Australian Institute of Health and Welfare (2020) Medicare-subsidised GP, allied health and specialist health care across local areas: 2013–14 to 2018–19, AIHW, Australian Government, accessed 28 May 2023.
Australian Institute of Health and Welfare. (2020). Medicare-subsidised GP, allied health and specialist health care across local areas: 2013–14 to 2018–19. Retrieved from https://www.aihw.gov.au/reports/primary-health-care/medicare-subsidised-health-local-areas-2019
Medicare-subsidised GP, allied health and specialist health care across local areas: 2013–14 to 2018–19. Australian Institute of Health and Welfare, 01 October 2020, https://www.aihw.gov.au/reports/primary-health-care/medicare-subsidised-health-local-areas-2019
Australian Institute of Health and Welfare. Medicare-subsidised GP, allied health and specialist health care across local areas: 2013–14 to 2018–19 [Internet]. Canberra: Australian Institute of Health and Welfare, 2020 [cited 2023 May. 28]. Available from: https://www.aihw.gov.au/reports/primary-health-care/medicare-subsidised-health-local-areas-2019
Australian Institute of Health and Welfare (AIHW) 2020, Medicare-subsidised GP, allied health and specialist health care across local areas: 2013–14 to 2018–19, viewed 28 May 2023, https://www.aihw.gov.au/reports/primary-health-care/medicare-subsidised-health-local-areas-2019
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This release provides information on non-hospital Medicare Benefits Schedule (MBS) service items up to 30 June 2019, which precedes the introduction of new MBS items in response to the COVID-19 pandemic.
In this report, non-hospital Medicare-subsidised services refers to services provided in non-inpatient settings. This excludes services delivered to patients admitted to hospital at the time of receiving the service or where the care was provided as part of an episode of hospital-substitute treatment where the patient received a benefit from a private health insurer. While services provided in-hospital are excluded, the data do include services provided in places like private outpatient clinics (which may or may not be located within the grounds of a hospital).
For detailed information on the reported services and MBS items, see the Australian Government Department of Health website: MBS Online.
GP attendances include Enhanced Primary Care, After-hours GP attendances, Practice Incentive Program (PIP) services, and Other GP services. These services are Medicare-subsidised patient/doctor encounters, such as visits and consultations, for which the patient has not been referred by another doctor. These services can be provided by a GP or other medical practitioner. Excludes services provided by practice nurses and Aboriginal and Torres Strait Islander health practitioners on a GP’s behalf.
From 1 July 2018, new items were introduced to enable non-specialist practitioners to provide general attendance services. The terms non-specialist practitioner and other medical practitioner are used interchangeably in this report. For more information see 1 May 2019 Medicare Benefits Schedule book (Department of Health 2019a). GP subgroups affected by this change are footnoted (b).
See Notes section below for more information.
In this report, GP Enhanced Primary Care refers to a range of services such as health assessments, medication management reviews, the creation and review of treatment plans, and coordination of care for people living with complex health conditions who require multidisciplinary, team-based care from a GP and at least two other providers.
GP subtotal – Enhanced Primary Care includes Health Assessments, Chronic Disease Management Plans, Multidisciplinary Case Conferences, Domiciliary and Residential Medication Management Reviews, and Mental Health services (including preparation or review of mental health treatment plans, extended consultations related to a mental health issue but excluding focussed psychological strategies and family group therapy).
These services are designed to provide a structured approach for GPs and non-specialist medical practitioners to care for people with chronic conditions and complex care needs, and to improve coordination of care for people who require multidisciplinary, team-based care.
A collaborative medication management service available to permanent residents of a residential aged care facility for whom quality use of medicines may be an issue or who are at risk of medication misadventure because of a significant change in their condition or medication regimen. These items are claimed by GPs or non-specialist medical practitioners.
Early intervention, assessment and management of patients with mental disorders by GPs or other medical practitioners (who are not specialists or consultant physicians). These services include assessments, planning patient care and treatments, referring to other mental health professionals, ongoing management and review of the patient’s progress.
This group comprises MBS items for the preparation and review of GP Mental Health Treatment Plans as well as extended consultations related to mental health issues, excluding GP Focussed Psychological Strategies and Family Group Therapy.
Items 894, 896, 898, 2121, 2150 and 2196 are attendances by video conferencing to provide mental health and well-being support to people living in drought-affected communities.
GP subtotal – After-hours GP attendances include urgent and non-urgent after-hours GP care.
