Review of methadone treatment in Australia

12.2 Option 2: specific CMBS items and common fee

Page last updated: October 1995

Under this option, the existing funding approach for public clinics would be maintained. Similarly, the current fee-for-service model of payment for services provided in the private sector would be maintained under Medicare, but specific items would be introduced to the Medicare Schedule for methadone services. In addition, it is proposed that standard fees would apply for each item of service, regardless of the qualifications of the service provider or the clinical setting in which they are provided.

Four items are suggested:

  • An item relating to the initial assessment of a client for admission to a methadone program. It is suggested that the Schedule Fee for this item be the same as that for Item Number 44, a complex GP consultation exceeding 40 minutes;

  • An item relating to counselling provided to a client already participating in a methadone program. The Schedule Fee for this item could be the same as that for Item 23, a less complex GP consultation less than 20 minutes;

  • An item relating to a prescription review for an existing methadone client. The suggested fee is the same as that for Item 3, a straightforward GP short surgery consultation; and

  • An item relating specifically to urinalysis for clients participating in methadone programs. This is effectively the same as Item Number 66343.
It is recognised that the definition of these items, and agreement on the fee levels associated with each would require negotiation with the medical profession within the context of the Medicare Schedule structure.

Within this model it is recognised that some clients receive other health care services from the GPs providing methadone services. These services may be provided contemporaneously with or separately from methadone treatment. When provided separately, these services may be separately billed under their existing item numbers, and subject to the same accountability procedures as the same services provided to non-methadone clients. Where these services are provided at the same time as a methadone consultation, and given that the fees are the same under the new and existing items, there is no financial advantage in recording services under one item rather than another. We suggest that billing for both methadone treatment under the new item numbers and other GP services simultaneously would not be an option.

In the case of services provided by psychiatrists, where the client is receiving consulting services over and above methadone services, these could be billed separately at their current fee levels. The investigative powers of the HIC provide it with the capacity to monitor these services, and subject them to professional scrutiny as to their appropriateness.

12.2.1 Advantages of this option
12.2.2 Disadvantages of this option
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12.2.1 Advantages of this option

  • The advantages described under Option 1 apply equally to this option, particularly those relating to the capacity of this option to cater for the different service needs of more complex cases and its attractiveness to GPs.

  • This option provides for improved clinical and financial accountability for methadone services. Services could be monitored by the HIC, and any systematically high levels of service provision identified and investigated.

  • The adoption of a standard fee structure removes an apparent inequity between GPs and psychiatrists where the services are of a like nature and the clinical needs of clients are comparable. At the same time, this approach allows for any additional services required for more complex cases to be provided and remunerated as required.

  • This option would result in a reduction in costs to the Commonwealth through the adoption of a lower fee structure for methadone services provided by psychiatrists. These are estimated to be of the order of $3 to $3.5 million per annum.

12.2.2 Disadvantages of this option

  • The disadvantages identified under Option 1 relating to the potential for over-servicing and failure to promote best practice also apply to this Option. However, the separate identification of methadone treatment from other GP and psychiatric services provides greater opportunity to identify inappropriate practices, and hence reduce the potential for abuse.

  • The separate identification of methadone treatment from other health services may meet consumer opposition because of confidentiality and privacy concerns, notwithstanding the fact that the HIC provisions over privacy already protect these concerns. Nevertheless, consumer concerns may have to be addressed.

  • GPs would be required to differentiate methadone consultations from other medical services provided to methadone clients. However, given that there is no financial incentive to charge different rates for these services, the issue becomes one of ensuring that the methadone service items are adequately defined, and that practitioners are educated about their differences. These issues could be addressed through practitioner training as part of the quality assurance mechanisms proposed in this report.

  • The reduction in fees proposed for psychiatrists providing methadone treatment is likely to meet strong opposition from psychiatrists. This may have particular implications in Queensland and New South Wales where psychiatrists have a major role in the provision of methadone services in the private sector.
As a further variation of this approach, the number of services provided under the methadone service items in the CMBS could be capped to specified levels in a year. The treatment profile identified in Section 10.2 may be used as a guide to the appropriate levels. The relative advantages and disadvantages of this approach are similar to those applying to the client management model described below. History has shown that setting ceilings to service provision tends to set a level to which services converge, and in this regard this approach becomes similar to the level of services provided under a client management approach.
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