Medicare funding model works against general practice: Rural GP

Rural GPs are being increasingly challenged by a Medicare system that rewards fast medicine – that is what was laid out at a recent Parliamentary Inquiry, with the RACGP calling for fairer funding for long consultations.
 
RACGP Rural Deputy Chair Dr Rod Omond fronted the Senate Rural and Regional Affairs and Transport References Committee last week as part of its inquiry into Medicare access and funding.
 
He explained that complex consultations are a key feature of rural general practice, with many patients travelling substantial distances to see their GP, often arriving with multiple conditions to discuss, manage and to coordinate further care for.
 
Yet, ‘the Medicare settings are increasingly working against this model of care’, Dr Omond told the hearing.
 
‘Current funding arrangements undervalue long and complex consultations, despite these being the consultations most commonly required in rural practice,’ he said.
 
‘Rural GPs routinely manage multiple chronic conditions, mental health, aged care, emergency presentations, procedural medicine, and preventive care, often within the same consultation.
 
‘Yet Medicare continues to reward shorter, high-volume consultations over those requiring comprehensive care, and it isolates the rural GP with funding rather than supporting practice teams. Funding should maximise scope of practice within GP-led practice teams.’
 
As an example, Dr Omond compared the income generated per hour depending on length of consultation provided.
 
While consultations tend to be longer in rural areas, a GP could charge an item 23 for six minutes and deliver around nine of those within an hour; whereas a longer item D consultation of 40 minutes or more would result in only three consultations in two hours, he said.
 
‘The difference, roughly ... is between up to $500 an hour with the very short consultations if you’re really getting through patients quickly, and down to about $200 an hour if you’re doing only long consultations – the level C consultations. Level D is even worse.’
 
In response, Queensland Liberal Senator Paul Scarr said, ‘I can almost feel the frustration – the whole system is there weighted towards this shorter-term churning through [of] patients as opposed to doctors wanting to spend longer with a patient to get the better outcome’.
 
Also on the committee, Tasmanian Labor Senator Josh Dolega told Dr Omond he had raised some valid points about the need to support longer consultations.
 
‘If you’re travelling 100 kilometres for [your GP appointment] you’re not going to get things done in five minutes, let alone be told where to even drive to go to get a blood test or a chest x-ray or whatever you might need so, a very, very legitimate concern that you raise,’ Senator Dolega said.
 
To address the concerns of rural GPs, the RACGP submission to the inquiry highlights several Medicare settings that unintentionally disadvantage rural Australians, including aspects of MyMedicare, telehealth eligibility requirements, and funding arrangements for aged care and mental health services, Dr Omond explained.
 
‘The consequence is not simply financial pressure on general practice. When rural practices become unsustainable, communities lose access to comprehensive healthcare, patients delay seeking care, continuity is disrupted, and hospitals increasingly become the default provider for conditions that should have been managed in primary care,’ he said.
 
‘The RACGP is therefore calling for structural reform rather than isolated funding measures.
 
‘Our recommendations include establishing an independent Medicare pricing authority, increasing rebates for longer consultations, improving the flexibility of my Medicare in rural communities, strengthening Medicare support for GP mental health and aged care services, and ensuring future Medicare reforms are appropriately stress-tested for rural Australia before implementation.
 
‘Investing in community based general practice represents one of the most effective investments governments can make. Strong general practice improves health outcomes, reduces avoidable hospital presentations, admissions, and strengthens the long-term sustainability of rural communities.’
 
While rural incentives have been introduced to support GPs, Dr Omond said the problem remains that longer consultations are still not addressed, as ‘you get paid more rural incentives by doing more consultations.’
 
Dr Omond also spoke of the role of councils in providing facilities for GPs and other health professionals, which has helped to attract and retain doctors in rural communities.
 
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