Medicare review: Have Your Say

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A review of Medicare is underway, giving you an opportunity to have your say about access to psychological care in the system. To make this easy I have assembled some basic points you can use to strengthen your message. Thousands of people support the Alliance for Better Access. Some people are fully behind us whereas others only want to see some of the changes we are asking for. I think that’s a great thing and shows what a diverse group we are. With that in mind, we have separated out each area for change. That way we can all join together to make the system fairer without working against one another.

The following sections give you an overview of each area of mental health care we want to change in the Medicare system. It is really important to share your own distinctive view in these Government submissions, because cut-and-paste replies tend to get binned. Under each heading we explain why we recommend these changes and show you which section of the survey is relevant to those issues. I have suggested some ideas on what your response in those sections could include. At the end there’s a link that will take you to the survey.

Remove Excessive GP Visits

Under the current system you need a GP referral to start getting help. That’s fine if the first person you speak to is a GP. But at the same time, if someone books in to see a mental health professional first that shouldn’t put them at a disadvantage. We want to see a system where there is no wrong door to start getting help. The other problem is that Medicare currently requires people to keep going back to their GP every few sessions to review their mental health care plan. There is often not a great deal to report after 6 visits, which is no failing on the part of the therapist or the client. Bouncing backwards and forwards between the GP and therapist is a hassle for clients and a needless drain on Medicare. The Alliance for Better Access has proposed a model for change to streamline the system (please take a look).

Which Section?
The second question in the survey asks whether you, or someone you know, has ever had a consultation, medical procedure or test you thought was unnecessary. In that section, tell them what you think of being made to see a GP for a referral before you can access psychological care. You can also talk about any problems you’ve experience (such as disrupted therapy) with going backwards and forwards between your GP and therapist. If you support our model of care then please say so in your response.

 

Remove Diagnostic Red-Tape

The current system requires your GP to generate a ‘mental health care plan’, diagnosing you with a mental disorder. Some people refuse to seek help because they are afraid of being labelled with a diagnosis of mental illness. You do not need a formal diagnosis to receive Medicare support for other common medical conditions, so why have that barrier in mental health care? If we are going to improve the Medicare system, then access to preventative care should be available in mental health care. We note that the recently published findings of the Royal Commission into Institutional Responses to Child Sexual Abuse (here) calls for the removal of the current Medicare rule which requires ‘an assessed mental disorder’ before psychological help is made available. We believe the same basis for that decision, around shame and the reality of mental health stigma, stop many people from reaching out for help when they need it. Another aspect of this problem is the suggestion that symptom severity alone should determine the number of sessions you can access. We know from decades of research that there are many factors, besides symptom severity, which contribute to the rate of recovery.

Which Section?
The survey asks whether you have ever had difficulties with Medicare ‘rules’. That section is a good place to tell them about your experience of having to get a diagnostic label before help was offered or having to pass tests in order to get support for more appointments. Is there a better way to structure the system? Tell them how you think the system should look and whether our model would be a better approach.

 

Increase Number of Visits Covered

The evidence from research is clear. We need to offer at least 15 to 20 visits of psychological care for the majority of people to improve from common mental health disorders, like depression, anxiety, and PTSD – and some people will need considerably more than 20 appointments too. Whether we look at randomised clinical trials (RCTs), or dose-response studies, or manualised treatment guides for specific mental health disorders, we find essentially the same results over and over again (here’s a quick summary). Ten sessions are not enough for most people to reach a stable point of recovery. By comparison, the Medicare system currently offers 50 sessions of psychiatric care, which is more focused on medical treatment. Our system should be equally supportive of medical and psychological treatment options.

Which Section?
Once again, the section about Medicare ‘rules’ is the best place to leave your comments, as it specifically highlights limits on “the number of times you can access certain Medicare services in a year”. I would strongly encourage you to refer to our summary to reinforce your view, as it contains a lot of useful resources from the research. It may also be helpful to quote the letter we received from Professor Aaron T. Beck, who invented cognitive behaviour therapy (CBT), stating that “up to 24 visits and possibly more” is the optimum treatment for depression.

