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\n GPs are concerned about the impact of MBS changes to the care they can provide patients.
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\n News<\/p>\n
\n Doctors are worried about how the scrapping of co-billed items and 12-month exemption rules will impact on patient care and clinic sustainability.
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\n GPs are concerned about the impact of MBS changes to the care they can provide patients.
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\u2018This allows me the time to explore the patients\u2019\u00a0needs and actually develop a trusting relationship with them, create a treatment plan\u00a0and also practice some preventive medicine,\u2019 he told newsGP.
newsGP weekly poll
\n Changes to MBS mental health items due to kick in on 1 November are likely to have a detrimental impact on patient wellbeing and the sustainability of clinics with a focus on mental health, GPs have warned.
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\nFrom that date, under reforms to Better Access<\/a>, key MBS mental health items will be scrapped, including item 2712 to review a mental health plan, and item 2713 for a mental health consultation longer than 20 minutes.
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\nGeneric time-based items will be used for this care instead.
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\nEquivalent mental health telehealth items are also due to stop, as will the current exemption to the 12-month relationship rule for GP Mental Health Treatment Plan (MHTP) items.
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\nDr Owen Harris, a GP working in inner-city Melbourne, has real concerns about the potential repercussions of losing items he has used to reduce the patient out-of-pocket costs often attached to complex mental health care.
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\nOffering standard appointments of 20 minutes, Dr Harris says his patients \u2013 who include people requiring treatment for problematic use of alcohol and other drugs, and gender-affirming care \u2013 often need longer.
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\nWhile he would love to bulk bill everyone, he says that is \u2018simply not possible given the structure of Medicare item numbers and rebates\u2019.
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\nUnder the existing system, Dr Harris reduces the cost to patients by co-billing, which is allowed under certain circumstances by Medicare guidelines.\u00a0
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\nOne example is co-billing a patient with hypertension and depression, with the \u2018standard\u2019 MBS item 23 privately billed, and MBS item 2713 bulk billed if the appointment lasts 26 minutes or more.
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\nAccording to Services Australia<\/a>, MBS item 2712 was used 521,485 times in the past financial year, with 1,082,666 MBS 2713<\/a> items billed \u2013 although the data does not specify when items have been co-billed.
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\nFor Dr Harris, the key is being able to thoroughly treat each patient in front of him.<\/p>\n
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\n\u2018Longer appointments with me mean less attendances overall, less trips to hospital, fewer referrals to specialists.\u2019
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\nDr Harris calculates patient costs could increase by \u201830% or more\u2019 under the changes unless he absorbs them himself \u2013 and fears a system already geared towards \u2018six-minute medicine\u2019 is about to get worse. \u00a0
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\n\u2018Under the new system, the financial incentive is to see as many people as possible in order to make use of the new bulk-billing incentives, ie six patients an hour rather than two or three,\u2019 he said.
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\n\u2018This is clearly not good for the patient, not good for the community, and is likely to result in a huge wave of burnout amongst GPs and the closure of even more clinics.\u2019
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\nAn analysis of the Better Access reforms published by Cubiko<\/a> describes the removal of co-billing as \u2018the biggest financial impact\u2019 of the changes, and predicts \u2018a noticeable drop in billings\u2019 related to those consultations.
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\nIts dataset suggests an average of 14 MHTP reviews at clinics every month, a level Cubiko says it would not expect to have a significant impact on long-term sustainability \u2013 but the company says this depends on the emphasis placed on mental health services.
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\n\u2018Many clinics may need to consider charging private or mixed fees for these longer, complex mental health consultations to maintain financial viability,\u2019 the blog states.
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\nEncouraging practices to adopt a proactive, transparent approach to the changes, the blog observes that item numbers used for preparing MHTPs will remain in place \u2013 and also finds potential \u2018silver linings\u2019.
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\n\u2018Ultimately whether you will better or worse off under the new framework comes down to how mental health reviews have been billed historically, and what bulk-billing incentives may apply within your MMM region,\u2019 the author writes.
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\nClose observers of the MBS have already pointed out difficulties in knowing when co-billing can and cannot happen<\/a> when using the outgoing item numbers, which are by no means universally liked.
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\nAssociate Professor Caroline Johnson sits on the RACGP Expert Committee \u2013 Quality Care and its Mental Health Working Group and is the RACGP representative on the Better Access Industry Liaison Group.\u00a0
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\nCommenting in a personal capacity as a GP who wants to help colleagues navigate the mental health system, she does not oppose the removal of items 2712 and 2713 per se.
