Time-based fee structure proposed for specialists in major MBS item overhaul

Medical politics

By Jennifer Cooke

20 Feb 2019

A proposed overhaul of MBS items for specialists will shed more than 60% of attendance items and replace them with new time-based standard attendance schedule fees.

In the first major restructure of attendance items for specialists since the 1980s, the MBS Review Taskforce has recommended a move away from initial and subsequent consultations, differential rebates for specialists and consultant physicians and additional payments for complex planning, to a time-based structure similar to that applied in general practice.

Among the recommendations in a landmark draft report delivered to the Minister for Health, Greg Hunt, by the Specialist and Consultant Physician Consultation Clinical Committee of the  Taskforce, is a higher schedule fee for items on a parallel structure of attendance covering acute, urgent and unplanned attendances outside consulting rooms.

The higher fee schedule would reflect the disruption and higher inputs of such attendances over five equivalent standard time-tiered attendance items, ranging from less than five minutes to more than an hour, according to the committee.

The time tiers would be divided into Level A attendances (less than 5 minutes); Level B (6-20 minutes); Level C (21-40 minutes); Level D (41-60 minutes) and Level E (more than 60 minutes).

Set up in May last year, the committee reviewed 143 items related to specialist attendances for the MBS Review Taskforce, which accounted for about 26 million services and $1.9 billion in benefits in the 2016-17 financial year.

Service items have grown at more than 4% per year over the past five years largely due to more services for an ageing population with increasing chronic disease. Specific attendance items for psychiatry, emergency medicine, intensive care, obstetrics, general practice and anaesthetics were reviewed by other clinical committees.

The clinician-led committee, which delivered its report in December following seven months of deliberation, also recommended that the outcomes of case conferences be uploaded to My Health Record as well as introducing a single incentive payment to consultant specialists when they adopt My Health Record, “triggered by achieving a volume of uploads that is proportional to the number of attendances that the provider performs”.

Actual fees would be set after more consultation given the wide variation in attendance times (and significant non-patient-facing time on each attendance) between and also within specialties, the draft report stated.

Last week, in a letter to stakeholders, comments from specialists were invited by the head of the taskforce, Professor Bruce Robinson, for submission by 17 May 2019.

Both the AMA and RACP are seeking feedback on the proposals from members. A spokesman for the AMA said a response would be provided to the committee.

After the coming federal election, the draft proposals “will be a matter for the incoming Health Minister”, the RACP told the limbic. “They are significant changes and their potential implications will need to be thought through carefully.”

Many of the current MBS items had not been reviewed since their introduction more than 40 years ago when traditional roles and training pathways of “specialists” and “consultant physicians” were more distinct and parallel attendance items were established. The committee found those items were now claimed inconsistently and were confusing for consumers.

To increase patient access to the items and encourage integrated care and shared decision-making, the committee also recommended new telehealth-specific attendance items, including the removal of the “no longer effective” 50% loading for telehealth services, a new framework for case conferencing items with three simplified categories, and more use of data to inform evidence-based clinical practice.

“Time-tiering will enable a simple structure for attendance items that enables more consistent rebates for patients for the same services, transparency for consumers, and clarity on informed financial consent,” the 190-page draft report stated.

Stakeholder feedback on the committee recommendations should be sent to [email protected], for the attention of Amanda Kennedy.

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