Decrease in funding a ‘turning point for general practices’

Morgan Liotta

15/10/2019 3:23:35 PM

A steady decline in bulk-billing rates can be attributed to under-funding and the cost of running a practice, experts told newsGP.

Fork in the road
Declining in bulk-billing rates can be attributed to under-funding and the cost of running a practice.

Data from the RACGP’s 2019 General Practice: Health of the Nation report shows growth in bulk-billing rates continues to slow in all areas outside of major cities of Australia since 2017–18.
Inner-regional areas saw a –0.1% decline, outer-regional areas –0.3%, remote areas –0.4%, and very remote areas –0.3%.
While statistics indicate that 86% of general practice services were bulk billed in 2018–19, Health of the Nation states that this does not represent the number of individual patients who are bulk billed or those who are bulk billed for all of their general practice care; for example, a patient who is bulk billed for some services and privately billed for another during a single GP visit, or patients with a chronic disease who are likely to receive more services due to being sicker.
This inflates the percentage of services bulk billed each year, but does not change the number of patients who are bulk billed each year.
Dr Michael Wright, Chair of the RACGP Expert Committee – Funding and Health System Reform (REC–FHSR), believes that lack of general practice funding is a key contributor to declining bulk-billing rates.
‘The figures this year suggest that GPs are less able to accept the Medicare rebate for full payment for patient services,’ he told newsGP.  
‘The costs of running a practice have continued to rise, while the Medicare freeze and low GP consultation rebates have meant that funding to support general practice services has decreased in real terms.’
Earlier this year, RACGP President Dr Harry Nespolon told newsGP that he was particularly concerned that fewer patients are bulk billed outside major cities, given people in rural areas are already experiencing worse health outcomes. 
Dr Sean Stevens, Chair RACGP Specific Interests Business of General Practice network, agrees that lack of funding presents issues in not only contributing to patient out-of-pocket costs, but also in running a practice that provides high-quality care.
‘The main cause [of declining bulk-billing rates] is the chronic under-funding of general practice,’ he told newsGP.
‘It’s just very difficult to run a quality practice and be able to bulk bill everybody.
‘Added to this you have the increasing burden of chronic and complex disease, which takes longer to deal with, and the remuneration for longer consultations is worse per hour.’

L–R: Dr Sean Stevens and Dr Michael Wright believe lack of funding presents issues in contributing to patient out-of-pocket costs, as well as running a practice that provides high-quality care.

GP owners surveyed for the 2019 Health of the Nation reported maintaining income as the biggest business challenge.
‘The only way many practice owners can maintain their income in the setting of rising costs and falling rebates is to start or increase private billing,’ he said.
Health of the Nation found that after maintaining income, work–life balance is of most concern to practice owners, who report facing challenges related to indirect costs associated with provision of high-quality care that is ‘unrecognised through current funding arrangements’.
Dr Wright believes that if general practice continues to be underfunded, patients will incur more out-of-pocket costs and practice ownership will be less appealing.
‘This looks like a turning point for general practices,’ he said.
‘After years of struggling to provide high-value care with low-value Medicare rebates, general practices are being left with no choice but to pass on increasing costs to our patients.

‘Without additional government funding for GP services, the need to pass on increasing costs to patients will grow.’

Health of Nation reports that 58% of GPs have no interest in becoming a practice owner, up from 53% in 2017.
Looking to the future of general practice business, Dr Stevens predicts the Federal Government will likely move towards using data to direct and monitor the care that GPs provide to better support the healthcare sector.
Technology use will also be increased, according to Dr Stevens, and building on data that 87% of GPs are now completely digital.
‘The smarter practices will start to look at alternative ways of generating income and will embrace newer technologies,’ Dr Steven said.
‘I think we’ll [also] see the trend for larger practices with economies of scale ... and an increasing trend towards patient enrolment, starting with the over-75s, but increasing from there.’
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Dr George Al-Horani   16/10/2019 8:56:19 AM

Good article shows our pain and struggling to be able to run a successful Medical Centre , but what’s more important!!!! ( What’s next ??!! ) .
Who does take these decisions to cut our funding ??!!
Who will fight for our rights ?
Our expenses keeps going higher and higher each year and funding keeps going lower and lower each year !
If you practice in a rich area .. that’s okay to start or increase your private billing !
But if your practice in a poor area then either you close your practice and all the patients load will end up at the local ED which is already struggling to cope ! Or keep your practice open in loss !!

The main problem we have is we as GPs keep working hard and always in the front line , but we have no real body to defend our rights .
Giving an opinion is something, but fighting for our rights is another thing .
We will just wait of a miracle to happen or may be for a GP to become a health minister and a decision maker ,one day , let’s pray for that .

Dr Peter Robert Bradley   16/10/2019 11:49:15 AM

What gets me is the mealy-mouthed mixed messages our representatives keep resorting to, like having a buck each way. For example...[President Dr Harry Nespolon told newsGP that he was particularly concerned that fewer patients are bulk billed outside major cities...and therefore experiencing worse health outcomes.]
This gives the impression the only concern is for the 'poor' patients, who can't afford a single dollar to contribute to their health care, when this is not so. The real reason is Govt. refusing to amend the one section in the Medicare act and allow GPs to just pass on a modest gap, whilst direct billing the rebates. That would solve it, but no..! Our leaders are so afraid they might be called greedy Drs, they won't tell the truth. While colleagues are saying "you have to drop bulk-billing (ie free service) to survive. The truth is, unless GPs charge a fee, the service will die. It is no longer a 'buck each way' deal..!

Dr Ayodele Ezekiel Ogunjobi   16/10/2019 12:08:30 PM

It's time GPs stop holding on to the feeding bottle called Medicare items and begin to understand that Medical Practice is a business just as others. We as GPs were not voted for by Australians and we should not be saddled with the burden to bear the brunt of unfavorable government policies.We buy medical consumables, pay staff, business loans and pay rents at market rates. We need to know our right-that we are not bound by Medicare items.Medicare items are for the patients and not for doctors, Let each GP charge for his service at current AMA rate. If the Government wants to cut funds and kill primary care, so be it. Let Human right activists/Politicians-and any interested GPs- take than on.

Dr Nell De Graaf   19/10/2019 7:16:39 AM

Bulk billing should only be a part of GP income and every patient should expect to pay a gap fee.This will lead to greater appreciation and respect for GP services.It is not possible or desirable for all GP services to be billed to Medicare.When a patient goes to see a specialist they dont expect to be bulk billed .When I go to buy petrol or groceries I dont expect the government to pay for them.
Healthcare is NOT “free” it is a part of normal life expenses.If people dont want to pay for GP services they are welcome to attend their local hospital and wait all day for it.....

Dr Paul Vernon Jenkinson   24/10/2019 2:18:24 AM

Oh for Heaven’s sake,charge what you think you are worth and let the customer complain to the insurer about the pitiful rebate!