GPs’ red tape warning over proposed ‘bill shock’ reforms

As the Federal Government weighs up how to improve fee transparency, the RACGP says several options on the table may adversely affect general practice.
 
In response to six options put forward by the Government to reduce ‘bill shock’, the college says five ‘rely primarily on expanded regulatory, compliance or enforcement mechanisms’.
 
These approaches would increase red tape but not address ‘underlying challenges associated with informed financial consent’, the RACGP said.
 
Among the options set out in a Government consultation paper is the potential beefing up of the Professional Services Review or the Department of Health, Disability and Ageing’s compliance branch to enforce informed financial consent obligations.
 
Further alternatives include expanding the powers of the Australian Health Practitioner Regulation Agency or the Australian Competition and Consumer Commission – or setting up a new regulator altogether.
 
The RACGP, however, says those proposals ‘risk increasing administrative burden on general practice’ as well as potentially ‘diverting time and resources away from patient care, increasing workforce pressures, and undermining general practice viability’.
 
‘General practices should not be expected to assume responsibility for communicating costs associated with services delivered by other providers, nor should it be burdened by compliance requirements that are not consistently applied across the wider healthcare system,’ the college states.
 
Instead, the RACGP has expressed conditional support for a sixth option, which would avoid any extra legislation and instead focus on education, guidance and voluntary compliance.
 
‘Improving awareness and understanding of existing requirements will better support informed financial consent, improve transparency for patients and reduce the risk of non-compliant billing practices, while avoiding unnecessary administrative burden on general practice,’ it said.
 
However, the RACGP said efforts should be made to ensure cost information is ‘contextualised and accurately reflects the factors influencing fees in general practice’, and warns against simplistic comparisons ‘that may misrepresent value, complexity or quality of care’.
 
The Government consultation paper, which was released last month, describes bill shock as ‘common’ among Australian patients.
 
It cites figures from Private Healthcare Australia which indicate 44% of patients are unaware of specialist fees prior to their appointment, as well as a Commonwealth Bank of Australia report which found 16% of respondents experienced bill shock with non-GP specialists in the previous 12 months, alongside 11% of those visiting a GP.
 
While noting wide support in the medical community for transparent fees, the paper also points to ‘limited regulatory oversight and remedies for patients’, which it says raises questions about the current protections for patients against ‘unexpected financial impacts’.
 
The Government included split billing in its consultation, saying it can undermine informed financial consent ‘by fragmenting cost information across multiple invoices and payers’.
 
However, the RACGP describes split billing as ‘an established and lawful feature of the Medicare system’, often arising when multiple services occur on a single occasion which include some that are bulk billed, and others that are charged privately.
 
‘Any reforms relating to fee transparency or informed financial consent should avoid creating confusion about existing billing practices or imposing restrictions beyond current Medicare requirements,’ it stated.
 
The college also points to its forthcoming sixth edition of Standards for general practices, which it says ‘further strengthens the existing accreditation framework in relation to fee transparency, informed financial consent and Medicare billing education’.
 
Specialist fees have been under particular scrutiny in recent months, with the Federal Health and Ageing Minister Mark Butler saying he will prioritise efforts to tackle high non-GP specialist fees during this term of government.
 
In March, the Council of Presidents of Medical Colleges (CPMC), which includes the RACGP, published a shared national framework which sets out standards for ethical billing, fee transparency and informed financial consent.
 
CPMC Chair Associate Professor Kerin Fielding said the framework sets out what the medical professional peak bodies expect of their members.
 
‘Where practitioners break the law – failing to get proper financial consent, misleading patients on costs, illegal billing – we support enforcement, full stop,’ she said at the time.
 
Prior to that, new legislation was introduced to Parliament to make displaying non-GP specialist fees the default option on the Federal Government’s Medical Costs Finder website.
 
Health officials have said there are no immediate plans to include individual GP fees, despite several references to general practice in the legislation.
 
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