Understanding Upcoming Changes to the Medicare Benefits Schedule and Their Impact on GP Practices
As the healthcare landscape continues to evolve, staying informed about regulatory changes is essential for general practitioners (GPs) and their practices.
With the Federal Election approaching in mid-2025, Medicare and bulk billing have become central topics of discussion.
One of the most significant developments is the proposed changes to the Medicare Benefits Schedule (MBS), initially set for implementation on 1 November 2024 but now postponed to 1 July 2025.
These changes, alongside an expansion of bulk billing incentives, could have far-reaching implications for GP practices across Australia.
This article explores the potential changes to the MBS, their financial and operational impacts, and strategies for GP practices to adapt effectively.
By delving into the specifics of the proposed reforms, including the expansion of bulk billing incentives and the introduction of the Chronic Condition Management framework, we aim to provide a comprehensive understanding of how these changes will reshape the healthcare landscape.
Additionally, the article highlights the challenges practices may face, such as reduced revenue streams and increased administrative adjustments, while offering actionable strategies to mitigate these impacts.
Through informed decision-making and proactive adaptation, GP practices can navigate these changes successfully, ensuring continued high-quality care for patients while maintaining financial sustainability.
Strengthening Medicare: Changes to Bulk Billing Incentives
The proposed changes to bulk billing incentives aim to make healthcare more accessible for patients while supporting GP practices.
Currently, bulk billing incentives are provided to GPs who bulk bill children under 16 and concession card holders.
The new proposal seeks to extend this incentive to all eligible patients, regardless of age or concession status.
A key component of the changes is the introduction of the Bulk Billing Practice Incentive Program.
Under this program, participating practices will receive an additional 12.5% loading payment for every $1 earned through MBS benefits.
However, this incentive comes with conditions: practices must fully bulk bill and participate in MyMedicare, a patient registration system designed to improve continuity of care.
These changes, set to take effect from 1 November 2025, have garnered bipartisan support, signaling a shared commitment to strengthening Medicare and improving access to healthcare services.
Chronic Disease Management: Current System and Rebates
Under the current MBS framework, patients diagnosed with chronic diseases are eligible for Medicare rebates when they visit their GP for a GP Management Plan (GPMP) or Team Care Arrangement (TCA).
These rebates are available once a year, with additional eligibility for reviews every three months.
For example, a patient with a chronic condition requiring coordinated care from a GP, non-GP specialist, and allied health professionals would need a TCA.
This arrangement ensures seamless collaboration among healthcare providers, improving patient outcomes.
The current Medicare rebates for Chronic Disease Management items are as follows:
- New GPMP (Item Number 721): $164.35 (once a year)
- New TCA (Item Number 723): $130.25 (once a year)
- Review GPMP (Item Number 732): $82.10 (three times a year)
- Review TCA (Item Number 732): $82.10 (three times a year)
Upcoming Changes to Chronic Disease Management
From 1 July 2025, the proposed Chronic Condition Management Item (GPCCM) will replace the existing GPMP and TCA framework.
This change includes a rebranding of the service and adjustments to item numbers and claim amounts.
While the government has not yet confirmed the exact rebate amounts, the following estimates provide an indication of how the changes might apply:
- New GPCCP (Item Number 965): $120.00 (once a year) (estimate only)
- Review GPCCP (Item Number 967 – TBC): $120.00 (three times a year) (estimate only)
Financial Implications for GP Practices
The proposed changes could have significant financial implications for GP practices, particularly those that predominantly bulk bill.
Based on the estimates above, a practice managing 2,000 patients on GPMP/TCA could see a reduction in service fee revenue of $215,040 annually.
This reduction underscores the need for practices to carefully evaluate their billing strategies and explore ways to offset potential revenue losses.
Key Considerations for GP Practices
- Shift from Chronic Disease to Chronic Condition:
The rebranding of the service from “Chronic Disease Management” to “Chronic Condition Management” may broaden eligibility criteria, allowing more patients to access care. - Reduction in Administrative Burden:
The removal of TCA requirements is expected to reduce paperwork for GPs and practice nurses, potentially leading to savings in administrative costs. - Impact on Bulk Billing Practices:
Many GPs currently bulk bill for GPMP and TCA consultations, encouraging regular patient visits and proactive disease management. The proposed changes may require practices to reassess their billing models.
Adaptation Strategies for GP Practices
To navigate the upcoming changes, GP practices will need to adopt proactive strategies:
- Identify Additional Patients:
Practices should identify patients who may benefit from the new Chronic Condition Management framework, ensuring they receive the care they need. - Evaluate Billing Models:
With changes to bulk billing incentives, practices may need to transition to mixed billing models to maintain financial sustainability. - Leverage Technology:
Participating in MyMedicare and utilizing digital tools can streamline administrative processes and improve patient engagement. - Focus on Preventive Care:
Emphasizing preventive care and chronic disease management can help reduce hospital admissions and improve patient outcomes.
Collaboration and Advocacy
The healthcare community must work collaboratively to address the challenges posed by these changes.
Advocacy efforts should focus on ensuring that the new MBS framework supports both patient care and practice sustainability.
Conclusion: Navigating the Evolving Healthcare Landscape
The proposed changes to the Medicare Benefits Schedule and bulk billing incentives represent a significant shift in Australia’s healthcare system.
These reforms aim to modernize Medicare, making healthcare more accessible and efficient for patients while addressing long-standing issues such as administrative complexity and funding gaps.
However, while these changes are designed to improve access to care and reduce administrative burdens, they also present financial and operational challenges for GP practices, particularly those reliant on bulk billing.
Practices may face reduced revenue streams and increased pressure to adapt to new billing models and patient management systems.
By staying informed, adopting adaptive strategies, and advocating for supportive policies, GP practices can continue to deliver high-quality care while navigating the evolving healthcare landscape.
Proactive measures, such as leveraging technology, optimizing patient workflows, and exploring mixed billing options, will be essential for maintaining financial sustainability and ensuring patient satisfaction.
Collaboration with professional associations and policymakers will also play a crucial role in shaping a healthcare system that balances accessibility, affordability, and quality care.
For more information on the proposed changes and their implications, visit the Department of Health’s official website or consult with your professional association.
