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14 Mar 2018

The AMA advocated tirelessly to end the Medicare rebate freeze, resulting in the announcement by the Government in the last Federal Budget that the freeze on patient rebates was to be progressively lifted. 

The freeze was lifted on bulk billing incentives for GP consultations on 1 July 2017. Reindexation will commence for GP consultations and other specialist consultations on 1 July 2018, for procedures from 1 July 2019, and targeted diagnostic imaging services from 1 July 2020. The lifting of the freeze on Medicare rebates will cost the Government around $1 billion.

Of course we would have liked to have seen it lifted all at once. The freeze, introduced by the previous Labor Government and continuing through the Abbott and Turnbull Governments, was a harmful policy. 

But the gradual thaw is good news for our patients, GPs and other specialists alike. It will be lifted earlier than planned, and one of the major contributors to out of pocket costs to patients will finally, albeit modestly, be indexed going forward.

The lifting of the freeze was prominent in the national media, but it is in reality but one component of our ongoing advocacy on appropriate funding for medical practitioners. We’ve also been successful in: 

  • reversing proposed cuts to bulk billing incentives for diagnostic imaging and pathology services;
  • scrapping proposed changes to the Medicare Safety Net that would have penalised vulnerable patients;
  • delaying the introduction of the Health Care Homes trial to allow fine-tuning of the details;
  • moving to an opt-out approach for participation in the My Health Record; and
  • recognising the importance of diagnostic imaging to clinical decision-making.

The second component of the rebate issue relates to the ongoing MBS Review – a body of work that seems to have been around forever, but is really only in its infancy in terms of implementation of changes to items.

The AMA committed to support in principle the ongoing operation of the MBS Review Taskforce, including a transparent, consultative clinician-led approach to high-value care and 'future-proofing' the system. We have also been responsible for regularly bringing together the Colleges, Associations and Societies (CAS) to be updated by the MBS Review Chair on the progress of the work of the Clinical Committees.

The AMA is continuing to work with members to identify areas to improve the review process and recommendations. We continue to press the Government to ensure that reviews remain more than just a cost-cutting exercise, or a mechanism to meddle with the scope of clinical decision making.

This work is supported through engaging with our wider membership via an AMA Working Group, as well as our Medical Practice Committee. I am reassured by the calibre of the feedback and advice we receive from our wider membership on medical policy – the feedback is constructive, insightful and always aims to improve patient care. Be assured the feedback makes its way directly into our day to day advocacy efforts.

Indeed, as a result of member feedback, the AMA has responded to every MBS Review consultation round in 2017, supplemented by my direct representations to the Health Minister, the Department of Health, and to Professor Bruce Robinson, the Chair of MBS Review Taskforce.

It is fair to say the AMA feels the MBS Review process still needs improvement in a number of areas. Our direct intervention in the Anaesthetic committee has seen Minister Hunt order a re-boot.

That is why we have also called for early engagement of the relevant CAS on each of the Clinical Committees to ensure future recommendations are practical and consistent.

We have called for complete transparency, starting with how Clinical Committee members are selected and details of the Committees’ scope of work. Finally, the AMA has strongly recommended the Clinical Committees engage early with other Department areas including the Medicare Compliance and Professional Services Review to ensure that any changes to the schedule are practical for clinicians and do not result in sub-optimal care for patients. We all know a poorly worded MBS item can set up a practitioner to fail, especially when advice mechanisms can be difficult, or indecisive.

Ultimately, what we do not want to see is a confusing MBS schedule, nor do we want to be limited in our clinical decision making. We want – and indeed we need - better targeted, increased investment in a modern MBS Schedule.

I can assure you that we will continue to advocate on these issues and seek more cohesive Government policy in areas such as: sensible compliance, further targeted investment in areas of need, and for the improvements to private health insurance policies, so as to limit the impact of out of pocket costs for patients.

The AMA continues to have wins on behalf of doctors and their patients. Our work is informed through your representatives at State and Federal level. We will continue our endeavours at Council and secretariat level in the months ahead.


Published: 14 Mar 2018