Sharp fall in bulk billing ahead of MyMedicare start

The Federal Government now has its final benchmark for improving the bulk billing rate, with the release of figures for the first quarter of this financial year showing yet another significant fall in services covered by the MBS patient rebate.
 
Ahead of the Government’s signature Medicare investment – the tripled bulk billing incentive, which began at the start of this month – the bulk billing rate declined to its lowest quarterly rate since 2009.
 
Figures show the proportion of non-referred bulk-billed GP services hit 76.5% from July to September, down from the previous low of 78.1% recorded in the March quarter earlier this year.
 
It is likely to provide the yardstick for measuring the impact of the $3.5 billion committed to increased bulk billing incentives over five years, part of one of the largest financial investments in Medicare for years.
 
Following the Budget in May, RACGP President Dr Nicole Higgins said GPs will have more options a for treating vulnerable patients, with the tripled bulk billing incentive applying to face-to-face general consultations (Levels B, C, D and E).
 
Patients need to be registered for MyMedicare to receive the larger rebates for telehealth consultations Level C and above.
 
Dr Emil Djakic, a member of RACGP Expert Committee – Funding and Health System Reform (REC–FHSR), told newsGP that while those patients will see a benefit, others are likely to see costs stay high.
 
‘The bulk billing rate is a narrative that belongs to government,’ he said.
 
‘Their changes with bulk billing incentives … will lead to more bulk billing directed to that targeted population, and we can say, “Yes, that’s a good thing”.
 
‘But there are clearly a lot of problems around just incentivising there, there’s still a large number of people who will be caught in the middle ground that the incentive won’t serve at all.
 
‘There, the necessary costs are being passed on and will continue to be passed on.’
 
In a Senate Estimates committee hearing earlier this year, Penny Shakespeare, the Deputy Secretary at the Department of Health and Aged Care (DoH), said there ‘are no projections’ for how the newly introduced incentive is likely to impact the bulk billing rate – but said it is likely to go up.
 
‘We do need to take action to stop bulk billing rates from trending down, which is what they’re doing at the moment,’ she said at the time.
 
‘And we believe, based on feedback we’ve had from the sector, that this will not only arrest that downward trend, but increase bulk billing.’
 
According to a survey run by newsGP as the changes came into force, around 16% of practices were set change to increase bulk billing as a result of the larger incentives.
 
Meanwhile, the latest DoH figures show children under the age of 16 remained the most likely to be bulk billed in the past financial quarter, with the rate standing at 87.4% from July to September this year.  
 
The rate fell most steeply for those aged from 16–64, with 69.3% of GP services for this category bulk billed compared to 78.7% for the previous year.
 
Bulk billing rates have declined significantly since 2021, as previous rebate freezes continued to affect general practices amid steepling operational costs.
 
For Dr Djakic, the question of whether the rate is likely to shift should not be an area of focus outside of the Government and the DoH.
 
‘The policy is specifically designed to incentivise bulk billing,’ he said. ‘The rate will shift, it virtually has to, that’s a celebration for Government to do.
 
‘We shouldn’t be using it as a metric, it’s a relevant metric to someone else’s policy.
 
‘Our metrics are about how many useful hours of general practice manpower are on the ground doing the job.
 
‘Success for us is the reduction in the likelihood or the vulnerability of closure of practices, and improvement is an uptick in the number of people who might view general practice as an attractive career pathway.
 
‘They are all very long-cycle things. We are so far into the red zone with the risk here around workforce, and we’ve been saying it for a number of years now.’

Clarification: This article was updated at 10.20 am on Wednesday 22 November to clarify that MyMedicare registration is required for patients to access triple bulk billing incentives for telehealth consulations Level C and up. It had previously stated that registration was required for larger Level B telehealth rebates as well.
 
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