 

One Medicare refund for psychological care

In the current Medicare system, a patient receives less support if their preferred therapist is not a clinical psychologist. There are many different kinds of highly skilled and experienced mental health professionals available in Australia and patients deserve fair and consistent support when they seek help. I should add that there are in fact a multitude of different post-graduate qualifications (i.e., Masters, PhD, and Doctorates) offering expertise in mental health care, besides clinical psychology. In principle, Medicare support should be equitable for patients who see any suitably qualified therapist who delivers the same service. We need a system which values each individual’s right to seek mental health care from a professional they trust.

We should not automatically assume that having one Medicare item for psychological care will reduce support for clinical psychology. There are in fact three possibilities:

  1. An MBS refund of around $85 per visit for all patients (decrease refund for clinical psychology items)
  2. An MBS refund of around $125 per visit for all patients (increase refund for other psychology items)
  3. An MBS refund of around $100 per visit for all patients (meeting somewhere in the middle)

The Alliance for Better Access is squarely focused on the needs of people seeking care. We want to see a system where the Medicare support you receive for psychological care is fair, consistent, and equal. Your choice of mental health professional should not be skewed by financial concerns. If you agree with us on that point, then please consider joining with us in recommending a single rebate at a level of support you think is reasonable.

Which Section?
The first question in the survey asks about parts of the Medicare system that have “worked well or not worked well”. I suggest using that question to explain how the different levels of Medicare support have affected your access to psychological treatment. Explain how the smaller rebate has impacted on therapy decisions, such as how often you make appointments and how many sessions you can afford. If you have been forced to stop receiving psychological care due to financial concerns, express that in the survey. If you have a story about how the different rates of Medicare support has influenced your choice of mental health care professional, then please share that story in your response.

When you are ready, click the button below to proceed (link opens new tab at Department of Health website).

MENTAL HEALTH PROFESSIONALS (Please take note): Make sure you carefully read the consultation overview before you proceed. In particular, I draw your attention to the section on the ‘Principles of Medicare’ which state “Medicare is a system for the payment of patient benefits, not a remuneration system for doctors.” Let’s all stay focused on the wider public need. Cheers.

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This is at times a highly charged topic and comments on this thread are moderated. If you are speaking as a mental health care professional please identify yourself to maintain ethical standards and professional respect for one another. I would like to keep the discussion positive and focused on improving the system to benefit people accessing care. Thank you in advance. 

  • Frank Breuer, Clinical Psychol

    I agree with one fee for experienced psychologist (whether clinical or not) but I suggest to raise the bar to become a Medicare provider. From my experience in peer and professional supervision I am firmly convinced that a registered psychologist in the first couple of years is not adequately equipped to work autonomously and responsibly in private practice (or Medical Centres). Hence, Medicare providers should be experienced psychologists only with a minimum of 3-5 years of full time experience. This would also help the profession to have a clearer quality focused profile as clinicians and we would appear more united to the public. In addition it could help reduce competition amongst psychologists, which may help to reduce practice overheads such as marketing costs. Newly registered psychologist should still be able to gain experience in private Practice but then under supervision and a different rebate arrangement.

    • betteraccess

      I have thought the same from time to time. Now that I think of your suggestion, I wonder if those 3 years of full time experience could be gained in other settings, rather than strictly needing to be in private practice per se? The other idea which comes to mind is to have a different funding arrangement (i.e., not Medicare) to support the work of newly graduated therapists as they develop skills in private practice under those first few years under supervision. Contracted funding arrangements similar to ATAPS might be a better option for those new practitioners, avoiding confusion with the general Medicare system. One of the big advantages of having a single Medicare rebate for psychological care is that the public knows what to expect. A knock on effect would be that the public can then very easily compare gap-fees before they begin therapy.

  • Ian William Harrison Macrae

    My Partner has just changed her GP and is now close to changing her Clinical Psychologist. No other reason exists apart from either retirement or a change of geo-location for both of the above. Apart from a GP and Clinical Psychologist, she has a fortnightly relationship with her Psychiatrist, Chemist and Mental Health Nurse. She has me too. We’ve been one of the lucky ones. My partner was a highly talented professional but her last 4 month visit to a Mental Health Unit was horrifically traumatic for her. I did the best I could and for us; thank heavens no ECT was provided. We pay a great deal of money for her needs and obviously, stability is all. We’ve been warned that if she does enter another “psychotic” state, she may well not recover ever again. We’re probably the working poor. I see no reason for evidence based Psychological care to not be available to all, but from our POV, we do have care. However, we’ve had to endure an enormous monetary cost because of our circumstances, and we’re not wealthy.