SSWAHS = SWSLHN + SLHN and the Medicare Locals - 44

Doctors paid too much for mental health role, says Minister

13th May 2011

Andrew Bracey and AAP   all articles by this author

MENTAL Health Minister Mark Butler has claimed GPs have been overpaid for developing mental health treatment plans, following criticism from doctors’ groups over Budget measures set to slash MBS rebates for drawing up the plans.

Labor committed $1.5 billion in new funds for mental health on Tuesday night but over one-third of that is to come from rationalising an existing program that provides access to psychiatrists, psychologists, social workers and occupational therapists.

Under the Better Access program, GPs refer patients to these health workers for continuing care.
But Mr Butler says doctors have been paid too much for their role.
"The recent evaluation of the Better Access program clearly showed the GPs have been getting paid over the odds," Mr Butler told Parliament on Thursday.

The average GP consultation under the program lasted 28 minutes, the Minister said, adding that doctors have been getting a flat rate of $163 for that when a standard Medicare consultation that lasts more than 40 minutes is just $99.
“[That's] two-thirds more money under Better Access for one-third less time," Mr Butler said, adding the Budget overhaul would bring the Better Access rebate "back into line with the standard time consult under Medicare”.

GPs will still receive a 27% premium on top of the standard rate if they have completed six hours of mental health training.

Under the new deal, doctors will receive $126 for consultations lasting more than 40 minutes and $86 for shorter visits.
“That is a fair deal for general practitioners,” the Minister said.

The Minister’s comments followed strong criticism earlier this week from AMA president Dr Andrew Pesce, who claimed the Budget measure devalues the role of the family doctor.
“The changes will take the family doctor out of the coordinating care role for people with mental health issues," Dr Pesce said earlier this week.
“We need to improve funding for mental health but this Budget decision gives with one hand and takes away with the other.”

Labor hopes to save $580 million over five years by rationalising Better Access.
The bulk of that, some $406 million, will come from reducing the GP rebates.
Another $174 million will be saved by reducing the number of treatments patients can receive from 12 to 10.

Comments:

Rainbow
13th May 2011
1:23pm

We should all take careful note and learn our lesson from the reduction in this rebate- when the government asks us to take on e-health and offers a fee for this service we should ask for a commitment that the fee will be ongoing and indexed to the CPI. Otherwise we should be united in our refusal to put our intellectual and practical resources to this onerous task.

 

Bite-my-Lip
13th May 2011
1:23pm

I don't think the reduction in fee is unwarranted. They should have scrapped the program all together. Along with the Dental Program. Put the money into bigger funding of some institutional care for the severly mentally ill. They cannot afford this middle class welfare and the psychology talkfest for the neurotic (the only people who seem to benefit from the program). All the money seems to have gone to the psychologists who have just raised their fees to put their services out of reach of those in real need.

 

woodsie
13th May 2011
1:42pm

I wish medical writers would stop referring to Medicare fees as "what the doctor gets". An important point to note is that the Medicare fees are not what the doctor will receive, unless they bulk-bill. These fees are what Medicare pays the patient toward the provision of the service. If any doctor thinks the new Medicare fees are inadequate, then simply charge the fee you think is appropriate, as is your right. Remember, almost all of the psychologists that we refer patients to will charge above the Medicare rebate.

 

John Miller
13th May 2011
2:17pm

Spot on Woodsie. From my perspective, all that has changed is that the patient will pay more for the service. I have yet to meet a clinical psychologist who doesn't charge more than the rebate; why then should the doctor?

 

gpns
16th May 2011
11:32am

I am a clinical psychologist that bulk bills. As in NO cost to the client.

 

gp04
13th May 2011
2:23pm

I hate doing MHA's- the patient is usually distressed, the paperwork is fiddly and onerus and the work is emotionally draining. If I am not going to 'be paid over the odds' I would prefer not to do them. Local community mental health team here we come- hope they got a good share of the billions!

