MBS review recommends rebate increase for longer consultations

The MBS Review Advisory Committee has released a draft report recognising that the current structure of time-tiered MBS rebates ‘disincentivises’ GPs from providing longer consultations.

It’s a position long held by the RACGP and other health bodies which have repeatedly called for a 40% increase to MSB rebates for level C and D consultations.

While a specific figure is not specified, the committee does recommend an increase to level C, D and E MBS rebates to balance out the current per-minute discrepancies between short and long consultations.

“GPs may be disincentivised from providing longer consultations (such as levels C and D) when appropriate because of such MBS items attracting lower fee-per-minute rates,” the report states.

“The working group also considered that the lower fee-per minute rates for levels C and D general attendances could disincentivise GPs from bulk billing these MBS items.”

The report states that consultation length should be based on clinical need.

While it acknowledged there is a relatively higher administrative workload associated with shorter consultations – and therefore a small dip in those consultations might be seen – the current per-minute differences between short and longer consultations was ‘too great’.

It considered a range of options, including the AMA’s proposal for a complete restructure of the MBS rebates, but ultimately settled on increasing fees for level C, D and E consultations as the option that could be implemented fastest.

Bulk billing also received a mention in the report, with the committee noting that bulk billing incentives structure tends to favour shorter consultations.

It recommended that bulk billing incentives should be based on a percentage of the MBS fee for the service that is bulk billed to avoid furthering the disproportionate remuneration of shorter consultations when compared to longer ones.

It found rural loadings for bulk billing incentives were appropriate and should be retained.

RACGP President Dr Michael Wright said the committee’s findings were a major step forward.

“There are a number of sensible recommendations that align with the RACGP's longstanding advocacy,” he said.

“As always, the detail will matter. The report does not yet set out the revised rebate amounts, but it is important that we begin this conversation about ensuring Medicare better reflects the time, complexity and continuity of care that patients need from their GP.”

The gender pay gap

It was noted in the report that the proportion of longer level C and D consultations provided by female GPs was high – providing a larger portion than their male counterparts.

This presents an equity issue due to the lower fee-per-minute rates for these MBS items, the committee found.

It is a concern newly elected RACGP President Dr Ramya Raman has written about for Medical Forum.

“Multiple studies have demonstrated that women GPs, on average, spend longer with patients, provide more preventive care, address more psychosocial concerns and deliver more patient-centred communication” she wrote in a column.

“Yet, under a funding model that heavily rewards throughput, these consultation patterns are often financially penalised. This is not simply a workforce issue. It is a gender equity issue.”

Long have there been calls

The RACGP has long called for an increase to rebates for longer consultations.

It formed part of its 19-point Plan for Accessible, Affordable General Practice ahead of the 2025 federal election, which also called for an increase to bulk billing for patients who need it most.

Earlier this year the College joined forces with 20 peak patient bodies to again call on the federal government to increase funding for longer consultations.