GP and non-specialist medical practitioner attendances provided on a public holiday, a Sunday, and during specified periods between Monday and Saturday. Note times vary depending on type of after-hours care, whether urgent or non-urgent, and for services provided at a place other than a consulting room. See After-hours GP (urgent) and After-hours GP (non-urgent) for more information.
After-hours GP attendance where the patient’s medical condition requires urgent assessment to prevent deterioration or potential deterioration in health and the assessment cannot be delayed until the next in-hours period. Eligibility requirements changed on 1 March 2018, which may affect comparability over time. Prior to this date, patients required urgent medical treatment (rather than assessment) to be eligible, and could book an urgent after-hours service two hours in advance (booking option no longer available).
Urgent after-hours are described as follows:
After-hours GP attendance for non-urgent assessment and treatment. These vary in time and complexity. Includes home visits and visits to residential aged care facilities.
Non-urgent after-hours are described as follows:
From 1 July 2018, new after-hours attendances provided by a medical practitioner have been introduced, and are described as follows:
GP subtotal PIP includes services provided as part of the Practice Incentive Program.
This program aims to support general practice activities including continuous improvements, quality care, enhance capacity and improve access and health outcomes for patients. A practice must be accredited, or registered for accreditation to participate in PIP services. Includes cervical smear, diabetes mellitus annual cycle of care and asthma cycle of care PIP services.
This service aims to encourage GPs and non-specialist medical practitioners to provide earlier diagnosis and effective management of people with established diabetes mellitus. The Annual Diabetes Cycle of Care must be completed over a period of 11 to 13 months, and includes (but is not limited to) measuring patients’ blood pressure, cholesterol and HbA1c, examining eyes and feet and reviewing diet, physical activity and medications. Services counted represent a completed cycle of care claimed by a GP, or non-specialist medical practitioners in eligible areas.
The completion of the Diabetes Mellitus Annual Cycle of Care can be used as an indication of GP and non-specialist medical practitioner care for patients with diabetes, but do not reflect the quality of care, prevalence of diabetes, or all diabetes-related care provided in the GP setting. Patients may also use other forms of health care to manage their diabetes, such as standard and long GP consultations, Chronic Disease Management plans, and paediatric and specialist services.
At a minimum the Asthma Cycle of Care includes at least 2 asthma related consultations within 12 months for a patient with moderate to severe asthma. This includes diagnosis and assessment of level of asthma control and severity of asthma, review of the patient's use of and access to asthma related medication and devices, provision of an asthma action plan and asthma self-management education. Services counted represent a completed cycle of care claimed by a GP, or by non-specialist medical practitioners in eligible areas.
The completion of the Asthma Cycle of Care can be used as an indication of GP and non-specialist medical practitioner care for patients with asthma, but do not reflect the quality of care, prevalence of asthma, or all asthma-related care provided in the GP setting. Patients may also use other forms of health care to manage their asthma, such as standard and long GP consultations, Chronic Disease Management plans, and paediatric and specialist services.
Professional attendance by a GP for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management.
From 1 March 2019, includes telehealth consultations by GPs for patients in selected flood affected areas (item 2095). This item is different to items in GP Telehealth (patient-end support) where the medical practitioner provides clinical support to a patient who is participating in a video conferencing consultation with a specialist or consultant physician.
Medicare benefits paid, and the resulting provider fees may be underestimated in 2018–19, as some expenditure relating to residential aged care item 90020 cannot be allocated. This expenditure is claimed under the new item 90001, introduced 1 March 2019 (included in ‘GP attendances (total)’ and ‘GP subtotal – Other’ only).
Professional attendance by a GP lasting less than 20 minutes, involving (where clinically relevant) taking patient history, performing a clinical examination, arranging any necessary investigation, implementing a management plan, and/or providing appropriate preventive health care.
From 1 March 2019, includes telehealth consultations by GPs for patients in selected flood affected areas (item 2144). This item is different to items in GP Telehealth (patient-end support) where the medical practitioner provides clinical support to a patient who is participating in a video conferencing consultation with a specialist or consultant physician.
Medicare benefits paid, and the resulting provider fees may be underestimated in 2018–19, as some expenditure relating to residential aged care item 90035 cannot be allocated. This expenditure is claimed under the new item 90001, introduced 1 March 2019 (included in ‘GP attendances (total)’ and ‘GP subtotal – Other’ only).
Professional attendance by a GP lasting at least 20 minutes, involving (where clinically relevant) taking detailed patient history, performing a clinical examination, arranging any necessary investigation, implementing a management plan, and/or providing appropriate preventive health care.
