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Telehealth pushes bulk-billing to record levels


Matt Woodley


1/09/2020 5:18:44 PM

But, average out-of-pocket costs for patients continue to increase.

Medicare card and coins.
Average out-of-pocket costs reached $39.33 in 2019–20, an increase of $0.87 on the previous year.

Bulk-billing rates under Medicare reached 87.5% in 2019–20, with total services increasing to 428.3 million and total benefits reaching $24.7 billion during this period.
 
But even though more than eight in 10 GP consultations were provided to patients free of charge, average out-of-pocket costs still increased by $0.87 to $39.33, according to official Medicare statistics.
 
Additionally, this figure remains higher than the Federal Government contribution to a standard level B consult ($38.75) and the gap is widening – last year the difference was only $0.26, whereas it has since more than doubled to $0.58.
 
RACGP Expert Committee – Funding and Health System Reform (REC–FHSR) member Dr Edwin Kruys told newsGP bulk-billing rates do not tell the whole story, and that telehealth had likely been a driver of the increase, as opposed to bulk-billing incentives.
 
‘As always there is more behind these messages from Government touting record bulk-billing rates,’ he said.
 
‘There is a compassion aspect to this which is not acknowledged by the Government – as many patients are facing job insecurities and financial hardship, GPs will be bulk-billing more often.
 
‘The higher bulk-billing incentives may play a role but I don’t think they offset the losses for most practices. This will no doubt impact on practices, especially those relying more on bulk-billing.’
 
More than 99% of phone and 97% of video consults were bulk-billed by GPs in 2019–20, which if removed, drops the bulk-billing rate to 86.4% – an increase of only 0.2% on the previous year.
 
 Of the total 163,209,334 non-referred attendances captured, more than 14 million were conducted using COVID-19 telehealth item numbers – including 13.9 million phone consultations and 504,307 via video.
 
The RACGP encourages members to determine a ‘fair and equitable fee’ for their services to ensure their practice’s sustainability.
 
‘MBS [Medicare Benefit Schedule] rebates alone are not indicative of the value or cost of providing general practice services,’ a college position statement on billing states.
 
‘GPs should therefore not feel obliged to set their fees solely according to the value of MBS rebates.
 
‘GPs are not required to bulk-bill any service … [but] should abide by legislative requirements and consider the impact of billing changes on their patients when determining their billing policy or model.’
 
In 2019–20, temporary telehealth items represented 8.8% of GP consultations and 4.1% of all Medicare services. Additionally, while bulk-billing reached record levels, only 87.4% of the population saw a GP in 2019–20, a 0.4% decrease on the previous year and the lowest rate since 2014–15.
 
This drop could be attributed to patients staying away from face-to-face consultations due to fears of contracting COVID-19, with some GPs reporting major drops in patient visits.
 
Nevertheless, Dr Kruys said the COVID-19 pandemic had added another layer of pressure for GPs.
 
‘COVID-19 creates an increased workload on top of usual care, think for example about the mental health consequences of the pandemic,’ he said.
 
‘We all know this comes at a personal risk of burnout for the healthcare teams in practices and areas most affected by COVID-19.
 
‘General Practice teams should be looking out for each other, now and in the months to come.’
 
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Dr Michael Lucas Bailey   2/09/2020 6:56:32 AM

Bulk billing has probably also increased as a means of reducing staff/patient direct contact with COVID even for non-telehealth consults. This may actually be the largest practical driver.


Dr Matthew James Harvey   2/09/2020 12:45:00 PM

I couldn’t read any further than this:

“But even though more than eight in 10 GP consultations were provided to patients free of charge, average out-of-pocket costs still increased by $0.87 to $39.33, according to official Medicare statistics.”

1. It’s 8/10 services, not consultations. A single consultation may include several services.

2. It’s not free of charge. The doctor just accepted the MBS rebate as the fee. The taxpayer still pays, nothing is free.

3. Out of pocket costs increased because of the additional costs to business associated with telehealth and mandatory Bulk Billing.

If the RACGP’s own publications can’t get those basic facts straight, what hope have we got for mainstream media to be on message?

Please do better.


Dr Gobind Singh Duggal   6/09/2020 10:48:01 PM

The only way GP's can protect themselves and continue to look after their patient is by telehealt, I think it is too much a risk for ageing GP to have face to face consultation, till it is safe to do so