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\nShe notes that MBS item 2712 was introduced more than 20 years ago due to emerging evidence that proactive follow-up of patients with depression led to better outcomes.\u00a0
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\n\u2018Whether an item number is the best way to achieve that \u201cproactive follow up\u201d remains unclear, and I suspect continuity of care and the quality of the GP\u2013patient relationship are more important factors than the financial incentive,\u2019 she told newsGP. \u00a0
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\nHowever, she acknowledges the item numbers\u2019 removal as \u2018a pain-point\u2019 for GPs who use them legitimately to co-bill alongside standard consultation items.\u00a0
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\n\u2018Item 2712 and 2713 have provided an opportunity to slightly reduce the significant financial penalty GPs experience when they offer longer consultations with their patients,\u2019 she said. \u00a0
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\n\u2018So the real problem with the removal of item 2712 and 2713 is that it removes one of the few mechanisms GPs have to maintain their income and still offer longer consultations.\u00a0
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\n\u2018The upcoming expansion of bulk-billing incentives will add to this disadvantage for GPs who work with patients who need more time, and unfortunately these are often exactly the patients we would like to bulk bill.\u2019
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\nLike Dr Harris, Associate Professor Johnson would like to see the changes paused until there is \u2018a more equitable redistribution of MBS funding to reduce the financial disadvantage for those who appropriately offer longer consultations\u2019.
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\nThe impact on telehealth
\nFor Dr Tim Kirchler, a GP working in headspace clinics in rural NSW, it is the telehealth changes that have the most significant ramifications to his practice and his patients.
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\nTelehealth mental health item numbers 92114 and 92115 (video) and 92126 and 92127 (phone) will no longer be available from 1 November, leaving only MBS telephone items for Focussed Psychological Strategies (FPS) available.
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\nThe exemption to the \u2018established clinical relationship\u2019 requirement for remaining telehealth items will also be removed \u2013 again apart from FPS items \u2013 making many patients ineligible for MBS rebates if they have not been seen in person in the past year, or have not signed up to MyMedicare.
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\n\u2018Our headspace centre covers a wide geographical rural area and many of our patients are unable to attend in person due to the distances involved,\u2019 Dr Kirchler told newsGP.
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\n\u2018Most of our patients are unable to afford private fees so this would mean that we either turn them away or accept a large decrease in Medicare billings.
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\n\u2018In our case the proportion of remote mental health services we provide means that this cut could affect the viability of our headspace centre\u2019s GP service.
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\n\u2018Overall this change is hugely detrimental to the provision of GP mental health services in rural areas.\u2019
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\nHe wants the change delayed until an alternative can be worked out.
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\n\u2018Ideally there should be a set of MBS items similar to the blood-borne virus, reproductive and sexual health items where timed items can be used for GP mental health telehealth visits without requiring the patient to have attended in person in any particular time frame,\u2019 he said.
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\nResponse from DoHDA
\nIn response to these concerns, the\u00a0Department\u00a0of Health, Disability and Ageing (DoHDA) said \u2018GPs will be able to use general consultation items for mental health services, including consultation and review of treatment plans\u2019.
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\n\u2018This means a patient can receive a benefit based on the time a GP spends with them, and they are able to get advice on both their physical and mental health needs in the one appointment,\u2019 a spokesperson told newsGP.
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\nThey also said GPs can bill for longer level D and level E consultations \u2018which recognises that GPs often spend longer with their patients to provide quality mental health care\u2019.
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\nWhile they pointed out that items 2712 and 2713 have a benefit of $83.65, less than the level C, level D and level E consultations of $84.90, $125.10 and $202.65 respectively, they did not directly address a newsGP question about co-billing.
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\n\u2018In addition, should a GP choose to bulk bill their patient they may also qualify for the triple bulk billing incentive instead of just a single, making these services more affordable for people in need of mental health support,\u2019 they said. \u00a0
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\nThe RACGP has previously written to the Government to request a delay so the changes do not coincide with the start of the Bulk Billing Practice Incentive Program, and so the findings of a review of MBS time-tiered items can be taken into account.
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\nRACGP President Dr Michael Wright continues to stress that complex mental health care cannot be provided in six minutes \u2013 and noted the recent Health of the Nation report which found more than seven in 10 GPs have mental health<\/a> as one of their top reasons for patient presentations.
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\n\u2018The RACGP is urging the Government, alongside their valuable investments in Medicare and GP training, to increase patient Medicare rebates for longer consultations by 40% and rebates for mental health items by 25%,\u2019 he said.
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\n\u2018For some, general practice can be the only point of care when seeking out mental health services, particularly in rural and remote areas.
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\n\u2018Increasing patient rebates to keep pace with the rate of inflation will help ensure everyone, no matter where they live, can access a trusted GP for their mental health issues without facing high out-of-pocket costs.\u2019
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\n bulk-billing items<\/a> MBS<\/a> mental health<\/a>
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\n How long do you spend with a patient for a perimenopause and menopause health assessment (MBS items 695 or 19000)?<\/p>\n","protected":false},"excerpt":{"rendered":"
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