Corporate clinics report ‘remarkable’ shift away from bulk billing

Filip Vukasin

15/08/2022 5:18:23 PM

As few as six in 10 patients are receiving free healthcare at Australia’s largest general practice providers, the latest figures suggest.

Patient paying for a consultation.
At one of the surveyed clinics, only 36% of item 23 consultations were bulk billed during July 2022.

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.’
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Dr Naomi Ruth Fraser   16/08/2022 7:57:28 AM

I am the only fully bulk billing GP in our clinic. My choice. My patient group are mostly low socioeconomic and elderly ( home visits and nursing home visits ) I love my work but it gets harder every year. We will not attract doctors to train as GP’s if the ‘fix’ in Medicare rebate involves even more paperwork - I am tempted to retrain as a pharmacist. That way I can diagnose, prescribe and dispense with out the onerous paperwork trail or responsibility. Mishaps will just present to the hospital for sorting out (there won’t be any gp’s left to pick up the pieces at this current rate!)

Dr Gardiyawasam Lindamulage Chaminda De Silva   16/08/2022 8:11:31 AM

Not only rise of the cost of running practices . No shows are also major concern. Some patients do not care to cancel their appointments booked if they are unable to attend . This has be come major issue . Last year along no shows cost our clinic over 100,000 dollars . Now we have to change our policy to charge cancellation fee.

Dr Daniel Petrus Jacobus Bothma   16/08/2022 9:04:17 AM

Your sub-heading stating "free healthcare" is grossly misleading. It is NOT free. It is paid for by tax dollars, and poorly spent tax dollars at that. 85% of medical services are provided in the community setting, yet only 15% of the annual health budget is directed here. The vast majority of the health budget is given to the bloated hospital where there is an excessive number of useless burocrats stifling good medical care.
I also believe it is far better when a direct financial relationship exists between the doctor and patient. It (usually) leads to an improved quality of care, and greater emphasis on patient-centred model of care. When you get your payment from a third party it can lead to a situation where patients become numbers. And care becomes a burden. The increasing number of young(er) physicians having burnout and wanting to leave the profession is a stark indication of this failure of the current financial model. In my humble (yet honest) opinion.

Dr Susan Margaret McDonald   16/08/2022 4:32:38 PM

It is not the responsibility of GP's to subsidise the primary care of Australians. When we bulk bill we do that from our own pockets. When I started general practice 40 years ago
80% of patients paid and 20% were on old age pensions. Now 80% of our patients are on cards and the 20% private can no longer carry the ones we get 55% of our fee for.
I now charge under 75's $60 and they have a $20 gap. I say if they don't pay the practice will have to close. Their choice!

Dr Megan Elisabeth Barrett   16/08/2022 7:43:33 PM

Good patient care means taking time. Werent we trained to let the patient speak for the first 90 seconds? Even a simple medical certificate can be a chance to discover an underlying problem or gain rapport or remind of some upcoming preventative health. Remember Murtagh's "is the patient trying to tell me something?". Often those things come at the end of the appointment once trust has been obtained. If I see 4 people an hour and bulk bill them all I will bill $160 per hour, of which 62% will go to the practice and some will go towards insurance and registration. That leaves about $90 per hour but that does not include all the unpaid time we spend doing paperwork. It also doesn't include superannuation or sick pay or holiday pay. I agree that some people do need to have bulk billed primary health care but also have to support my family as the primary income. My answer was to get a job in a hospital where I am paid by the hour and don't have to compromise patient care.

BM   20/08/2022 8:13:18 AM

The entire issue is completely misled by data expressed as oranges when it is apples. That is, episode rates are expressed and reported like they are patient based rates. I believe that if data is expressed as patient based rates for those who are fully bulk billing, then the percentages will plumet. Increases in Public Medical Insurance rebates started to fall behind CPI 37 years ago!!!