MBS rebate freeze must go
The new year is with us and the Medicare Benefits Schedule (MBS) rebate freeze is in place until July 2018; this has ramifications for the whole of general practice and quality-led primary care. Patient care must be supported by a sustainable financial model.
The consumer price index (CPI) continues to rise; our rent, wages, material costs, CPD, accreditation and professional insurance costs rise with it.
Bulk billing rates remain extraordinarily high. It is popular with patients (my home town has seen the opening of three new bulk billing clinics in the last six months or so) and is therefore also popular among many GPs.
The MBS rebate is an ‘insurance agreement’ between the government and the patient. The GP may decide to accept that whole payment (i.e. the patient is bulk billed).
GPs may also decide to charge an appropriate private fee for a clinical service. This is an individual choice and this model has always been supported by the RACGP.
Medicare is a universal access health care system and its concept is endorsed by the RACGP. There is no question Australia is a rich nation, with generally excellent health outcomes, but those parts of our populations that are disadvantaged or acutely ill should be free from concern around any financial disincentive that puts a barrier between them and their GP. To this end, bulk billing was originally devised with populations such as aged care, palliative care and patients from low socio-economic cohorts in mind.
But as technology advances, patient expectations grow and demand for services increases.
There is an unavoidable cost imperative, and an ongoing rebate freeze will make it increasingly difficult to provide quality care, especially for practices that bulk bill all comers. As well, GP training practices will have additional fiscal risks.
At what price good health care? At what price good primary health care?
All Western countries are struggling to juggle demand versus service volume with an ever evolving health demographic.
What is certain is that countries with a strong primary health – general practice – system in place have better health outcomes and are cost efficient. The rebate freeze threatens this centrally accepted tenet.
Adding further complication to the debate is the exponential growth in the numbers of patients with chronic complex disease states. This also challenges the modus operandi and historical methods of remuneration.
The RACGP Vision for general practice and a sustainable healthcare system outlines a way forward and challenges traditional thinking, suggesting patient enrolment and recognition that complexity and continuity of care will improve patient outcomes.
In response to the debate over the rebate freeze, the Federal Government has established two critical committees: the Primary Health Care Advisory Group (PHCAG) chaired by Steve Hambleton; and the MBS review taskforce, chaired by Bruce Robinson.
The PHCAG has reported to government: the MBS review is continuing. The RACGP has provided constructive input to the PHCAG and will continue to provide input into the MBS review.
The RACGP will be making a representation this month encouraging the Federal Government to release the PHCAG recommendations, so debate and deliberation can produce palpable actions.
We will be lobbying for real, sustainable, long-lasting reforms to the primary healthcare system so that our patients can be kept out of expensive hospital care, and instead be treated in the community through improved, patient-focused chronic disease management and integration of care.
We need solutions soon. The provision of quality general practice is now under threat. The rebate freeze should be rescinded and constructive dialogue should follow.
Dr Frank R Jones
RACGP President
Bushfire season is here
Volatile and extreme weather conditions, as seen recently across Australia, expose patients, practices and individuals to increased risk of bushfires, flooding, and other extreme weather events. Now is the time to ensure that your practice is best prepared.
The RACGP has developed and endorsed a range of resources to support general practices to prepare for, respond to and recover from the impact of emergencies and natural disasters.
The RACGP’s Managing emergencies and pandemics in general practice: A guide for preparation, response and recovery provides an overview of the planning process and outlines a range of activities that can be undertaken to help protect practice infrastructure and contents during the summer season.
GPs can ensure their patients and colleagues are aware of the danger of extreme weather conditions by referring them to the appropriate local or state authorities' emergency and disaster response web pages.
For further information regarding the RACGP endorsed Emergency Response Planning Tool (ERPT), call 1800 008 384 or email help@healthpointanz.org.au.
Revised ePIP eligibility criteria
The ePIP eligibility criteria will be revised, with general practices required to upload a shared health summary to the My Health Record system for 0.5% of the practice’s standardised whole patient equivalent (SWPE) to be eligible for their ePIP payment. The revised eligibility criteria will take effect in May 2016, timed to align with the commencement of the reference period May to July, or the August 2016 payment quarter.
The revised ePIP requirements equate to about five shared health summaries per full-time equivalent GP per quarter (i.e. for a practice with five full-time equivalent GPs, it would equate to 25 uploads per quarter).
The Department of Health has advised that to assist general practices in meeting the new requirements, online training will be available nationally from February 2016, and face to face training from March/April 2016. The RACGP will inform members as further details about this training are made available.
The Department is expected to formally announce these changes in early 2016. PIP participating general practices will be advised of the changes to the eligibility criteria for the ePIP through regular communication channels such as the PIP newsletter, websites and via Primary Health Networks.
Clinical Pearl
Who to test for chlamydia
Chlamydia is the most frequently reported notifiable condition in Australia with >85,000 diagnoses annually. Chlamydia is transmitted sexually and is often asymptomatic, meaning many people are not aware that they carry the infection. Test people who are: <30 years and sexually active; have had more than two partners in the last year; have had an STI in the past 12 months or a sexual partner with an STI; are at increased risk of complications of an STI; have signs or symptoms suggestive of chlamydia or those who request a sexual health check.
Testing is simple. Most asymptomatic patients can collect samples themselves including vaginal swabs and ano-rectal swabs. For more information, see the Australian STI Management Guidelines for Use in Primary Care. These guidelines were approved by the RACGP as an Accepted Clinical Resource in 2014.
In Practice poll
Work is underway to draft the next edition of the RACGP Standards for general practices (the Standards). As part of this process, the RACGP called for stakeholder feedback on the 4th edition Standards, including what works well, what needs changing and any identified gaps.
During the consultation period a number of stakeholders suggested that defibrillators should be included in the next edition of the Standards. The RACGP has included an indicator on defibrillators in the first draft of the 5th edition Standards, however it is unflagged and therefore not mandatory. The draft indicator is:
Indicator 3.1 G – Our practice has a defibrillator.
You are invited to participate in the RACGP poll to determine whether this indicator is appropriate for inclusion in the next edition of the Standards and, if so, whether the indicator should be a mandatory (flagged) requirement or not (unflagged).