MBS Review: Its 7-point plan for general practice

Mr150119 Tue 1

The MBS Review Taskforce has finally released its draft plan for general practice, with proposals to introduce major reforms to GP management plans and a call to cut the funding for medication reviews.

After two years of closed-door deliberations, and months of leaks and rumours, GPs and the wider public have been given a first full look at the recommendations from the review’s general practice and primary care committee.

Below, we list the main reform suggestions:

1. New, super-long consult item

The committee endorsed the RACGP’s proposal for the creation of a level E consult lasting one hour or more.

No suggestions on the rebate, but the aim is to provide adequate funding for dealing with complex patients — including those with mental health issues or patients at the end of life.

2. Scrap item for short health assessments

The committee says Medicare item 701 for Health Assessments under 30 minutes should be deleted.

Around 47,000 of these items were claimed in 2016 and were worth $3 million; however, that amount had fallen 4.8% over the previous five years, it said.

The committee called for a review of health assessments, saying there was "limited evidence" behind their use for many patients.

However, it has suggested that the other health assessment items should be expanded to include children in out-of-home care and discharged prisoners.

3. Ban on level B item claims lasting less than six minutes

This move is meant to address what was once described by then-prime minister Tony Abbott as "sausage-machine medicine".

Around 91 million claims are made each year for standard level B consults, at an annual cost of more than $3 billion.

The committee did not produce any evidence the item was being misused by GPs claiming it for consults under six minutes, but argued the short consults "may not always constitute high-value care".

The report also noted “a number of committee members” had disagreed with the recommendation. The members were not named.

4. Cuts to Medication Management Review items

Medication Management Reviews should be linked to GP management plans with a “substantially reduced” fee, it said.

Again, there is no detail on how much should be cut. Currently worth up to $155 per service, use of the items has been falling in recent years, from around 144,000 claimed 2011/12 to 130,000 in 2016/17.

5.  Payments to GPs and practices to enrol patients

At the heart of the committee’s plan is a Health Care Homes-style proposal to fund patients to formally enrol with their practice under Medicare, allowing patients to see any GP in their registered practice for chronic disease management.

The committee did not publish its proposed fee for patient enrolment — specifying fees was outside its remit — but it said funding should vary depending on the risk profile of each patient. The fee would be expected to cover telehealth access and some after-hours care for enrolled patients who face difficulties getting to face-to-face consultations due to disability or remoteness.

“Patient enrolment will encourage practices to build continuity of care into their business models, ensuring support for longitudinal care and population health, as well as acute, episodic care,” the committee argued in its report.

“Enrolment will lead to stronger GP stewardship, with GPs supported to drive data-driven improvements in quality of care, and in referral and prescribing practices leading to potential downstream savings from preventable hospitalisations.”

6. Minimum 40-minute time limit for GP management plan item

The committee recommended that consults for GP management plans should last a minimum of 40 minutes but they should be combined with team care arrangements to reduce red tape.

Rebates for reviewing the plans should be increased to the same level as those for creating the plans to encourage better follow-up, the committee said.

Under the shake-up, there would also be rebates for GPs to participate in case conferences with other health professionals.

7. Revamped items to promote GP telehealth

The descriptors for Medicare items 99 and 82220-82222 should be expanded to make GPs eligible to provide telehealth consultations under certain circumstances, the committee said.

More information: Read the full report