Specialists overlooked in Medicare reform: RACP


By Geir O'Rourke

3 Feb 2023

The Federal Government’s plans to reform Medicare appear to be forgetting a key element of the health system by leaving specialist care out of the conversation, the RACP is warning.

Minister for Health Mark Butler released his blueprint for revamping primary care on Friday, promising major changes to the sector plus a cash injection of $750 million.

Drawn up by a committee called the Strengthening Medical Taskforce, the plan includes a recommendation to better integrate general practice with the rest of the health system, including specialists and hospital services – although how this will be done is not spelled out.

RACP president Dr Jacqueline Small has already come out in support of the recommendation, but says patients need more access to specialist care than is foreshadowed in the report.

“Including medical specialists in integrated and team-based models of care will deliver better outcomes for patients, provide support and capability development for GPs and other health professionals, and address problems with accessing specialist medical care,” she said last week.

“Supporting medical specialists to work more closely with GP practices is one model that could improve patient satisfaction and health outcomes, reduce fragmentation of care and reduce hospitalisations from chronic and complex conditions.”

She urged the Federal Government to involve medical specialists in primary care reform and implement the college’s model of chronic care management.

Specialists should also be involved in the design and operation of the network of Urgent Care Clinics set to be rolled out nationally with government funding as well as the voluntary patient registration scheme planned for general practice.

It comes after concerns were raised about where specialists would fit in the government’s plans given there was not one physician among the 17 experts on the Strengthening Medicare Taskforce which produced the report.

The body, which met at least six times since July 2022, did include six GPs, plus nurses, health economists, consumers as well as Mr Butler himself.

Dr Small said the omission was a mistake.

“We need to make sure that any reform to Australia’s primary care system addresses the importance of integrated models of health care for patients that includes physicians and paediatricians,” she said on Thursday.

“Almost half of Australians now have one or more chronic condition and many are faced with increasing waiting times and out-of-pocket costs to see GPs and specialist physicians which lead to preventable complications and hospital admissions,” she said.

“We are concerned that the Strengthening Medicare Taskforce has left medical specialist care out of the conversation in addressing these issues, and that this could result in an outcome that means patients can’t access the care they need.”

Improving Medicare rebates for specialist care and funding support for GPs to seek advice from medical specialists should be another priority, Dr Small added.

Meanwhile, it has now been more than two years since the Medicare Review Taskforce recommended a major overhaul of specialist and consultant physician consultation items, with the government still yet to formally respond.

The radical reform would have deleted the separate ‘initial’ and ‘subsequent’ consultation items from the MBS, with specialist care instead funded under five GP-style time tiers.

At the time, the RACP campaigned for the higher rebates for initial consults to remain.

“This item should be non-time based and have a standard fee to account for the high upfront ‘expenditure’ of time for an initial attendance in laying the groundwork for future attendances,” the college argued in its 2019 submission to the taskforce.

“The requirement would be that this [initial consult] item would only be available for the initial attendances but that all subsequent attendances would then be based on the time-tiered approach,” it said.

The college added that a survey of its members found a quarter were opposed to time-tiered items, while more than 30% believed exemptions should be permitted if they were introduced.

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