From 1 March 2019, includes telehealth consultations by GPs for patients in selected flood affected areas (item 2180). This item is different to items in GP Telehealth (patient-end support) where the medical practitioner provides clinical support to a patient who is participating in a video conferencing consultation with a specialist or consultant physician.
Medicare benefits paid, and the resulting provider fees may be underestimated in 2018–19, as some expenditure relating to residential aged care item 90043 cannot be allocated. This expenditure is claimed under the new item 90001, introduced 1 March 2019 (included in ‘GP attendances (total)’ and ‘GP subtotal – Other’ only).
Professional attendance by a GP lasting at least 40 minutes, involving (where clinically relevant) taking extensive patient history, performing a clinical examination, arranging any necessary investigations, implementing a management plan, and/or providing appropriate preventive health care.
From 1 March 2019, includes telehealth consultations by GPs for patients in selected flood affected areas (item 2193). This item is different to items in GP Telehealth (patient-end support) where the medical practitioner provides clinical support to a patient who is participating in a video conferencing consultation with a specialist or consultant physician.
Medicare benefits paid, and the resulting provider fees may be underestimated in 2018–19, as some expenditure relating to residential aged care item 90051 cannot be allocated. This expenditure is claimed under the new item 90001, introduced 1 March 2019 (included in ‘GP attendances (total)’ and ‘GP subtotal – Other’ only).
Non-referred professional attendance by a medical practitioner who is not a vocationally registered GP. These services are broadly similar to the other GP services included in this report. Includes services provided to patients in the community and residential aged care facilities.
From 1 March 2019, includes telehealth consultations by medical practitioners for patients in selected flood affected areas (items 899, 901, 905 and 906). These items are different to items in GP Telehealth (patient-end support) where the medical practitioner provides clinical support to a patient who is participating in a video conferencing consultation with a specialist of consultant physician.
From 1 July 2018, for Group A2 and Subgroups A7.2, A35.3 and A35.4, changes in provider eligibility in selected geographic areas may impact comparability over time.
Includes Focussed Psychological Strategies for patients with assessed mental disorders, and family group therapy. The provision of Focussed Psychological Strategies to a patient must be made either in the context of a GP Mental Health Treatment Plan, shared care plan or a psychiatrist assessment and management plan.
Family group therapy services can be provided by medical practitioners, including specialists and consultant physicians other than consultant psychiatrists.
Prior to 1 July 2018, Focussed Psychological Strategy services could be provided by eligible medical practitioners who practiced in a general practice (other than a specialist or a consultant physician). From 1 July 2018, these items were not restricted to being provided in a general practice.
Prolonged attendance for a patient in imminent danger of death. Services range from at least 1 hour to 5 hours or more.
From 1 July 2018, new items were introduced to enable non-specialist medical practitioners to provide general attendance services.
Non-directive pregnancy support counselling services provided to a person who is pregnant or who has been pregnant in the 12 months preceding the first service, by a medical practitioner (including a GP, but not including a specialist or consultant physician).
Provision of clinical support by a medical practitioner to a patient (in a telehealth eligible area) who is participating in a video conferencing consultation with a specialist or consultant physician. Does not include telephone or email consultations.
Psychological therapy services provided by eligible clinical psychologists. Includes individual attendances, group therapy, and telehealth video consultations. Note: Clinical psychologists may also claim services included in the ‘Other Psychologists’ and ‘Other Allied Mental Health’categories.
Items 80001, 80011 and 80021 refer to psychological therapy services via videoconferencing to people located in telehealth eligible areas.
Focussed Psychological Strategies and enhanced primary care services provided by any eligible psychologist, including clinical and other psychologists (i.e. fully registered psychologists in the relevant jurisdiction regardless of any specialist clinical training). Includes individual attendances, group therapy, and telehealth video consultations.
Items 80101, 80111 and 80121 refer to telehealth services provided to people located in eligible areas.
Mental health services provided by other allied health professionals such as occupational therapists, mental health nurses, Aboriginal health workers and some social workers. Psychologists (clinical or other) may also provide some of these services, however they cannot be readily separated from the other mental health workers included in the group. These services cover Focussed Psychological Strategies – allied mental health (occupational therapist and social worker items) and enhanced primary care – allied health (mental health worker item). Includes individual attendances, group therapy, and telehealth video consultations.
Items 80126, 80136, 80146, 80151, 80161 and 80171 refer to telehealth services provided to people located in eligible areas.
See Notes section below for information on footnotes.
BTOS/Group/subgroup/ item included(a)
Service by a practice nurse, Aboriginal health worker or Aboriginal and Torres Strait Islander health practitioner provided on behalf of, and under the supervision of, a medical practitioner. This group includes telehealth patient-end support services. These services do not require a referral.
