A menopause-specific Medicare item has been in place for more than two months now, so how is item 695 working in practice?
GP consults that assess a patient’s experience of early menopause, perimenopause, menopause, or premature ovarian insufficiency have been able to attract a $101.90 rebate since the item was introduced in July.
Under Medicare, the assessment must last 20 minutes or more and include history-taking, blood pressure measurement and a basic physical examination.
Perth GP Jana Combrinck, who has a special interest in women’s health, told Medical Forum the creation of the item was needed as there was nothing specific to remunerate GPs for the time it takes for a menopause consultation.
She carries out such assessments in her role at Simply Women in Duncraig, and said they usually take between 30 and 45 minutes.
The amount allocated to the rebate generally was not sufficient to cover the cost of a long consultation, she said.
In speaking to other GPs at a recent conference specific to menopause, Dr Combrinck said many GPs were continuing to use level D item 44 for such consults as they were spending more than 40 minutes on these appointments.
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“I think you’d be hard done to do a menopause assessment at the 20-minute mark,” she said.
“And this is why we have to charge a gap, because you often spend at least 30 minutes with these patients, and the rebate isn’t adequately reflective of the amount of time and effort put into that consultation.
“So, it’s a good start, but potentially, it should be a little bit more.”
To better support GPs, she suggests an item should be created for follow up consults in regard to menopause as Item 695 can only be used once a year for eligible patients.
“The big thing about menopause is it’s not just an initial consult, patients come into you, you do that initial consult, and then there needs to be an element of review,” Dr Combrinck said.
“I review them at six weeks, I check in again at six months, and then I do an annual review. I think creating an item number for those review appointments would be useful.”
She said this would also reinforce expectations about the level of care expected around menopause.
“It would provide a framework of what’s important to be checked and it would also educate both doctors and the public on the fact that this isn’t a one consult done and dusted.
“You’ve got to continually review their situation; it changes when they go from being perimenopausal to post-menopausal. You need to continue to have that collaborative relationship.
“So, I think perhaps there is a bit of danger in just creating that initial menopause item number and not introducing the concept of a review.”
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Dr Combrinck said she hoped more work would be done to ensure doctors are upskilled in the area of menopause beyond simply the introduction of the item number, to ensure a high level of health care for all women.
“It would be a very sad day if, let’s say, bulk billing practices just start churning out a generic message to everyone in the age range of above 40 to 60 to come in for their menopause assessment so that they can bill this item, and then don’t actually do a thorough menopause care plan to look after these patients.
“I think whenever there’s a new item number that’s the danger and we do want to make sure that this is being utilised by the doctors that do the bulk of the menopause management in community to make sure that everyone gets the same level of care.”
The announcement of the new Medicare item had also caused some confusion among the public due to inconsistent messaging.
“A Labor MP said the government have now allocated bulk billed appointments for menopause and perimenopause and within the GP community, there was a massive outcry because she had misunderstood it,” Dr Combrinck.
“They introduced a rebate, but there’s nothing there mandating that it should be bulk billed, so that’s caused a bit of frustration.
“Some patients expecting that this consult is going to be bulk billed are then finding out that actually it’s not bulk billed and the gap is still essentially the same for them. So, I think how it was introduced was potentially a bit damaging to it.”
Dr Combrinck echoed calls by the AMA to increase rebates in general as there has been very little movement in Medicare rebates over the last 15 to 20 years, she said.
“It just hasn’t reflected the costs of running a practice, so I think in general, that needs to be looked at, not specific just to the menopause item, but just for time-based consults as well.”
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