The RACP has warned that the government’s ‘radical’ move to introduce time-tiered MBS attendance items for specialists may have significant unintended consequences including higher gap fees, overcompensation of ‘procedural’ specialities and a workforce exodus from in-patient services.
In its response to proposals by the MBS Review Taskforce to replace standard attendance (initial and subsequent) with time-based items, the College says this could lead to specialists becoming clockwatchers and severely penalise those in non-procedural specialities where practice requires less hands-on time with patients but more background work.
A poll of the College’s 17,000 membership drew 566 responses, of which around 66% expressed some degree of agreement with the proposals from the Taskforce’s Specialist and Consultant Physician Consultation Clinical Committee.
However many respondents also had caveats about time-tiered attendance items, with about half saying some form of initial attendance item should be retained to compensate physicians “for the high upfront ‘expenditure’ of time for an initial attendance in laying the groundwork for future attendances.”
RACP members expressed 6 major concerns about a time-based attendance item system:
1. It will reward inefficiency and promote ‘clock watching’.
Inexperienced or slow practitioners may be over-rewarded compared to efficient physicians. At the same time, if both doctor and patients have an ‘eye on the clock’, this may create conflict about the appropriate amount of time and payment for a consultation and damage doctor-patient trust and shared decision making.
2. Difficult to implement, especially for in-patient settings
A time-based system could create more admin work for booking and managing appointments and take the focus off patient care. It will be especially difficult to account for time in in-patient settings where a physician may be ‘multi-tasking’, seeing several patients at one time but perhaps providing only brief face-to-face or phone advice for some. If undercompensated for non-patient facing time, some consultant physicians to shift from in-patient to wholly outpatient attendances.
3. Fears of being ‘time audited’ will promote suboptimal ‘6 minute medicine’