Telehealth pushes bulk-billing to record levels

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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bulk-billing Medicare telehealth