Upcoming MBS changes GPs need to know

UPDATED: This article was updated at 4.15 pm on 1 July to reflect a late decision by Federal Minister for Health and Ageing Mark Butler to delay the implementation of new telehealth pattern of service rules until at least the end of September.

From 1 July a number of changes will be introduced to the Medicare Benefits Schedule (MBS).
 
While some of these changes will see a slight increase to patient rebates, such as the 1.6% indexation being applied to most general medical services items, others will restrict the type and level of care that GPs can provide.
 
To help GPs prepare for the July updates, newsGP lists the changes most likely to impact on their day-to-day practice.

Prescribed pattern of services rules extension
The Federal Government has announced a last minute decision to delay the extension of the 80/20 rule to GP telehealth items (video and phone) until at least the end of September.
 
Under this rule, a medical practitioner would have been deemed to have engaged in inappropriate practice if they rendered or initiated 80 or more services on 20 or more days in a 12-month period.
 
A new 30/20 rule for GP phone services, which would only allow a practitioner to render more than 30 phone services a day on fewer than 20 days within a 12-month period, has also been delayed until at least the end of September.
 
These changes were originally scheduled to be introduced on 1 January 2022 but were deferred in response to rising COVID-19 cases and RACGP advocacy.
 
In a letter to Federal Health Secretary Professor Brendan Murphy sent earlier this month, RACGP Vice President Dr Bruce Willett again strongly recommended that changes to the 80/20 and 30/20 prescribed pattern of service rules be deferred as a ‘matter of urgency’.
 
‘The high number of COVID-19 cases in the community continues to be a challenge for GPs and the broader health sector,’ he wrote.
 
‘The RACGP is concerned that the circumstances have not changed since the decision to defer was made and that the re-introduction of these rules in July 2022 will generate unnecessary anxiety amongst GPs, potentially impacting on patient care.
 
‘Telehealth consultations, particularly via phone, have been a vital tool in the pandemic response [and] access to telehealth is even more critical during the winter months as the incidence of seasonal illnesses increases.’
 
The RACGP has indicated that it will continue to query the appropriateness of these rules, while pushing for a review and clarity on whether they will remain in place.
 
Discontinuation of Level C phone item
MBS item 92746 (Level C phone item) is scheduled to expire on 30 June.
 
The RACGP has said it continues to advocate for the Level C phone item to be extended as a matter of urgency, and it is seeking advice from Federal Health Minister Mark Butler on options to extend rebates for longer phone consultations.
 
The college has consistently called for longer phone consultation items to be reinstated as part of a permanent telehealth model, warning that achievements in improving patient access will be compromised by a limited telehealth model. GPs have also argued that patients with complex care needs require flexible access to healthcare, including longer phone consultations, and that these changes will likely have the greatest impact on the most vulnerable members of society.
 
Annual indexation
The MBS indexation factor for 1 July 2022 is 1.6%.
 
Indexation will be applied to most general medical services items, all diagnostic imaging services except nuclear medicine imaging, and six pathology items (74990, 74991, 75861, 75862, 75863, 75864).
 
For the first time, indexation will apply to MRI diagnostic imaging services in Group I5.
 
Indexation is currently calculated using the Wage Cost Index 5 method that results in annual increases lower than the Consumer Price Index.
 
The RACGP has called for a better measure of indexation to ensure automatic price increases for patient rebates fully reflect the rising costs of living and providing high-quality medical care, highlighting that the current method is contributing to higher out-of-pocket costs for patients.
 
According to the college, failure to set patient rebates accurately from the outset, coupled with years of zero or inappropriate indexation, means that 1 July rebates continue to not reflect quality service provision and the rising cost of living.
 
Changes to cervical screening items
Cervical screening items 73071 and 73073 will be amended to expand access to self-collected cervical screening tests.
 
Other changes
Additional changes will be made to colorectal surgery, pathology and diagnostic imaging services.
 
More information on the MBS updates, including current fact sheets, is available on MBS Online.
 
The RACGP’s MBS online tool will also be updated on 1 July with the latest rebates. The tool allows GPs to enter fees for services provided in their practice, automatically calculating the patient out-of-pocket contribution based on the Medicare rebate.
 
GPs can click through to the full item descriptors on MBS Online and also use one of the RACGP’s lists or create a customised list of items that can be downloaded and printed.
 
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30/20 rule 80/20 rule MBS items telehealth