Doctors in stand-off over plans to shake up specialist billing


Melbourne GP Mukesh Haikerwal said time-based billing “detracts from the fact you’re providing a clinical service”.

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“You’re not looking after patients, you’re looking after the clock,” he said.

Dr Haikerwal said the MBS review had descended into a “farce” and had always been about “cutting costs, reducing services and giving the presence of innovation – which just will not happen”.

The current system of Medicare rebates – focused on “episodic care” – was poorly suited to dealing with Australia’s ageing population and rising burden of chronic disease, he said.

In its submission to the MBS review, the AMA said if specialist rebates were time-based, it would lead to awkward conversations with patients if their appointment went over time because their medical condition was more complex than expected.

GPs have long complained that time-based billing leads to rushed appointments, with some churning through as many as 10 patients an hour to maximise their Medicare rebates and turning away “complex” patients at bulk-billing clinics.

Dr Bartone, who is a GP, said the system failed to account for the “complexities” of practice.

But the Royal Australian College of General Practitioners (RACGP), the peak body for GPs, is backing the proposal to bring specialist rebates into line with their own.

In the RACGP’s submission to the review, the college argued that the absence of time-tiered billing for specialists meant that an intial consultation “could take less than 10 minutes and still attract a rebate of $85.55”.

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A standard GP visit of up to 20 minutes attracts a Medicare rebate of $37.60.

RACGP president Harry Nespolon said time-based billing would discourage specialists from sending patients back to their GP for unnecessary referrals, a practice that has been attributed to the lower rebate applied to follow-up appointments.

“At the moment, there is a bizarre situation where patients are asked to come back and get a referral even though GPs have already given them an indefinite referral – just so the specialist can get a higher rebate,” Dr Nespolon said.

“It’s an incredible annoyance for both the GP and patient when they’re asked to get a referral that is not necessary … The most important part of this is the patient.”

But he confirmed the RACGP remained opposed to time-based billing for GPs, saying the amount of the rebate should “reflect the value of the consultation” rather than the number of minutes spent with the patient.

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