 

nan
13th May 2011
2:38pm

This is because the mental health costs went overthe roof after psychologists were granted medicare payments and they just increased their consultations and the costs skyrocketed. There is no evaluation of the fees charged by psychos who are not even accredited or registered properly. Now GPs who charge lower fees and try to do a proper job are targeted. are

 

Jack
13th May 2011
2:39pm

aa

 

Jack
13th May 2011
2:40pm

Wont be too many MHP done at ~$90 for 20min. This is all part of the cunning plan by our cunning political classes to shift Medicare form private to public. Will fit in ever so nicely with "Super" Clinics. The sicophant public health doctors think the current mental health proposals are wonderful as they will massively expand their empires and demonstrate just how very important they are in the grand scheme of things. If the changes were really just about money the Minister would have just dropped the requirement to do MHP for GPs to refer to psychologists. Its not just about money its about ideology and that is a debate that just isnt worth entering into with a socialist who has power - akin to getting into a battle of wits with a two year old.

 

FedUpRuralDoc
13th May 2011
2:54pm

All boils down into what medicare is, or isn't.

It IS a rebate system for patients. It ISN'T a payment scheme for doctors.

Just charge what you think you are worth (the lawyers just divide time into 6 minute blocks and charge accordingly, plus fees for letters/postage etc). The patient can take up the issue of an inadequate rebate with the Govt.

AMA needs to come out fighting on this issue. I won't hold my breath.

 

wyecroft
13th May 2011
2:58pm

Response to Woodsie and Bite-my-lip. As a clinical psychologist I only 'bulk-bill' as I believe that my patients are already in 'high need' and are unable to either pay upfront or pay a gap. I can live on the bulk-bill payment. I also only charge a private patient the bulk-bill rate and have NEVER charged the APS recommended rate. Please do not generalise and I am happy to meet John Miller who feels he has "yet to meet a clinical psychologist who doesn't charge more than the rebate".
Signed: Not all the same.

 

Lelaina
13th May 2011
4:42pm

Thank-you wyecroft, there are some human not money driven health professionals still in this country. As a practice nurse, I am often the person who has a discussion with a patient first and who advises that they see the GP to discuss the MHCP. As practice nurses do we get any money for this service? No. Do we complain? No. And what about the practice nurses that do the actual plans? Who gets the money? Not us. I am also aware of psychologists that "bulk bill" and who recognise the reality of patients who are in "high need". I am also prepared to stand next to you and meet John Miller and any other GP who feels the same. Thank-you wyecroft for your care and understanding of these patients, we need more of you!

 

Bite-my-Lip
13th May 2011
5:19pm

wyecroft may not be all the same, but there are precious few of him/her. Sure there is a service available for those who cannot afford it. But this was meant to be "better access to mental health" not "the same access to mental health before millions of dollars were sunk into it". Even the designer of the program was concerned about the negative impact that it has on the patients who need it the most.
For the severely mental ill, a good social worker can achieve more than a psychologist. The homeless, the destitute: Many of them grace my doors, but I have an ordinary urban practice- I discount me fee to them as well so its not only psychologists and nurses that have charity in minds. In the end my bottom line pays for my practice nurse and any money given to her as an employee comes directly out of what I pay to my bank manager. Apparently we are on the same side: though often it doesn't feel that way.

 

FedUpRuralDoc
13th May 2011
5:19pm

..and Lelaina needs to understand that as a practice nurse he or she is paid a wage generated by the charging of mental health care plans - which covers her wage, long service, superannuation, the cost of the building, the cost of other admin staff, the electricity bill, rates, the upgrading of computers etc etc.


Most docs bulkbill MH plans. We recognise the patient is vulnerable. But the Govt is now asking GPs to effectively subsidise these consults by accepting a lesser rebate if bulkbilled only. It just dosn't make business sense.

Oh, unless we slash staff wages...

