Residential aged care visits not financially viable for GPs, expert says

A GP with a special interest in aged care says the Government needs to increase Medicare benefits by at least 30% to encourage more health practitioners to visit residential aged care facilities (RACFs).
 
Associate Professor Joel Rhee, GP and Chair of the RACGP Cancer and Palliative Care Specific Interests network, told newsGP the current level of remuneration acts as a barrier for doctors, including specialists, to treat people with very complex health needs.
 
‘The current remuneration structure is discouraging, it’s a barrier for GPs,’ Associate Professor Rhee said.
 
‘Many people who enter nursing homes are older, they are pensioners, they obviously don’t have a lot of money. They have complex care needs, and yet the sort of funding the Government is willing to provide for seeing these patients, it can’t even compete with GPs sitting in their surgery and seeing more patients in their clinic.
 
‘It makes no sense. I think the Government would have recognised that there is a huge issue with the funding, and yet they haven’t done anything about it.’
 
This follows an Australian Medical Association (AMA) report that showed close to a third of doctors plan to cut back or completely end their visits to patients in RACFs over the next two years.
 
Inadequate patient rebates that do not compensate for lost time in surgery and unpaid non-face-to-face time were cited as two of the main reasons for the decision. The survey respondents also called for more suitably trained and experienced staff members at RACFs.
 
The report found that doctors are making more visits to RACFs than they were two years ago, and are spending more time with patients. However, 35.67% of the doctors surveyed reported they plan to not take on new patients, reduce the number of visits, or stop completely over the next two years.
 
The proportion of respondents who visit RACFs has also dropped by 13.55% since 2015.
 
Associate Professor Rhee said a bulk-billing GP can earn up to $170 an hour for their general practice by seeing four patients in the clinic. But those earnings are eaten up, including in travel and unpaid administrative time, if they visit an RACF.
 
‘You have spent over an hour-and-a-half seeing three patients and in that … you could have billed something like $240 by staying in the clinic,’ he said.
 
‘You wouldn’t be making close to that if you went to the nursing home. I mean, why would GPs do it?
 
‘It comes down to the fact that GPs are only doing it … because they care for the patients. Many of these people have been their patients for years and they really want to continue to look after them.’
 
The AMA report also raised concerns about a future shortage of medical practitioners willing to visit these patients, with doctors aged 41–60 the largest age group reporting they visit RACFs (46.94%) and contributing to the highest proportion of monthly visits (49.32%). Respondents aged 61 and over contribute 47.11% of monthly RACF visits, with those aged 40 or under contributing only 3.57%.
 
Nearly half of the medical practitioners who responded said it was ‘very difficult’ to access mobile X-ray and ultrasound services and consultation with specialists.
 
Associate Professor Rhee said it is difficult to get specialists to see patients in RACFs as they do not get paid any more than treating people in their own practice, with the exception of geriatricians who have a special item number paying $473.55 for the initial visit.
 
Associate Professor Rhee said more aged care patients may end up in emergency departments if they could not access primary care in time.
 
‘More and more Australians are getting older and the aged care services are probably going to require a lot more GPs to see these patients,’ he said.
 
‘And the reality is many of these patients are being looked after by older GPs who are probably going to retire in the next 10 years, and if we don’t do something about it then who is going to see all these patients? I have got no idea.
 
‘What could happen is that maybe … each GP who does nursing home visits has to look after 100 or 200 patients [and] therefore cannot get around to seeing everybody in a timely manner, so maybe some of these patients may end up in [an emergency department].’
 
The Department of Health did not respond to request for comment.

Medicare RACFs residential aged care facilities