit of $180.20, or $3.64 per minute less 10%.

The AMA stressed that the exact figures it had come up with were indicative only.

While this option would smooth out the time-based remuneration skew, it would require the biggest Medicare restructure.

“When considering these proposals, please note that history shows that more complex changes have proven more difficult to achieve and generally take longer to implement,” the AMA said.

Regardless of member preference on the exact redesign mechanism, the AMA said it remains committed to fighting for fair patient rebates and adequate indexation.