If there’s one thing most agree over, it’s that the Medicare consult item rebates need a revamp – but exactly what that should look like is a more complicated story.

Both the AMA and the RACGP have proposed changes to the rebates, but the AMA is also proposing changes to the time tiers.

What is the AMA proposing?

The AMA’s proposed restructure includes seven time tiers that aim to better compensate longer consultations. For example, they propose changing level B to ‘level 2’ with a cutoff time of 15 minutes, and level C to ‘level 3,’ encompassing 16 to 25 minutes.

Given that the average consultation lasts about 19 minutes, according to the 2024 Health of the Nation report, this change might be more significant than it seems at first glance, since 16 – < 26 minute consultations would attract a rebate of $78.25.

As you can see in the above table, rebates for longer consultations would also go up, in some cases quite significantly. For example, the rebate for consultations in the 36 – 39 minute time frame would increase by 80%.

Consultations that run between 46 – 59 minutes would attract a $186.30 rebate, while consultations that hit the hour mark or more would attract a $260.83 rebate.

What’s the RACGP proposing?

For its part, the RACGP is proposing a 40% increase to Medicare rebates for level C and level D GP consultations, as well as a 25% increase to Medicare rebates for GP mental health items.

A level C would rise from $82.90 to $116.06, and a level D would increase from $122.15 to $171.01.

The College says this will “get the bulk billing rate back to 85% for those who need it most.”

They also propose expanding the tripled bulk billing incentive to include everyone aged 34 and under.

We asked GPs about two of the AMA’s recommendations around consult items

Last fortnight Healthed surveyed almost 2200 GPs about two particular recommendations from the AMA (more to come on the RACGP’s proposal – stay tuned).

Eight out of 10 GPs expressed support for the change that would increase the rebate (by 85%) for consultations that run between 16 and 19 minutes, but slightly decrease the rebate (by 6%) for consultations between 20 – 25 minutes.

“Most of my consults are say 17 to 18 minutes so this would be better for me,” one GP commented.

“It would help me to feel a bit more valued and a little less like a charity,” said another.

“The grey area of 15 to 20 mins period will be eradicated, reducing fraudulent claims,” another GP said.

“This is especially valuable for GPs who do complex care with impecunious people, whose average item 23 lasts 18 or 19 minutes.” – surveyed GP

The lower rebate for 20 – 25 minute consultations did not go entirely unnoticed though.

“We would be losing money on the 20 – 25 minute consults. Perhaps 78.25 should at least match the current $82 or thereabouts,” suggested one GP in the survey.

Overall, most GPs thought that this proposed change would have a positive impact on a number of metrics.

• Two thirds of GPs said these two changes would have a positive impact on the financial viability of their practice
• 65% predicted a positive impact on their personal income
• 59% felt these changes would improve their job satisfaction
• 58% predicted a positive impact on the viability of bulk billing generally

‘Still not high enough.’

However, many GPs also commented that the rebates would still be too low.

“The fees should increase more substantially to play catch after the Medicare rebate freeze,” one GP said.

“It is a step in the right direction, though still significantly underfunded,” said another.

“It’s insufficient. I pay my hairdresser almost double that fee for a plain 15 minute trim,” another GP noted.

What your colleagues are saying

“Rebates are still far too low and insulting for responsibility of medical care and practice costs. Why is time for documenting consultation notes, reviewing patient charts prior to consultation, checking and considering results/management when patient is not present never addressed or considered for consultation times?”

“The new tiers from the AMA are too complicated to follow in GP practice, too many items.”

“Complexity is the issue, not the time. Also, there is not any merit for experienced doctors compared to new graduated doctors. The payment is the same for somebody who just graduated and one who has been there for 40 years.”

“The rebate makes a difference to the patient as my clinic privately bills most consults.”
“Because my patients are geriatric and poor, I bulk bill them due to empathy … but sometimes I feel cheated after all my years of study and experience!”

“There should be a greater increase in rebates than what is suggested. There should be an independent, non-political arbitration system for regular increases in Medicare rebates. There should also be a one-off payment to all GPs who did not receive an increase in the 4-year Medicare rebate freeze.”

“It may make my practice viable, but more importantly it may incentivise local medical students I have to consider doing general practice as a long-term career. None of my locally trained medical students have ever gone into general practice after seeing what I do, and the earnings I get!”