Review of bulk billing consent requirement flagged

Jolyon Attwooll

14/12/2022 4:48:59 PM

DoH is looking into ‘assignment of benefit’ requirement for bulk billing, with the arrangement under the spotlight due to telehealth.

GP in telehealth consult
The widespread use of telehealth ushered in changes to the assignment of benefit requirement.

The Department of Health and Aged Care (DoH) has confirmed it is reviewing the need for GPs to seek patient consent to bulk bill.
The Services Australia website currently states that GPs shortly will no longer be allowed to seek verbal consent to bulk bill their patients from the end of this year. If applied, it would mean GPs following bureaucratic protocol need to seek permission to bulk bill in writing or via email for a telehealth consultation.
However, following an inquiry from newsGP, the DoH acknowledged that with telehealth now a permanent healthcare fixture ‘an ongoing solution to assignment of benefit is required’.
The option for verbal consent, introduced with widespread telehealth in the early months of the pandemic, was a temporary measure set to be withdrawn on 31 December according to Services Australia.
‘The department is investigating options that are suitable for permanent telehealth services,’ a DoH spokesperson told newsGP.
‘Whilst this is being pursued, the Department of Health and Aged Care will extend current arrangements as a temporary measure, with updates to relevant online information forthcoming.
‘Further, as is always the case, practitioners must have appropriate records in support of their billing.’
The impending change was not on the radar of many GPs, but some of those who had noticed expressed strong concerns about the implications.
Among them is Dr Tim Senior, a GP who works in an NSW-based Aboriginal Medical Service, who raised the issue on social media.

He told newsGP that if the arrangements reverted to pre-pandemic settings, they could stop bulk billed telehealth ‘in its tracks’ and points out that some of his patients do not have readily accessible email accounts.
‘If we have to get consent each time we’re having a telehealth consultation in order to bulk bill it, I just don’t see how we’re able to do that, particularly for patients with COVID who can’t come in,’ Dr Senior said.
‘Adding that bit of extra bureaucratic grit into the system just makes it harder to provide bulk billing care for people who may not be able to afford it.’
The previously planned change would also have come at a time when bulk billing levels have dropped substantially, with the latest quarterly statistics revealing a rate of just 83.4%, compared to 88.8% in 2020–21.
Dr Emil Djakic, a member of RACGP Expert Committee – Funding and Health System Reform (REC–FHSR), said the ‘assignment of benefit’ requirement is a legacy of an outdated system.
‘What it represents is the fact that this is a system that’s now approaching 50 years of age and yet again, we’re seeing people twist and retro-engineer something which is designed around paper-based systems,’ he told newsGP.
He queries the need for bulk-billed patients to assign their right to a bulk billed Medicare rebate to their doctor, which has historically been required with a signed form (now the Services Australia DB020).
According to Dr Djakic, it reinforces the need for significant structural reform to Medicare.
‘It’s due process up at the extreme end of uselessness in order to actively demonstrate how the money moves,’ he said.
‘This is not a process that is reflective of the real world.’
Dr Michael Bonning, another member of REC–FHSR, said the requirement indicates a lack of understanding of how claiming works.
‘Most practitioners, while documenting whether a consultation will be bulk billed or privately billed in the notes, will not have used a hard copy patient attribution of benefits receipt for many years,’ he told newsGP.
‘Medicare online now means that our patient management systems do this and keep the records.

