Recently the ANMF made a submission in response to a public consultation paper from the Medicare Benefits Schedule (MBS) Review Taskforce (the Taskforce), chaired by Dr Bruce Robinson. As it is over 20 years since the current MBS was introduced, the ANMF agrees it is imperative all 5,769 MBS items be reviewed for their relevance and contemporary evidence base for healthcare practice.
We consider there are parts of the MBS that are out-of date. Of particular note is the language which currently focusses on medical practitioners. This needs to be reflective of current practice by encompassing the full range of health professionals eligible to access Medicare items, which in terms of the nursing and midwifery professions means nurse practitioners (NPs) and eligible midwives.
The ANMF has remained a staunch advocate of universal health insurance coverage for all Australians since the introduction of Medibank in 1975, later revamped as Medicare in 1984. The philosophical underpinning of the nursing and midwifery professions is that all people, regardless of socio-economic status, should be able to access healthcare services appropriate to their needs. That is, access to healthcare services should always be based on clinical need and not on ability to pay.
In our submission we argued it is essential this opportunity for reform of the MBS does not perpetuate more of what we have now. We need change which will enable innovation. With the increasing age of our population and growing rates of chronic and complex disease, we need to re-think the way healthcare is delivered. NPs and eligible midwives are key to this change, and the Medicare system needs to provide the option for them to contribute their expertise, delivered in the way that best meets the expectations and needs of individuals and the community.
During the consultative phase of the review the Taskforce has sought guidance on examples where the MBS seems to be failing to support delivery of best value healthcare; and, recommended improvements to the surrounding ‘rules’, processes and systems that support the MBS.
From the perspective of the nursing and midwifery professions, the ANMF response highlights two essential areas to contemporise the MBS. These are:
- to remove the out-moded item based funding model of nurses in general practice providing services ‘for and on behalf’ of the medical practitioner, and
- to more appropriately accommodate the services provided by NPs and eligible midwives.
Specifically we pointed out to the Taskforce the fact that the original intent of the Practice Nurse Incentive Program (PNIP) funding was to enhance the role of nurses working in general practice. The retention of some Medicare items for nurses has meant that this intent has not been fully achieved. This has perpetuated a model whereby employers and/or practice managers direct nurses to focus care only on those activities that can be billed through Medicare, severely limiting their ability to determine the care required.
These remaining Medicare items for nurses must be removed, and instead, funding for the PNIP increased. We argue this from our firmly held position that nurses and midwives, as regulated health professionals, are not ‘supervised by’ nor do they provide care ‘for and on behalf of’ any other healthcare professional. Rather we see that all healthcare is a collaborative effort focused on positive outcomes for individuals and groups.
With regard to NPs and eligible midwives, the ANMF considers the current health funding models in Australia create serious barriers and limit their effectiveness in terms of equity, access and value for money in healthcare delivery. We have, therefore, called on the Taskforce to recommend NPs and eligible midwives be granted more scope to order diagnostic investigations (particularly imaging) and initiate (rather than just continuing) prescribing under the MBS rules; to allow NPs to be eligible for PNIP funding; to enable NPs to employ other nurses under the PNIP funding; for there to be access to ‘request and refer’ MBS provider numbers for NPs and eligible midwives in the public sector, as is the case for medical interns; and, for there to be a substantial increase in payment for MBS items for NPs and eligible midwives in private practice to enable them to establish a viable and sustainable practice.
For a copy of the ANMF submission to the MBS Review Taskforce go to: http://anmf.org.au/pages/professional-submissions
As 2015 ends….
The ANMF Federal Office Professional Team wish all ANMF members a safe and happy festive season. We look forward to continuing to work with you to influence policy development at the federal government level, and in raising awareness of the critical role nurses and midwives play in the provision of health and aged care, improving health outcomes for all people in Australia.
We also wish to publically thank our Professional Officer colleagues from the ANMF state and territory Branches, for their support and assistance throughout the past year. We wish them a great Christmas and productive New Year.
Julianne Bryce, Elizabeth Foley and Julie Reeves
Federal Professional Officers