Bulk-billing changes are coming into effect tomorrow — what does it mean for you?
Clinics who are registered with the government’s new program will display signs like this. (ABC News: Billy Cooper)
Source : .abc.net.au
From tomorrow, you may find it easier to see a GP for free.
From November 1, new incentives come into effect to encourage doctors to bulk-bill for every visit.
It’s a historic $7.9 billion government investment into Medicare and designed to resuscitate bulk-billing, which has been on the decline since the pandemic.
But the scheme is not compulsory and many doctors have told the ABC they will not be signing up.
Let’s look at what this all means.
What exactly is changing?
Right now, GPs get a financial incentive from the government every time they bulk-bill a concession card holder or child under the age of 16.
The incentive for a standard appointment (6 to 19 minutes) is $21.85 for a doctor in a metropolitan area but is even higher if you’re in a regional or remote area.
This is now being expanded so GPs will receive that incentive payment when they bulk-bill any patient.
The incentive does not apply to everything you may see a GP for, so don’t be surprised if there’s still an out-pocket-fee for services like procedures.
It is applied to what’s known as “eligible services”, which include short, standard and long appointments.
There’s also a new program being launched which medical practices can register for to get even more incentives.
The government will reward clinics where every doctor bulk-bills every patient for those “eligible services”.
Those who meet the criteria will receive a 12.5 per cent incentive payment on every dollar they earn through Medicare, which will be distributed quarterly and split between clinics and doctors.
Which GPs will start bulk-billing all patients?
Patients can check if a GP will be fully bulk-billing by visiting the doctor’s Healthdirect profile — GPs must update this within 24 hours of signing up to the government program.
There are around 6,500 GP clinics nationwide and 1,600 are currently fully bulk-billing.
Another 1,000 mixed billing practices (which use bulk-billing and private billing) have indicated they will switch to full bulk-billing from tomorrow.
ForHealth is the second-largest general practice provider in Australia and seven in 10 of its clinics will convert to bulk-billing practices.
CEO Andrew Cohen said it took a bit of work to convince some GPs to make the commitment, but the incentives meant bulk-billing was a viable business model again.
ForHealth’s core business operates in low socio-economic and regional areas where there are already high levels of bulk-billing so it’s a modest change for high financial reward.
The response from patients has been emotional, Mr Cohen said
“We’ve already had patients cry at reception … just a lot of relief.”
Ochre Health is another corporate medical group with clinics across Australia and currently 20 per cent of its practices are fully bulk-billing.
After tomorrow, 50 per cent will switch over.
“It will be a gradual thing … we won’t land there on the first of November but I think we’ll end up there,” co-founder Hamish Meldrum said.
‘This is about patients’
GP Mark Fitzmaurice runs a medical centre in Sydney’s northern suburbs and for 24 years it has bulk-billed every service, including procedures.
But in the last year, operational costs soared and Mr Fitzmaurice had doubts about the viability of the model.
“I’ve resisted, but it’s been hard to resist moving to mixed billing.”
Dr Mark Fitzmaurice says patients have a lot to lose if their doctor does not implement the scheme. (ABC News: Billy Cooper)
This incentive package means the clinic will be able to continue bulk-billing every service as each doctor will bring in an extra $1,000 a week.
He is strongly urging other doctors to give it a chance.
“I know it’s complicated, so I spent hours doing the calculations … and it’s the patients who really suffer if you don’t swap over.”
Dr Fitzmaurice said a mixed-billing doctor with standard fees would lose around $70 a day if they started bulk-billing everyone but the roughly 46 patients they would see in a day would be out-of-pocket a combined total of $500 under the mixed billing model.
And the government is “the big winner” as they would not have to pay $450 of incentives to that doctor, he said.
Dr Fitzmaurice said doctors should be wary of some rhetoric around the scheme including that it devalues GPs or makes them beholden to the government.
“This isn’t the government tricking us … this is about patients and their welfare — it can’t be that they can only see a doctor when they can afford it.”
Dr Mark Fitzmaurice says the changes mean more people can see their doctor for preventative health care, not just when something is wrong.
However, he said signing up to the program was “unnecessarily” complex and time-consuming.
He said the government needed to urgently streamline the process to encourage more clinics.
Why some GPs aren’t changing
Some doctors say the incentives will not offset the cost of bulk-billing every patient and their bottom line will suffer.
Matthias and Lauren Ranaweera own The Gympie Clinic in the Wide-Bay Burnett region of Queensland, which is a mixed-billing practice.
The couple say 100 per cent bulk-billing would mean the practice loses hundreds of thousands of dollars a year.
Husband-and-wife team Matthias and Lauren Ranaweera say they can not provide good care if they are forced to shut their doors. (ABC News: Paige Cockburn)
“If we lose that money it means losing a number of staff, so who would you like us to say goodbye to?” asked Ms Ranaweera, who leads the administrative side of the clinic.
Dr Ranaweera feels the government’s scheme devalues the work GPs do.
“It’s not just seeing a patient and sorting out one problem — it’s managing their health for the entirety of their life, it’s visiting the aged care facility, it’s organising multi-disciplinary care, it’s training registrars so GPs stay in the community,” he said.
“The government is saying, ‘This is the value we put on you and your service’ but I don’t agree with that value.”
The clinic already bulk-bills around 65 per cent of patients but the doctors are worried everyone will now expect it and there will be confrontations with frontline reception staff.
“People will come in and say, ‘The prime minister told me all I need is my Medicare card’ but that’s not how it’s going to work for us, unfortunately,” Ms Ranaweera said.
“The sentiment is that if you don’t bulk-bill you’re greedy, but that has to change,” Dr Ranaweera said.
Did doctors want this?
The Royal Australian College of GPs (RACGP) did not lobby the government for this policy, instead they wanted higher rebates for longer appointments to support GPs who were seeing more complex presentations each year.
President Michael Wright said the government’s investment in bulk-billing would mostly help clinics already 100 per cent bulk-billing or those in regional and rural areas, but others were more cautious.
“After a near decade-long Medicare freeze and years of chronic underfunding, many GPs are nervous about switching back to a system that once again makes them 100 per cent reliant on government funding decisions,” he said.
“For these GPs, this decision is fundamentally a trust issue, not just a financial one.”
Dr Ranaweera said he was worried future governments might freeze Medicare rebates as they did between 2013 and 2017, and his clinic would then have to opt out of the bulk-billing scheme, creating confusion for patients.
Will this work?
There will likely be an immediate uptick in the bulk-billing rate post-November 1, but the government has accepted it may take four years to get widespread uptake.
Government modelling estimates that around 4,800 clinics will be financially better off if they become fully bulk-billing and around 3,600 practices will sign up over the first two years.
The government is also banking on community pressure to get more uptake.
Clinics that sign up must publicly promote their participation in the scheme with signage on their doors, so it will be obvious which doctors are not taking part.
This may prompt questions from patients wondering why they are still paying a fee.
“I think general practices will start to see that the practice down the road or around the corner has moved to fully bulk-billing, and they take that more seriously themselves,” Health Minister Mark Butler said earlier this week.
Mr Butler said he remains “confident” the government can get nine out of 10 GP appointments bulk-billed by 2030.
