Long-awaited Medicare review says rebates should be increased

In short:

Medicare rebates are rewarding GPs for shorter appointments and under-serving women in particular, according to a major new report.

Doctors argue it is a "flaw" of Medicare that is incentivising GPs to churn through patients, recommending the rebate for longer consultations be boosted.

What's next?

The report is now open for consultation until mid-October.

Patients who need longer GP appointments, particularly women with complex health needs, are being short-changed by inadequate Medicare rebates that should be increased, a major government review has found.

The draft report from the federal government's independent Medicare advisory committee found the system is rewarding short GP appointments more generously than those over 20 minutes, financially penalising doctors for providing longer consultations with patients when clinically appropriate.

Royal Australian College of GPs (RACGP) president Michael Wright said it had been a "flaw" of Medicare that incentivised GPs to churn through patients.

"What we've seen over the last 20 years is care is getting more complex, GPs are on average spending more time with patients, but they're being penalised by Medicare for doing that," he said.

The average cost of a long appointment — which is more than 20 minutes but less than 40 minutes — is $132, according to the latest government figures.

This means patients are typically about $52 out of pocket, but because prices vary significantly, the gap fee can be as much as $100.

However, the Medicare rebate does not double just because the appointment time does — generally the rebate per minute decreases as the appointment gets longer.

The Medicare Benefits Schedule (MBS) Review Advisory Committee report suggested this was inequitable.

"Patients aren't getting a fair go when it comes to longer consultations," Danielle McMullen, president of the Australian Medical Association (AMA)said.

"Those longer visits have a poorer rebate and we really need to rebalance the scales there."

Major medical bodies have long argued the current system is not fit for purpose as patients are presenting with increasingly complex needs.

The review said increasing the rebates for appointments lasting longer than 20 minutes was an option that could be implemented the fastest.

But it did not say how much the rebates should be increased by, with Dr Wright noting the "devil is in the detail".

The RACGP has previously said increasing the rebate for appointments between 20 and 59 minutes by 40 per cent would cost the federal government up to $1 billion a year.

Abolishing acupuncture and antenatal Medicare items

Female patients and GPs are particularly disadvantaged under the current system, according to the report, because they are more likely to use or provide longer consultations.

Dr McMullen said complex issues such as reproductive care or menopause management took time, and she had personally experienced the gender pay gap in practices where male doctors saw more patients per hour.

"That has an impact on the sustainability of the business as well, which is a factor when we're trying to improve flexibility in our workforce and get more doctors to be GPs," she said.

The report also found bulk-billing incentives further exacerbated the issue, as GPs currently received the same flat-rate incentive for both short and long appointments.

The federal government last year expanded the bulk-billing incentive to all Australians, as part of a plan costing $8.5 billion over four years.

But the review proposed changing the incentive from a flat-rate to one tied to the length of the consultation.

It also recommended abolishing standalone items for GPs who provide services such as acupuncture and antenatal care, arguing clinicians should be able to provide holistic care and bill according to the length of the consult, rather than the condition.

Evidence has shown acupuncture can help with conditions such as chronic pain, and some patients choose to receive it from their GP as they can be bulk-billed or address other health concerns in the same appointment.

Dr McMullen said she was not sure if patients would be better off under the new proposal.

"If this becomes a cost-cutting exercise then that's a problem … we want to see more detail about how they will balance that with appropriate rebates for time-tiered consultations," she said.

The review also recommended simplifying the rules around after-hours care by defining it as any service after 6pm on a weekday and abolishing the many Medicare items for after-hours care, instead replacing them with a loading fee.

"Obviously practices need to pay their staff more from that time to keep the doors open and we do think this will go a long way to help more practices be open later into the evening," Dr McMullen said.

The report is now open for consultation.

A health department spokesperson said the final version was due to be handed to the government by the end of the year.

"The MRAC is an independent committee which makes recommendations to government, which are then subject to consideration. Any changes to the MBS then need to be considered in a budget context," they said.