Corporate clinics report ‘remarkable’ shift away from bulk billing

Medicare bulk billing rates are likely closer to 61%, according to new statistics from the Primary Care Business Council (PCBC), a group representing the seven largest general practice operators in Australia.
 
The estimate, contained in a report in The Australian, was reached by collating all cases of a GP consultation lasting under 20 minutes (item 23) – the most billed item number – across all 500 of the clinics operated by the PCBC for the month of July.
 
This is a 12% decline from two years ago. At one of the analysed clinics the rate was just 36%.
 
The rate differs sharply from figures promoted by the previous Federal Government from March 2022, which reported the bulk-billing rate to be 88% but aligns more closely with previous reporting from newsGP, which pointed out that only 67.6% of patients had all GP services bulk billed in 2021–22.
 
For RACGP President Adjunct Professor Karen Price, the PCBC figures provide more evidence that bulk-billing rates are ‘not what they seem’.
 
‘Bulk-billing rates are in free fall and without urgent action some patients will be left behind,’ she said.
 
‘The figures are skewed because there are some patients with multiple, complex issues who see their GP again and again for different types of health problems and this inflates the proportion of GP services that are bulk billed.
 
‘In addition, practices are required to bulk bill COVID-19 vaccination services and for much of 2020 some patients, including children and concession card holders, were bulk billed for every single telehealth consult.’
 
Meanwhile, Federal Health Minister Mark Butler, who is also Chair of the newly-created Strengthening Medicare Taskforce, told The Australian he is particularly concerned at anecdotal reports that some pensioners are now being charged gap fees.
 
‘What we’ve had for the last several years is very much a sugar-coating of what’s happening in primary care, and particularly in general practice,’ he said.
 
‘It just doesn’t gel at all with what patients and increasingly doctors are telling us about what’s happening on the ground.’
 
The RACGP’s position regarding bulk billing is that current Medicare rebates are too low, unsustainable and do not reflect the cost of providing healthcare, and Professor Price agrees that previous governments have ‘sugar-coated’ the state of primary healthcare.
 
‘In reality, many people are finding it more and more difficult to find a bulk-billing GP,’ she said.
 
‘This will have significant consequences for the health and wellbeing of many patients nationwide.’
 
A contributing factor for Dr Mansi Patel, a GP and clinic owner in Melbourne, is that costs for most things have risen substantially over the past two years.
 
‘Wages are going up, superannuation goes up, entitlements to staff continue to increase and the cost of consumables has grown a lot,’ she told newsGP.
 
‘Saline and chlorhexidine are about three times what they used to be. Gloves have gone up by over triple the price.
 
‘Without mask mandates, patients don’t think to come to the clinic with one but we still have to enforce their use in clinic. So we give patients masks and that’s another cost.’
 
But even though the pandemic has added increased pressure on general practices, the underfunding of primary care is a long-term issue that was impact bulk-billing rates even prior to the arrival of COVID-19.
 
Jeremy Stones, CEO of Better Medical – a PCBC member that operates 80 general practices in South Australia, Queensland, Victoria and Tasmania – told newsGP that more than one in four patients treated by clinics in the Council were not being bulk billed as far back as 2018–19.
 
However, a key difference now is that the shift towards mixed billing appears to be gathering pace.
 
‘PCBC encompasses every state and territory, inner metro, outer metro … [and] up to this point, it had been income earners who could afford to pay fees. But now, more and more we are seeing concession card holders and pensioners being charged,’ he said.
 
‘Yes they’re still discounted, but even that’s necessary for practice viability. The sentiment is … that the trend will continue and accelerate.
 
‘The speed of change of has been remarkable.’
 
And it is not just large corporate practices that are moving more towards mixed billing. Dr Patel’s Southbank clinic, which she owns with her husband, has also had to adjust.
 
‘We increased our gap in July because it’s unsustainable,’ she said. ‘As practice owners, we have taken a pay cut these last two years.
 
‘I’ve also noticed other bulk-billing clinics in the area now charging patients.’
 
Without more support for general practice, Professor Price says the rest of the healthcare system will also come under increasing pressure.
 
‘Unless greater investment is made in general practice care, more and more practices will have little choice but to pass the cost on to patients,’ she said.
 
‘This can result in patients delaying or avoiding consultations with their GP and having a health condition worsen to the extent that they end up in a hospital bed.
 
‘When this is replicated in communities across Australia, particularly in rural and remote areas, the health of the nation suffers.’
 
The other concern about underfunding primary care is the effect on medical students and would-be GPs, who may shun general practice due to overworked conditions and lower pay compared to other specialities.
 
‘Urgent action is needed,’ Professor Price said. ‘And that includes greater investment in general practice care.’
 
Log in below to join the conversation.
 

bulk billing item 23 Medicare mixed billing