Care plan crackdown has AMA support - with one caveat

Mr230119 Wed 1
Dr Tony Bartone, AMA President

AMA president Dr Tony Bartone says a proposal to crack down on dodgy care plans by introducing a minimum 40-minute threshold has his in-principle support — if it comes with a boost in funding.

The MBS Review Taskforce’s general practice and primary care committee is recommending rewriting the descriptor for Medicare item 721 so that doctors and practice nurses would be required to spend at least 40 minutes developing a GP management plan (GPMP).

There is currently no time restriction on the item, which has a fee of $144 and is billed by GPs more than 2.5 million times per year.

But although the committee has not released any figures detailing the proportion of care plans drawn up in under 40 minutes, Dr Bartone says the idea sounds reasonable because most GPs should take at least that long.

“The stuff around the 721 is pretty interesting and I can understand where that is all coming from,” he said.

“I'm not justifying the 40 minutes, but I can see what [the committee] is trying to get to, which is they don't want 10-minute care plans, which some people are allegedly doing.”

Read more: MBS Review: Its 7-point plan for general practice

The Melbourne GP said that together with his practice nurse, he often spent much longer than 40 minutes working on a care plan, although he said he could imagine that GPs who wrote multiple plans a day might take less time.

“If it is done properly, the red tape will make sure that it takes far longer than that for most GPs,” he said.

However, he added: “We probably wouldn't be too focused on a lot of the detail of the recommendations at this stage and we will need to take a closer look at the evidence around that.”

Under the committee’s reform plan finally released for consultation last month, Team Care Arrangements (Medicare item 723) would also be scrapped, with GPs offering access to MBS-funded allied health services under a GPMP.

The committee’s report states that item 723 — worth $114 — is claimed alongside 77% of GPMPs.

Axing the item would be expected to save the government in excess of $250 million a year — although the losses would be balanced at least in part by boosting the rebate for the GPMP review item (item 732) to the same level as the management plan itself, according to the report.

Dr Bartone said the AMA was still developing a detailed response to the committee’s report, which also proposed a Health Care Homes-style patient enrolment fee when practices formally registered patients.

Nevertheless, he said the AMA agreed the “broad thrust of the report” was in the right direction.

“We support it on the proviso that it is about repositioning the funding into those care plans created by people doing the right thing,” he said.

“It cannot be about taking away money from people using them properly and it needs to be accompanied by a significant increase in funding for chronic disease management."

The committee’s report was released to “key stakeholders”, including the AMA and RACGP, for consultation in August before being published online at the end of last year.

It is not yet clear when or if the committee will begin accepting submissions from other groups.

In response, RACGP said it was working on a response to the recommendations, which it would release in due course.

More information: MBS Review Taskforce report