News

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Is mixed billing the answer to business sustainability?

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Practice viability has been a longstanding concern for general practice.
 
A rise in chronic disease has resulted in patients needing more one-on-one time with their healthcare provider, while salaries and the costs of health technology have simultaneously increased. The pandemic has also generated additional operating costs, such as personal protective equipment, rapid antigen tests and additional staffing.
 
All the while, government funding has failed to keep up.
 
But with a growing need for high-quality care in the community, how can practices remain viable?
 
Dr Emil Djakic, who is a member of the RACGP Expert Committee – Funding and Health System Reform (REC–FHSR), believes an important first step is for GPs to look at their billing and costs.
 
‘General practice has got a much-celebrated diversity in delivery,’ he told newsGP.
 
‘GPs need to be talking about whether they are achieving the outcomes that they want as a doctor. And if they’re not, how do they plan to address that?
 
‘From a fiscal outcome point of view, there's only two variables – work faster and longer, or charge more.’
 
To make this assessment, Dr Djakic advises that each GP consider what they think their working year is valued at, both from a fiscal and professional point of view, and how it fits with their social conscience.
 
‘They’re all part of this equation,’ he said.
 
Dr Djakic did exactly that almost 20 years ago. He analysed his average billing rates, how much time he sets aside for leave, how many patients he sees per week and the costs of the practice.
 
Where he initially thought he had to work harder and faster, he discovered that less was in fact more.
 
‘What I found was that I didn’t need to see 35 patients a day, I needed to see 28 to reach my target,’ Dr Djakic said.
 
‘It actually meant I could relax more. I could sit back and focus on my role professionally and found that it was more sustainable.
 
‘If you want to set yourself an unrealistic goal, go for it, [but] you’re going to have some problems.’
 
To assist GPs, the RACGP has compiled a range of resources around managing billing and maintaining wellbeing, including a billing calculator aimed at presenting GPs with a clearer picture of their current set up and the possible outcomes of tweaking their billing model.
 
Meanwhile, a number of case studies have been made available, outlining possible mixed billing options, including strategies to consider such as bulk billing certain patients and specific services.
 
While many factors influence a clinic’s billing practices, including patient demographics, practice location and desired income, Dr Djakic says it does not have to be all or nothing when it comes to passing on the cost of care to patients.
 
‘You don’t have to all of a sudden move to charging everybody,’ he said. ‘The big area to look at in general practice is not so much those who have concession card holder status, but those who don’t [to whom] general practice continues to provide a discount.
 
‘You can choose to select which part of your standard population you might choose to pass costs onto. It is a reality that the community lives with anyway, you only have to look at the price of petrol at the moment – this is the real world.’
 
Members also have access to a presentation on ‘Work-life balance and valuing your professional role’ recorded by members of the REC–FHSR for GP21. It encourages GPs to think about their personal expectations in terms of income, financial sustainability and work-life balance, covering:

• issues affecting the sustainability of general practice
• billing habits of GPs and other medical specialists
• strategies to improve practice viability and achieve a better work-life balance
• RACGP resources to help GPs manage their billing.

Dr Djakic said the benefits of practice sustainability are far-reaching, and have a flow on effect to patients and the quality of care they receive, but also the sector and its future.
 
‘We are wanting to see that profile raised because losing doctors to the system because of business or losing practices completely is a disaster for patients, and it takes a long time to restore or repair, particularly if it’s in a fringe regional or rural area,’ he said.
 
‘We’d also like to think that happier, healthier, more fulfilled GPs are going to find themselves choosing to stay in the system for longer and that will add to the net workforce base over time.
 
‘We will also, I think, find ourselves talking to our junior colleagues and our students with a little bit more positivity and enthusiasm to say there is a future here for you that’s professionally fulfilling, financially rewarding and vocationally delivers in serving your community.
 
‘Getting that balance right is important.’
 
The RACGP is set to undertake a number of activities in the new year to encourage members to think about their billing model, and whether it is sufficient to cover personal/practice costs and achieve an optimal work-life balance.
 
For Dr Djakic, it is about empowering all college members, from practice owners to contracted GPs, to take action.
 
‘There might be those GPs who are currently working in an employed setting thinking “surely there’s more”,’ he said.  
 
‘Or it might simply be existing GPs who just think “if I tweaked this a bit and achieve the same financial outcome but I’m working 5% less … that means I can go along and watch my youngster play football down at the local ground on Wednesday night”.
 
‘Those things matter – and that’s not indulging the profession, it’s just acknowledging that you’ve got to have that balance.’
 
The case studies and video are available on the RACGP resources to help you manage your billing webpage.
 
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bulk-billing chronic disease COVID-19 funding general practice mixed billing primary care

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