Falling bulk billing rates a ‘sign of things to come’, RACGP warns

Anastasia Tsirtsakis

7/12/2022 3:42:26 PM

To avoid patients missing out on care, the college is calling for urgent action, with a funding boost for general practice top of the agenda.

A patient at the front desk, paying by card.
The quarterly bulk billing rate is down from 87% to 83.4%.

The number of Australians receiving care in general practice has continued to rise over the past 12 months, but so too have out-of-pocket expenses for patients.
The move away from bulk billing is seen in the Federal Government’s latest quarterly Medicare statistics (Q1 2022–23), revealing a quarterly bulk billing rate of 83.4% – down from 87%.
But RACGP President Dr Nicole Higgins fears the data underplays the true extent of the problem.
‘There is an important distinction between the proportion of GP services that are bulk billed and the proportion of patients who had all their GP consults bulk billed,’ Dr Higgins said.
‘So, for example, we know in the previous term of government there were claims that bulk billing was sitting at a healthy 88%. But a more critical look at the data revealed that the percentage of patients who had all their GP care bulk billed was sitting at just two-thirds nationally in 2020 and 2021. For some jurisdictions, the figure was much lower.’
Further to that, Dr Higgins notes that patients with complex health conditions that require regular appointments with their GP, such as asthma and diabetes, inflate the proportion of GP services that are bulk billed.
‘What all this means is that the statistics are even more alarming than you would initially assume,’ she said.
‘The reason for this is simple – Medicare rebates simply have not kept pace with the cost of providing high-quality patient care.
‘As a result, practices are under strain, and many are making the difficult but necessary decision to stop bulk billing some or all of their patients and move to a private or mixed billing model.’
The downward trend in bulk billing rates is also seen in the annual data, down from 88.8% in 2020–21 to 88.3% in 2021–22. When removing COVID-19 vaccination and telehealth services, the bulk billing rate is even lower at 83.9%.
More specifically, bulk billing of the standard Level B consultation saw a 2.5% drop compared to the previous financial year, while Level C and D had a 2.4% and 2.1% decline respectively.
The transition away from bulk billing has long been anticipated by the RACGP, with the sector significantly impacted by the rising costs of running a general practice yet still grappling with the effects of the six-year Medicare rebate freeze.
In a 2021 CommBank GP Insights Report, the majority of GPs surveyed noted an increase in general practice operating costs, from consumables (84%) and professional and business insurance (75%), to technology (72%), staff payroll (71%) and recruitment costs (63%).
Meanwhile, a recent report by the Australian Medical Association (AMA) also revealed the true state of poor indexation, with the Level B item number alone having been inadequately indexed by around $8.6 billion since 1993.
To address the issue and secure the long-term viability of general practice care, Dr Higgins says the RACGP is focused on positive solutions – starting with an urgent call on the Government to boost patient rebates.
‘This will enhance accessibility to GP care and, in the process, relieve pressure on the entire healthcare system including our under pressure hospitals and emergency departments,’ she said.
‘There is no point looking in the rear vision mirror. We know what the solutions are – it’s just a matter of making it happen.’
In the meantime, Dr Higgins is a member of the Government’s Strengthening Medicare Taskforce, which is developing recommendations to improve patient access to general practice and reduce pressure on hospitals.
‘I will work with the Government to find solutions that includes lifting Medicare patient rebates to a level that actually reflects the practicalities of providing care amid rising costs and an ageing population,’ she said.
‘Let’s work together, get this done, and make sure that no patients fall between the cracks of our health system.’
Boosting MBS patient rebates is one of a number of reforms that the college advocated for in its October 2022–23 Pre-Budget submission, including:

  • increasing Medicare rebates for longer consultations, and create a new Medicare item for GP consultations longer than 60 minutes
  • investing in rural and remote health by increasing incentives that recognise the unique role of rural-based GPs and encourage GPs to work in rural communities
  • supporting longer telehealth phone consultations lasting more than 20 minutes
  • introducing new service incentive payments to better care for older people, those with mental health conditions and people with disability
  • providing additional support for patients to see their GP within seven days of an unplanned hospital admission or emergency department presentation.
‘Action is needed now to get on top of this problem to ensure all patients can access the care they need when they need it from their regular GP,’ Dr Higgins said.
‘Or more and more patients will be required to pay out of pocket.’
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bulk billing funding MBS Medicare mixed billing

newsGP weekly poll Which of the below incentive amounts (paid annually) would be sufficient to encourage you to provide eight consultations and two care plans to a residential aged care patient per year?

newsGP weekly poll Which of the below incentive amounts (paid annually) would be sufficient to encourage you to provide eight consultations and two care plans to a residential aged care patient per year?



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