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Govt changes provoke doctor fury

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The Federal Government has set itself on a collision course with the medical profession over radical changes to the Medicare system that the AMA warns will result in much higher fees for patients and reduced access to care.

AMA President Associate Professor Brian Owler said the Government’s unilateral move to slash the rebate for GP consultations lasting less than 10 minutes, cut Medicare rebates by $5, and extend the indexation freeze on the Medicare Benefits Schedule through to mid-2018, had provoked the angriest response seen from the profession in many years.

A/Professor Owler said the three changes amounted to an attack on all medical practitioners that would ultimately result in higher charges for patients and reduced access to quality care.

“This is a triple blow that will hit general practice like a wrecking ball,” the AMA President said. “Over the past week, the AMA went out to its members and asked what they thought of the new co-payment proposal. What we received back were some of the angriest emails the AMA has received over any issue in a long time.

“The AMA will do all it can to stop these destructive changes.”

Following sustained criticism from the AMA, the Government ditched its original plan to impose an across-the-board $7 co-payment on all patients and has proposed that there be no change to rebates and bulk billing incentives for vulnerable patients, including children younger than 16 years, concession card holders, veterans and nursing home residents. It has also scrapped any change to rebates and incentives for pathology and diagnostic imaging services.

But, in a major blow to general practitioners and their patients, the Government will cut the Medicare rebate for consultations with adult patients without a concession card by $5, extend an across-the-board freeze on MBS rebate indexation through till 2018 and slash the rebate for GP consultations that last less than 10 minutes.

Unveiling the package, Prime Minister Tony Abbott made it clear that the Government hoped most doctors would seek to recoup the $5 rebate cut by charging their patients an equivalent co-payment.

“Plainly, what we’re saying to doctors is that, with adults who don’t have concession cards, we don’t mind you charging a co-payment of up to $5,” Mr Abbott said. “That’s what we’re saying, obviously we’re saying that. Frankly, we think that’s an entirely reasonable position, an absolutely reasonable position.”

Parliament bypass

Unlike the original $7 co-payment proposal, which was scrapped in the face of a hostile Senate, much of the Government’s latest package can be implemented without legislation.

The Government has already started introducing the draconian measures.

Last week it unveiled regulatory changes to redefine Level A and Level B GP consultations.

The Government has changed the basis on which GP consultations are classified. Where previously they were differentiated according to complexity, from 19 January 2015 they will be classified according to time.

The new schedule is:

  • level A consultation rebate (less than 10 minutes) – $11.95;
  • level B (10-20 mins) – $32.05;
  • level C (20 to 40 mins) – $66.70; and
  • level D (more than 40 mins) – $100.55.

The changes will mean a dramatic re-ordering in the classification of consultations, and medical practices will have less than a month to update their systems and billing arrangements accordingly.

At present, just 3 per cent of all GP attendances are Level A consultations, while 83 per cent are Level B.

Under the new classification, the number of Level A consultations (which attract a much smaller fee) will dramatically increase to around 26 per cent of all GP attendances.

A/Professor Owler said that, because the Government had made the change by regulation, it did not require parliamentary approval to come into force.

The new regulations will have effect unless and until they are disallowed by the Senate. Leaving aside questions about whether or not the Senate would disallow the changes, the earliest it could act on them is 26 March next year.

The Government is able to avoid even that level of accountability with the most potentially damaging aspect of its new package, the multi-year freeze on MBS rebate indexation.

To index the rebates, governments are required to make amendments through regulation, which can then be subject to disallowance motions by the Senate. But, to impose a freeze of the rebates, the Government simply leaves the current regulations as they are.

$500 million hit to GPs

Mr Abbott and Health Minister Peter Dutton tried to present the change as a measure to boost the quality of care.

“We think the change in the way in which the [level] A and B [consultations] can be charged, so having a minimum of 10 minutes before they can charge a level B consultation, that that will concentrate a lot of the doctor’s effort on those who are most in need of help, those with chronic diseases,” Mr Dutton said. “It will skew the finances, when doctors are considering this, towards spending more quality time with patients, as opposed to just churning people through”.

But A/Professor Owler said the change not only devalued the care provided by experienced GPs, but would result in ever-higher costs for patients, and warned that estimates of a $45 gap fee to see a GP within three years might be conservative.

He said 26 per cent of consultations that were classified as Level B under the existing system would be downgraded to Level A under the new schedule, delivering an instant rebate cut from $37.05 to $11.95.

He said the measure alone would rip almost $500 million out of general practice next year, and even more would be stripped away when rebates for non-concession card holders are cut by $5 from 1 July 2015 – money which would have to be recouped from patients.

“What it will mean is that GPs are forced to pass these changes on to their patients in terms of costs,” he said.

A/Professor Owler said experienced GPs were often able to conduct an examination, take a history, prescribe and management plan and counsel a patient within eight or nine minutes, but such efficiency would be punished under the Government’s changes.

“Why that consultation should be worth on $11 now, compared to the $37 that it was worth last week, is certainly not something the AMA supports,” he said. “That is an enormous burden on practices which, at the end of the day, are small businesses.”

In addition to the reclassification of consultations, the Government also plans a $5 cut to the Medicare rebate, which A/Professor Owler said practices would have no choice but to pass on to their patients.

Six-year MBS indexation freeze

The AMA President warned patients would also ultimately be hurt by the Government’s decision to extend the pause on indexation of Medicare rebates through to mid-2018 for all practitioners, GPs as well as specialists.

“With the rebate freeze, we are going to see the value of the Medicare rebate actually be devalued.

“What’s going to happen is that as specialists and GPs’ practice costs rise, they’re going to have to stop bulk billing, they’re going to have to stop using no-gap schedules, and people are going to have to pay more out of their own pocket.”

Currently, around 82 per cent of GP visits are bulk billed, and around 89 per cent of specialist services are provided with no gap fee.

Adrian Rollins