Sports and exercise physicians say a “misclassification” by Medicare has left them unable to access chronic care items available to other physicians, preventing many patients with chronic conditions who would benefit from accessing their care.
The Australian College of Sports and Exercise Physicians (ACSEP) is now mounting a push for access to the Medicare’s Chronic Disease Management (CDM) items, arguing the current situation is inequitable and is stopping them from bulk billing patients.
ACSEP says currently their patients can’t claim their consultation under CDM items which offer rebates of $224.35 for an initial consult and $112.30 for a follow-up, and instead can only access rebates of $72.75 and $36.55 respectively.
ACSEP’s research committee member Dr John Orchard said the net result is only wealthy patients can afford to see sports and exercise physicians.
“There is a lot of evidence that exercise is first line for many of the chronic conditions osteoarthritis, back pain, cancer, depression, diabetes, obesity, cardiovascular disease. Yet the specialists in exercise treatment aren’t able to access that scheme,” he told the limbic.
“Almost every physician gets the same rebate for chronic care consults,” he said. “We just want it to be equitable.”
The anomaly stems from Medicare not recognising sports and exercise medicine as a physician speciality, even though they “match every definition”, said Dr Orchard.
The relatively young speciality was recognised by Medicare in 2010, at the same time as sexual health and addiction medicine were, but while the latter two were “upgraded” to physician status in 2016, SEM was left behind.
It will now take a determination by Health Minister Greg Hunt to change the status quo, a move that is both important and the only equitable solution, argues Dr Orchard.
Currently there are no sport and exercise physicians able to run bulk billing practices and SEM services are not available in public hospitals, he said.
“GPs are sending their well-off patients to us and getting back ‘this was a great consult it’s got me exercising again’…then realising if they send someone who doesn’t have a lot of money, they say it was really good but I can’t afford a second appointment and there are no public lists.”
As an illustration of the impact to public health system, he said last year a rheumatologist approached the ACSEP requesting fellows to join an OA clinic associated with a public hospital in Sydney, but they were unable to because the clinic used a bulk-billing model based on chronic care items.
“We will exist with the market we have got with GPs referring but what GPs have currently got to do is ask ‘can this person afford to be $150 out of pocket for each visit?'”
Dr Orchard denied the pitch was an attempt to drum up business.
“It’s not like we haven’t got any patients and we’re trying to get some. We’re all fully booked at the moment but with people paying a lot out of pocket.
“If we got it (access to the rebates) we would probably have a manpower shortage, demand would increase if people could afford it, and wait times would probably go up”.
The college was seeking to train more registrars, he added.