March 2019: RACF MBS rebate changes


Changes to Medicare rebates for services provided in residential aged care facilities


On 1 March 2019, residential aged care facility items 20, 35, 43 and 51 were deleted and replaced with new attendance items (90020, 90035, 90043, 90051). These new attendance items have a nominal fee, that mirrors the value of the equivalent MBS item for professional attendance by GPs in a consultation room.

A one-off $55 Medicare payment has also been introduced (item 90001) to cover travel time and costs for GPs attending residential aged care facilities.

After hours and telehealth items for residential aged care facilities are not affected by this change.

The new GP items for residential aged care facilities and their descriptors are provided in the table below and can also be found on the Department of Health website

 

Previous item number

Previous fee

New item number

New fee

Descriptor (no change)

N/A

N/A

90001 – Flag fall

$55

**New item**

A flag fall service to which item 90020, 90035, 90043 or 90051 applies. For the initial attendance at one residential aged care facility on one occasion, applicable to a maximum of one patient attended on.

20 – Level A (<20 mins)

Six patients or less: the fee for item 3, plus $47.40 divided by the number of patients seen.

Seven patients or more: the fee for item 3 plus $3.35 per patient.

90020 – Level A (<20 mins)

$17.20

Professional attendance (other than a service to which another item applies) at a residential aged care facility (other than a professional attendance at a self‑contained unit) or professional attendance at consulting rooms situated within such a complex if the patient is accommodated in a residential aged care facility (other than accommodation in a self‑contained unit) by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management—an attendance on one or more patients at one residential aged care facility on one occasion - each patient.

35 – Level B (<20 mins)

Six patients or less: the fee for item 23, plus $47.40 divided by the number of patients seen.

Seven patients or more: the fee for item 23 plus $3.35 per patient.

90035 – Level B (<20 mins)

$37.60

Professional attendance by a general practitioner at a residential aged care facility to residents of the facility (other than a service to which another item in the table applies), lasting less than 20 minutes and including any of the following that are clinically relevant:

  1. taking a patient history;
  2. performing a clinical examination;
  3. arranging any necessary investigation;
  4. implementing a management plan;
  5. providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients at one residential aged care facility on one occasion—each patient.

43 – Level C (20-40 mins)

Six patients or less: the fee for item 36, plus $47.40 divided by the number of patients seen.

Seven patients or more: the fee for item 36 plus $3.35 per patient.

90043 – Level C (20-40 mins)

$72.80

Professional attendance by a general practitioner at a residential aged care facility to residents of the facility (other than a service to which another item in the table applies), lasting at least 20 minutes and including any of the following that are clinically relevant:

  1. taking a detailed patient history;
  2. performing a clinical examination;
  3. arranging any necessary investigation;
  4. implementing a management plan;
  5. providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

51 – Level D (<40 mins)

Six patients or less: the fee for item 44, plus $47.40 divided by the number of patients seen.

Seven patients or more: the fee for item 44 plus $3.35 per patient.

90051 – Level D (<40 mins)

$107.15

Professional attendance by a general practitioner at a residential aged care facility to residents of the facility (other than a service to which another item in the table applies), lasting at least 40 minutes and including any of the following that are clinically relevant:

  1. taking an extensive patient history;
  2. performing a clinical examination;
  3. arranging any necessary investigation;
  4. implementing a management plan;
  5. providing appropriate preventive health care;

for one or more health‑related issues, with appropriate documentation—an attendance on one or more patients at one residential aged care facility on one occasion—each patient


How will this affect GPs working in residential aged care facilities?

The RACGP has previously advocated for changes to the calculation that determines the rebate value for professional attendances in residential aged care facilities, noting that it:

  • was overly complex
  • resulted in a diminishing rebate per patient seen
  • made it difficult for GPs to raise a private bill to cover the additional costs of providing care.

The RACGP sees that this change goes some way to recognise the issues associated with the previous rebate structure.

However, the new structure will result in a net reduction in funding for GPs, if they are:

  • seeing 17 patients or more, for the same length of time (eg. billing 17x item 35)
  • seeing multiple patients for different lengths of time (eg. billing 1x item 35 and 1x item 43)

The RACGP therefore considers that the changes does not adequately remove the barriers faced by GPs providing care in residential aged care facilities, and do not meet their intended purpose of providing further support to GPs providing care in these settings.

The RACGP is communicating with the Minister for Health and Minister for Aged Care regarding our concerns with the new rebates and will keep members informed of advocacy in this area.