‘It’s just another thing that undermines the sustainability and functionality of already busy general practices.’
Dr Djakic is unaware of any attempt by the Professional Services Review (PSR) to enforce the assignment of benefit requirement. Like Dr Senior, he said the implications for patient care would be significant if that approach changes.
‘This is not reflective of the real world of what is actually happening,’ he said.
‘If you look at productivity and what this contributes, if they seriously want this to translate into something that has to be done, it’s potentially going to just rob hundreds of hours every day from the general practice workforce’s capacity to get on and do what the Government actually wants them to do, which is to see patients and treat people.’
For Dr Senior, the current situation is little comfort.
‘At the moment, they haven’t clamped down upon it. At the moment the PSR isn’t interested. But who knows what will happen six months, 12 months from now,’ he said.
‘Even if the PSR are not interested, Medicare like to do nudge letters.
‘I think it’s deliberate policy not to cut Medicare rebates because that’s politically unsustainable, but to put grit in the system to make sure we know we’re being watched, so that we are under-billing, so that we are pushing costs on to patients.
‘The problem that has for health equity is massive. Where patients can afford co-payments, [it is] not a problem, but for communities who can’t, their healthcare is under real threat.’
In its response to newsGP, the DoH did not specify timelines for the extension to the current arrangements, nor for a solution compatible with permanent telehealth to be reached.
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Dr Milton Arthur Sales   15/12/2022 6:26:17 AM

We have started using Hotdoc to pre gather credit card details before the consult to facilitate fee payment rather than bulk billing Telehealth.
Don’t trust PSR not to focus on this in the future. They may need to “prove” there is Medicare “ fraud” to justify a failure of indexing

Bargdrew   15/12/2022 6:46:45 AM

I kinda know where this added layer of complexity is going so come 2022, no more bulkbilled telehealth fo moi . Cos privately you don't need consent is what I understand from this new doctrine which I think has not been thought through in terms of practicality. Doctors are not lawyers u see. They like medical work, not legalities or paperwork. Same complaint from teachers, aged care workers, but some find ways to make things unnecessarily harder

Dr Partha Sarothi Modak   15/12/2022 6:59:01 AM

‘If you look at productivity and what this contributes, if they seriously want this to translate into something that has to be done, it’s potentially going to just rob hundreds of hours every day from the general practice workforce’s capacity to get on and do what the Government actually wants them to do, which is to see patients and treat people.’
OR, it’s potentially going to just deprive hundreds and hundreds of patients every day from having the PRIVILEGE they have been enjoying to receive their general practice care bulk billed as we will just have to private bill these patients to save the wastage of our time and resources fulfilling this unrealistic, unnecessary bureaucratic requirement of the government.

Dr Bradley Arthur Olsen   15/12/2022 10:05:40 AM

Time for me to retire , but I need written consent first

Dr Stuart Crowther Burton   15/12/2022 11:07:09 AM

Once again the process becomes the obsession and not the provision of service. The advent of Telehealth has been a godsend for my mainly Nursing Home patients. How does Medicare intend to enable consent when most of my patients cognitively impaired. Telehealth has enabled me to provide timely telehealth advice for management of nursing home patients. This is yet another unnecessary impost.

Dr Slavko Doslo   15/12/2022 11:53:02 AM

If we charge ALL patients for phone consult who are eligible for bulk billing 39.75$ plus 6.60 $ for 10990 = 46.35$ which is not bad as patient save on petrol 2.30 $ on diesel and traffic + time, and not eligible your practice fee than we do not have to have this nuisance and bulk billing will be 0%, so from famous 83.4 % bb rate that will drop drastically down, and politicians can not praise themselves for bulk billing rate winning in Australia, WE GP are funny
we should stand together and abolish bb for ever
Charge 47 $ all eligible for bb if you want ( 1 coffee less for them per month) and bulk billing will be ZERO
think about it please

Dr Sonya Sibilla Moncrieff   17/12/2022 6:43:19 AM

Just from an environmental point of view this is archaic. The reams of paper, taking up space for no patient or practice benefit other than to make an obstacle to bulk billing.. My practice manager was only able to purchase 2 boxes of paper recently as a paper shortage was cited to be coming (that and the toilet paper is enough to end modern civilization)

Another solution needs to be brought forward, other than storing 1000s of pages of paper.

Dr Andrew Robert Jackson   4/01/2023 4:42:05 PM

Excellent commentary esp Dr Djakic.
And, make no mistake, it's a BIG bit of grit and, to mix metaphors, is another coffin nail for bulk billing esp for nursing homes, if not reversed.