8.           Options considered

The Working Group of the Taskforce considered six options to address concerns about the appropriate use of urgent after-hours items, as follow:

  1. Better define ‘urgent’ versus ‘non-urgent’.
  2. Enforce the current item requirements noting that the item requires that the treatment is urgent, not simply the assessment.
  3. Lower the rebates for urgent after-hours services for all providers.
  4. Reduce rebates for urgent after-hours attendances when those services are provided by home deputising services.
  5. Reduce rebates for urgent after-hours attendances when those services are provided by home deputising services in metropolitan areas only.
  6. Restrict access to urgent after-hours items to providers who work predominantly ‘in-hours’.

There was consensus that no single option would be completely effective, and that elements of several should be combined to form the optimal approach. It was agreed that quality should be the overarching priority and that the approach adopted focus on promoting high-quality models of care, with the suppression of low-value care being a natural consequence of the new arrangements.

In relation to Option 1, there was general agreement that definitions of ‘urgent’ in relation to medical services are too subjective to be helpful as a compliance tool, although further efforts in this area should be made.

In relation to Option 2, it was noted that the current item descriptors for the urgent after-hours items stipulate that “the patient’s condition requires urgent medical treatment”. It was agreed that the trigger for a service should be the urgent assessment of the patient’s condition, and that treatment might in fact not be necessary based on that assessment. This means that the current wording might inadvertently make a valid urgent attendance ineligible for a MBS benefit. It was therefore agreed that the wording of the descriptors be amended to stipulate “assessment” as the trigger for an urgent after-hours attendance.

Option 3 was seen as disrespectful to GPs providing high-quality after-hours care in addition to their in-hours workload, and as a fatal impediment to after-hours care in rural areas. Similarly, Option 5 was seen as disrespectful to GPs in metropolitan areas, who would have access to lower rebates than their rural colleagues for equivalent services. Members also noted the longstanding MBS fee-setting principle, supported by the AMA and RACGP, under which fees and rebates are uniform across the country no matter the location of services.

Option 4 and 6 effectively address the same issue (rewarding high-value care through a provider gateway). Option 6, with its emphasis on recognising and rewarding high-quality providers, was seen as most consistent with the Working Group’s preferred approach.

An alternative to these options was considered, being the abolition of urgent after-hours items 597 and 599, with their higher fees. It was noted that other after-hours items are available and are routinely used. A variation on this proposal involved retaining the urgent after-hours items but capping access to them at 1 or 2 claims per provider per day.

While the Working Group was attracted to the simplicity of this approach, it was felt that the deletion of these items would unfairly penalise GPs providing high-quality after-hours services in addition to a normal in-hours workload, by removing additional compensation for the lifestyle disruption and costs incurred by them.

It was agreed that an approach be developed drawing on the intent of Options 1, 4 and 6. Ultimately, this took the form of revised MBS item descriptors and explanatory notes for urgent after-hours items which exclude the use of these items for services provided by medical deputising services but preserve the use of these higher rebated items for GPs and other medical practitioners who are providing urgent after-hours services to their patients through after-hours on call arrangements.