More paperwork would drive 94% to private billing: Poll

More than nine in 10 newsGP readers have said the introduction of extra bulk billing bureaucracy for telehealth would drive them to bill more consultations privately.
 
The results of the latest survey, ‘Will additional bulk billing red tape make you more likely to privately bill telehealth consultations?’ show an overwhelming number of GPs prepared to move away from bulk billing.
 
Of the 2627 responses received, 2460 entered ‘yes’ votes – accounting for 94% of those who took part. Of the remainder, 3% said they were unsure, with a similar number answering ‘no’.
 
It follows a week of significant focus on the issue, prompted by a change to the assignment of benefit process, which is a legal requirement under the Health Insurance Act 1973 to record patient consent for bulk billing benefits to be paid directly to the provider.
 
Under the process for telehealth introduced shortly after the onset of the COVID-19 pandemic, a temporary arrangement was put in place allowing verbal consent to be recorded in the patient notes. That set-up that was stopped by Services Australia last month with the introduction of forms.
 
On Friday last week, Federal Health and Aged Care Minister Mark Butler intervened to reassure GPs concerned about the change.
 
‘I have asked my department to provide options to address concerns about the assignment of benefit for Medicare bulk billed claims, including legislative amendments,’ he said.
 
‘My department has advised me that until these changes are made, there are no plans to pursue any broad punitive actions on this issue, unless it relates to fraudulent claims against Medicare.’
 
The Department of Health and Aged Care (DoH) has also said it will be in touch with the college about consultation ahead of introducing legislative amendments.
 
While RACGP President Dr Nicole Higgins welcomed the Minister’s intervention, she said the change has caused GPs unnecessary stress.
 
‘The results of the newsGP poll don’t surprise me in the slightest – GPs categorically do not have any capacity to spend more time on outdated red tape at the expense of patient care,’ she told newsGP.
 
‘As a practice owner, I completely understand the reaction among GPs and practices at a time where we are already overstretched.
 
‘I appreciate Minister Butler has agreed to look at legislative reform to reverse this pointless and unnecessary bureaucratic burden.
 
‘The sooner that can happen and we get a clear idea of when the change will be in place, the more time GPs will have to get on with their job – caring for patients.’
 
Dr Higgins’ call was echoed by the independent Federal MP for Kooyong, Dr Monique Ryan, who released a statement on Monday calling for the change to be scrapped urgently.
 
‘People are missing out on bulk-billed sessions because of a poorly thought-through regulation that requires patients to provide written consent for telehealth appointments,’ Dr Ryan said.
 
‘It’s a major misstep which I’m hearing is already impacting doctors’ bulk-billing activities.
 
‘It will affect our most vulnerable the most: those without email or mobile phones, such as the elderly, the socially isolated, culturally diverse patients and those in rural and remote settings.
 
‘I acknowledge Minister Butler’s comments on Friday stating he would examine the changes. I urge him to go a step further and scrap them as soon as possible.’
 
The additional layer of red tape for GPs carrying out telehealth appointments was revealed in a change to the Services Australia website last month.
 
It says the first choice for obtaining patient consent to be bulk billed for telehealth is in writing or email, and if that is not possible, verbal consent can still be sought during the consultation – but must be now be recorded using forms sent to the patient.
 
‘If the patient doesn’t agree to assign their benefits, you can send them a private bill for the service,’ the Services Australia website notes.
 
‘You should keep a copy of all correspondence, claims and forms for at least two years. This is for auditing purposes if you are subject to a compliance review.’
 
Following the first public report of the change on newsGP last Monday, several GPs commented that they would stop bulk billing telehealth consultations as a result – and the change was widely discussed among general practices during the week.
 
An Australian National Audit Office (ANAO) report published in January year criticised the DoH for its ‘failure to identify and manage legal risk’ by allowing verbal consent to be recorded in patient notes.
 
It warned of potentially ‘severe’ legal consequences for failing to observe the requirement to provide a signed copy of the agreement to patients.
 
‘Where a provider does not provide a copy of the signed agreement in approved form to the patient, there is no legal basis for Services Australia to pay the benefit to the provider.
 
‘Additionally, providers can be criminally liable for failing to complete the agreement form properly.’
 
The controversy aired a few weeks before the official start of one of the flagship health measures of the 2023–24 Federal Budget, the tripling of the bulk billing incentive, which set out $3.5 billion over five years to address the decline in bulk billing.
 
Due to start on 1 November, the tripled incentive will apply to level B telehealth consultations lasting 6–20 minutes.
 
It will only apply to longer telehealth consultations if the patients are registered with MyMedicare through their GP.
 
In the past financial year, there were 25,937,488 standard level B telehealth phone consultations using MBS item 91891.
 
The last month for which Services Australia data is included, from July to August this year, shows a significant uptick in the monthly rate of billing the item number, with 4,096,446 services provided during that month.
 
There is not yet any publicly available data to show whether the recent controversy has had an impact on the use of MBS telehealth numbers.
 
More information on assignment of benefit and signature requirements can be found on the RACGP website.
 
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