Sources: AHPA 2017a; Department of Health 2019a
Notes:
(a) Medicare codes are based on the 1 May 2019 Medical Benefits Schedule book (Department of Health 2019a). Broad Type of Service (BTOS) groups similar Medicare services. For information on BTOS groups, see Department of Health’s Annual Medicare Statistics. MBS items can also be grouped into a hierarchy of Group – Subgroup – Item. MBS Groups start with a letter followed by two numbers, e.g. Group A15. All items within a nominated group are included, unless stated. An MBS Subgroup is represented by a Group code followed by a full stop and a number, e.g. Subgroup A15.1. This indicates all items within the subgroup have been included, unless stated. Where a Group or Subgroup is followed by numbers in brackets (e.g. A15.2 (735–779)), only the MBS items in the brackets are included.
(b) From 1 July 2018, new MBS items were introduced to enable non-specialist practitioners to provide general attendance services. The new MBS item group established differential (tiered) rebates on GP items for non-vocationally recognised general practitioners (non-VR GPs) that integrated an incentive for doctors to become fully qualified and to work in regional, rural and remote areas. New MBS items have been created under Group A7 – Acupuncture and non-specialist practitioner items. These items replicate the General Practice items under Schedule A of the MBS, and set the relevant item fee at 80% of the equivalent VR item. For GP subtotal PIP and subgroups (Cervical smear PIP, Diabetes Cycle of Care PIP or Asthma Cycle of Care PIP), new items were introduced to enable non-specialist practitioners to provide services in eligible areas. Note, the terms non-specialist practitioner and other medical practitioner are used interchangeably in this report. For more information see 1 May 2019 Medicare Benefits Schedule book (Department of Health 2019a).
(c) In 2017–18, item 6087 (Health Care Home MBS item) was excluded to protect confidentiality. In 2018–19, item 6087 is included but not reported separately.
(d) Items 283, 285, 286, 287, 371 and 372 (GP Focussed Psychological Strategies MBS items) are included in both GP subtotal – Other and GP subtotal – Enhanced Primary Care for 2018–19 results. These new items contribute to GP Focussed Psychological Strategies and Family Group Therapy which is a service group of GP subtotal – Other. These new items are also categorised as GP subtotal – Enhanced Primary Care items under BTOS groups.
(e) Completion of cervical screening, Diabetes Cycle of Care or Asthma Cycle of Care through the use of relevant MBS items initiated the relevant Service Incentive Payment (SIP) through the PIP until 31 July 2019. From 1 August 2019, claims made against these items by GPs or non-specialist medical practitioners will no longer receive an incentive payment. This change does not affect data presented in this report, but will be reflected in future reporting for the period 2019–20 onwards.
(f) Items discontinued, however, some services were processed during 2013–14 to 2017–18.
(g) These items refer to GP attendances within residential aged care facilities. People who live in residential aged care facilities may access other GP services, including visiting a GP at their practice outside of the facility. In particular this group does not include MBS items 244, 225, 226, 227, 701, 703, 705 or 707 (health assessments) or items 235, 236, 237, 238, 239, 240, 243, 244, 735, 739, 743, 747, 750 or 758 (case conferences), which can also be provided to permanent residents of residential aged care facilities. In MBS claims data, it is not possible to distinguish between patients who are permanent residents and those who are receiving respite care in residential aged care facilities.
(h) Excludes items in groups N1, N2, N3 (Medicare Chronic Disease Dental Scheme), which ceased 1 December 2012.
(i) Clinical psychologist refers to Clinical psychologist psychological therapy services. Other psychologist includes other psychology services that can be provided by clinical psychologists or other psychologists. Psychologists (clinical or other) also provide some Other Allied Mental Health services.
(j) Does not include Other Allied Health MBS items 82030 and 82035.
(k) Does not include the Other Allied Mental Health MBS items 80140, 80145 and 80146 (Mental health services provided by occupational therapists).
(l) Does not include items 297, 320, 322, 324, 326 and 328 as these items refer to attendances in hospitals. However, a small number of services for these items were processed as non-hospital in 2014–15 and 2015–16, which may be due to administrative error (see Technical Note for more information). These small number of services have been included in the report for 2014–15 and 2015–16.
AHPA 2017a. What is allied health?. Melbourne: AHPA. Viewed 14 July 2020.
Department of Health 2019a. Medicare Benefits Schedule book, operating from 01 May 2019. Canberra: Department of Health. Viewed 14 July 2020.
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