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Bulk-billing incentives for non-GP specialists on the table
The Government proposal to help address ‘excessive’ fees also considers nudge letters, fee caps on MBS items, and greater transparency.
The issue of rising medical costs for non-GP specialists has been in the spotlight in recent months.
Beefed-up bulk-billing incentive payments for non-GP specialists are among the options under consideration as the Government sets out possible ways to tackle what it deems as ‘excessive’ specialist fees.
A Department of Health, Disability and Ageing (DoHDA) consultation paper includes a range of actions it suggests could be used to help keep costs down for patients, with authors also outlining the proposed policies’ potential risks.
Launched this week, the paper says there is ‘significant community concern’ about increasing healthcare costs, particularly for non-GP specialists, and says these concerns ‘are reflected in Medicare data’.
‘In 2025, Australians spent $4.17 billion out-of-pocket on out-of-hospital specialist services, an increase of 75.8% since 2019,’ the authors state.
It says the outcome of the consultation ‘will inform our development of methods to identify “excessive” fees for specialist medical services, and identify opportunities for intervention to protect patients’.
Six possibilities are mooted for intervention:
- enhance fee transparency
- nudge letters to notify providers about billing practice concerns
- peer assessment
- fee caps for items under the MBS
- potential to consider aggregate billings to determine if average billings are excessive
- practice incentive payments alongside bulk-billing incentives to encourage lower out-of-pocket fees.
The paper notes that adopting a similar incentive approach to the tripled bulk billing incentive introduced across general practice ‘would require significantly more investment to achieve the same outcomes’.
The consultation, which is open until 19 October, also notes several potential risks linked to government intervention, including that providers could leave Medicare altogether, as well as reduce their level of bulk billing.
The issue of excessive fees has become a familiar theme in this term of Government, with Federal Health and Ageing Minister Mark Butler citing it as one of his top priorities.
RACGP President Dr Michael Wright stressed the importance of transparency, as well as accessible patient care.
‘It’s really important that patients are able to access the care they need and that it’s affordable and high quality,’ he told
newsGP.
‘Transparency is also needed for knowing when people can be referred to public outpatient clinics.
‘Many GPs say they’re having trouble referring patients to those, and in their absence, it’s placing extra demand on private specialists.’
In its consultation paper, DoHDA acknowledges ‘challenges in implementing any measures to address excessive fees’.
‘These include that there may be reasons to explain what may otherwise look like excessive fee charging,’ it states.
‘This could include clinical complexity reasons in relation to a particular service, the way services have been billed in a particular case (eg: fees for multiple items billed against one item).
‘This will be taken into account in considering an appropriate regulatory model and approach.’
The MBS items deemed ‘in scope’ for the consultation include specialist attendances, obstetrics, anaesthetics, pathology tests, diagnostic imaging, operations, radiotherapy and therapeutic nuclear medicine, as well as other miscellaneous MBS services.
Medicare services GPs carry out are also among them, with the paper noting some procedural MBS items ‘can be delivered by several eligible specialist types, general practitioners, and other eligible health providers’.
In March this year, the Council of Presidents of Medical Colleges – a group that includes the RACGP – issued a
shared national framework for ethical billing, fee transparency and informed financial consent.
The Federal Government recently closed a separate consultation considering how to improve fee transparency, with the RACGP criticising several options as likely to have an adverse effect on general practice.
Five of six options
proposed by the Government to address ‘bill shock’ rely ‘primarily on expanded regulatory, compliance or enforcement mechanisms,’ the college warned.
A related Government consultation looking into ‘Modernising Referral Pathways’ closed in March.
Earlier this year, the Government introduced legislation designed to ensure non-GP specialist fees could be listed by default on a revamped
Medical Costs Finder website.
Meanwhile a
House of Representatives inquiry ‘into access and affordability of medical specialists’ is currently underway and accepting submissions until 16 October.
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