 

Cranky midlife GP
13th May 2011
6:33pm

surely the government is counting on significantly less MH plans, thus saving 10 fold on psychologist rebates. The psychologists should be very worried as too many should not have been subsidized at all. Only the clinical psychologists demonstrate competence in assisting the significantly mentally unwell patients.

 

Mary
13th May 2011
6:38pm

Sigh, interproffesional mud slinging is so passe. Let's keep the focus on the needs of patients and if we want to make lots of money we can charge accordingly and the market will sort it out (or we could start fossicking for minterals).

The average wage of a practice nurse is $29 an hour - rather low if the nurse is talented and driving care plans and health checks, given that the minimum wage in this country for a call centre operator is $17.50. Would be good to see nurses looking to establish and own general practices.

 

Andrew
13th May 2011
7:28pm

Whoa - Socialist Government employing divide and conquer, and predictably, out come the knives.... but they are pointed in the wrong direction! Most non procedural health services are underfunded and most health professionals underpaid, because for years, no politician in Australia has told the truth that quality care costs more than society is spending. Someone has to pay more for better or put up with less than good. Private vs public purse, psychologist vs nurse vs GP -those arguments are all second tier issues - missed the forest for the trees . Society as a whole is taught to value stocks, shares and futures - it no longer values quality health care. When periodically the media do some superficial treatment of waiting list times, deaths in A &E's etc etc. politicians employ sleight of hand to deflect blame, promise illusions and post pone cost.
70% approx of GP services are bulk billed.
The market won't sort it out because the average GP has swallowed the Medicare and political propoganda over years that good GPs care enough not to charge more, when "Medicare Doesn't Care" to pay a reasonable refund. Many of the GPs that don't swallow it, don't know how to effectively respond. After all they are not taught market based business skills in the socialist University ivory towers.
Socialists gave us the Soviet Union - great success - sausage for all.

13th May 2011
11:37pm

Like wyecroft, I am also a bulk billing Clinical Psychologist. I practice in a high need area too.
To Bite-My-Lip, I have to say that whilst Social Workers are fantastic professionals who can provide support and liaison, they are not skilled in psychotherapy. You don't send a psychotic, depressed, traumatised, autistic or personality disordered person to a Social worker for therapy. Please meet some psychologist and learn about what we do and why the public welcomes our input.

 

Solo Victorian Regional GP
14th May 2011
3:44pm

I am level 2 mental health trained. There is a big difference in the amount of work I need to do if I am referring to a psychologist versus planning to do the treatment myself. If I am referring to a psychologist my prioroty is usually to assess whether the patient qualifies for a MHTP and whether a psychologist is the right person. Often the patient is already seeing a psychologist and my role is reduced to a bureaucrat. If I am doing it all myself there is much more I need to do at this planning stage. Once the details are clearer I will decide if my commitment to mental health for over 30 years will involve maintaining my level 2 CPD for this triennium or not. So much for restructuring my practice to accomodate the mental health work. I am looking at other ways to make up the shortfall. I can guarantee I will make more money. From Medicare's point of view I will be costing them more.

 

doc
15th May 2011
7:34am

I used to bulk bill all my mental health plans, but will now charge my usual gap. The mental health plan did make it easier to care for the severely mentally ill without it being too much of a financial burdon on the practice, but sadly this will no longer be the case. Mental Health plans are not only created as a referral mechanism. Many of my patients don't want/need to see a psychologist but need ongoing psychological care. This has been a huge blow to the severely mentally ill, who need regular GP visits, and who are financially destitute. I hope the funds are funnelled into programs that cater for them.

 

ed
17th May 2011
11:56pm

There are suirgeries where everybody is charged $20-$30 more than the scheduled fee, even for pentioners and destitutes. The owner then holidays in exotic destinations while paying a pittance to the drs working for him. Best is he employs women doctors who never protest and accept whatever he gives.Such parasites exist in semirural practices and most of them run Divisions. Crooks exist at all levels, so why blame Nicola and Julia.