‘Not viable’: GPs’ ‘sadness’ at ending bulk billing of veterans

Owners of a GP clinic that is no longer accepting the Department of Veterans’ Affairs’ (DVA) rebate as payment have said their decision is a ‘sad’ necessity due to long-term underfunding.
 
Dr Melian Deery is a GP and co-owner of the YourGP clinic in Canberra, along with her GP husband Dr John Deery.
 
The practice recently informed Veteran White Card holders that they will be charged full fees, given a backdrop of unsustainable increases in practice costs, with inflation far out-stripping rises to Medicare and DVA rebates.
 
Dr Deery told newsGP it was a difficult move.
 
‘It was a big decision to make and made under significant financial pressure,’ she said.
 
‘It was 100% about financial viability. It was not a decision we took lightly; we considered it carefully over six months.’
 
The clinic’s decision and the potential impact on veterans has had wide coverage, with one health analyst suggesting this week that the decision might be politically driven.
 
‘Given the veterans benefit is 15% higher than the benefit for concessional cardholders, and 35% higher than an ordinary punter being bulk billed, it is hard to see why GPs would stop charging vets under the DVA arrangements – other than to make a political point,’ Charles Maskell-Knight, a former senior public servant in the Department of Health, told The Guardian.
 
However Dr Deery says that the clinics she and her husband run have around 600 veterans registered as patients across three practices, and that it was a move they would rather not have made.
 
‘We greatly value our veterans,’ she said.
 
‘One of the sadnesses to me was that veterans might not understand and may feel under-supported by the community they have served.
 
‘This decision is driven by government underfunding of veteran care.’
 
For GP and former Army Major Dr Kerry Summerscales, the inference of political motivation is both unfair and unwelcome.
 
‘I find those comments to be highly, not only irresponsible, but offensive,’ she told newsGP.
 
‘I am sick and tired of the GP bashing. We are actually trying our best.’
 
The Mackay-based GP, 90% of whose patients are veterans, says she will continue to accept the DVA incentive payment, but that it is coming at a cost to the practice as a whole.
 
‘We’ve had long, hard discussions about how this will impact and how we can actually cover that,’ Dr Summerscales said.
 
‘It is a personal decision of mine, and the practice has been gracious enough to absorb the cost of that.
 
‘Yes, it does mean that my personal income is less, but then I’m not being reduced to eating noodles and I also do have a military pension as well.
 
‘From a practice point of view, it’s not feasible and it’s not viable.’
 
Dr Summerscales also highlights the administrative burden of working with the DVA, and says she backs and understands clinics who make the same decision as the YourGP clinic in Canberra.
 
She remains concerned that the collection of valuable information about veterans’ health will be disrupted if bulk billing patterns shift.
 
In an email sent by the YourGP clinic to patients, the practice owners acknowledged that the change ‘will come as a shock’.
 
‘We wish to assure you that this change in billing is being implemented reluctantly, and with sadness, due to the financial necessities of running a small business,’ the email reads.
 
Along with Medicare rebates, DVA rebates have been frozen for much of the past decade. In its email, the YourGP clinic says the reimbursement currently covers less than half of the cost of their standard fees.
 
‘DVA payments are based on a model that financially penalises doctors for spending more time with patients,’ the email reads.
 
‘The more time your GP spends with you, the less they are paid per hour. This devalues the time spent when providing care for complex consults that many veterans need, especially for mental health conditions.
 
‘We believe that veterans deserve gold-standard medical care.’

The owners told patients that if finances are a concern, they could discuss eligibility for a care plan with their GP – and that the clinic would waive transfer fees if veterans made the decision to move to a different general practice.
 
Patients were also encouraged to write to their local federal member of parliament to raise the issue or contact the DVA to discuss payment of a gap fee.
 
‘Both major parties have been complicit in the underfunding of your care,’ the practice stated in the email.

‘GPs have been campaigning to raise patient rebates for years with no results. Only when MPs feel pressure on this issue will there be change.’
 
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