GPs forced to turn away Veteran Card holders due to low rebates: RACGP

GPs are becoming increasingly unable to accept Veteran Cards due to insufficient rebates that are failing to keep up with the cost of patient care, according to a new RACGP submission.
 
While the college is ‘very supportive’ of the Coordinated Veterans’ Care (CVC) program, it stated that ‘refusal of Veteran Cards will continue’ if indexation of the Department of Veteran Affairs (DVA) fee schedule is not increased.
 
Under the program, GPs can receive a fee that is 115% of the normal MBS item rebate for the equivalent service. In return for the higher rates, they are unable to charge DVA clients a gap fee.
 
But with practices increasingly relying on mixed billing to stay afloat due to poor indexation, the college says even the higher fees associated with the program are not enough to make up the shortfall.
 
The submission also addressed a lack of education and awareness among GPs regarding the program, as well as the complex bureaucratic processes that lead some eligible veterans to give up on accessing the service.
 
RACGP Vice President Associate Professor Michael Clements, a Townsville-based GP and veteran of the Royal Australian Airforce, said a lot of GPs are not familiar with all of the various DVA programs, funding models and codes as they may only manage a small number of veterans.
 
‘If they are not dealing with veterans regularly then they may not be up to date,’ he told newsGP.
 
‘I do think there is a need for practices to learn and understand how to look after our veterans.’
 
Meanwhile, RACGP President Dr Nicole Higgins said simple changes to the CVC would improve access to care for more veterans.
 
‘It’s crucial that returning veterans get the care and support they need throughout their lives, and general practice is at the heart of coordinated care, and any support work,’ she said.
 
‘The indexation of the DVA schedule is too low and doesn’t come close to the cost of providing care, which means some practices are unable to accept Veteran Cards. This needs to be addressed urgently to improve access to care.
 
‘We’re also recommending DVA introduce a GP awareness campaign to promote the program … [and] improve access to care for patients who need it.’
 
In response to questions regarding greater indexation of rebates, a DVA spokesperson said GPs can already claim a supplementary Veteran Access Payment for services delivered to DVA clients, which received a $33.3 million boost over four years in last year’s Federal Budget.
 
‘From 1 November 2023, the total payment for a GP consultation of up to 20 minutes [Level B] plus the … VAP increased from $55.45 to $71.90 in metropolitan areas and from $62.85 to $94.30 in the most remote areas of Australia,’ they told newsGP.
 
‘In addition to this investment, the 2023–24 Budget also made changes to indexation arrangements to better align with wages and prices movements.
 
‘On 1 July 2023, DVA fees for medical practitioners were indexed by 3.6%, with another one-off fee indexation of 0.5% on 1 November 2023.’
 
The spokesperson also said the DVA is working to simplify its processes to make it easier for veterans to access support.
 
‘This includes the current process to harmonise and simplify the legislative framework, moving from three Acts to one ongoing Act,’ they said.
 
‘We are currently consulting with the veteran community about this draft legislation and we encourage all veterans, and interested stakeholders, to have their say. Consultation is open until 28 April.’
 
Despite the access challenges, more than 35,000 GPs provided over 1.4 million services to 145,178 Veteran Card holders in 2022–23, and Associate Professor Clements said parts of the veterans’ care program ‘really do go above and beyond what there is in standard Medicare’.
 
‘We absolutely use the CVC as a routine part of our care model for our patients,’ he said.
 
However, the program does not include White Card holders and veterans aged over 50 with a chronic health condition that is not a mental health condition – a restriction Associate Professor Clements believes should be reconsidered.
 
‘Many [veterans] may have chronic conditions that may or may not be service-related as they age,’ he said.
 
‘At the moment aged care residents who are veterans are excluded from CVC and we do know that many of our veterans are finding it hard to find a GP to take them on in an aged care facility.
 
‘So expanding the CVC program to include residents of aged care would likely see an immediate boost in the number of these veterans finding a GP that is going to look after them.’
 
The DVA spokesperson said the ongoing evaluation will assess the benefits, including clinical outcomes and wellbeing impacts, of the CVC Program for Gold Card holders with a chronic condition and White Card holders with an accepted mental health condition.
 
‘Evaluation will also explore options to redesign the CVC Program to better meet the chronic disease management and mental health needs of current and future DVA clients,’ they said.
 
‘Consultation … has already occurred with a wide range of stakeholders.
 
‘Findings from this evaluation will inform future program improvements.’
 
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