Three in four doctors not confident navigating Medicare: Poll

More than three in four newsGP readers are unsure of how to find the right Medicare billing information, according to a recent survey. 
 
In a newsGP poll run last month, 76% of 935 respondents reported not being confident finding information on Medicare requirements and billing.
 
Only 13% said they feel assured about locating relevant details, the survey indicates.
 
The results highlight the challenges of Medicare systemic reform, which were outlined by the Independent Review of Medicare Integrity and Compliance Review – known as the Philip Review after its author Dr Pradeep Philip – that was released last April.
 
Dr Philip, a health economist and a former senior government bureaucrat, was appointed by Federal Health and Aged Care Minister Mark Butler after significant and contentious media coverage in late 2022 about the integrity of the Medicare system.
 
In his final report, he highlighted systemic complexity, a lack of clarity in the compliance processes, as well as flaws in decision support in the workings of Medicare. He described its legislation, governance, systems, processes, and tools as ‘currently not fit for purpose’.
 
The results of the newsGP poll are no surprise to the RACGP President Dr Nicole Higgins, who said the college has long advocated for better education for GPs to mitigate the complexity.
 
‘Medicare has been under-funded, fragmented and overly complex for way too long, and GPs are continuing to struggle,’ she told newsGP.
 
‘It’s no wonder that the Philip Review found the current Medicare system unfit for purpose.’
 
While there has been no formal response to the Philip Review in its entirety, the Federal Government has since put several measures in place as a result.
 
In the 2023–24 Budget it announced $29.8 million over four years ‘to strengthen the integrity of the Medicare system in response to key recommendations of the Philip Review’.
 
The funding has been used to set up a Department of Health and Aged Care (DoHAC) taskforce, designed to ‘identify and disrupt fraud and serious non-compliance’ as well as immediate policy and legislative amendments.
 
Dr Higgins said the work is ongoing and involves the college.
 
‘Since the review came out, we have been working hard with Medicare to improve compliance activities and shift to education, and have seen some significant improvements,’ she said.
 
In his review, Dr Philip said processes have not adapted enough to reflect different technologies and business models, nor the increasing complexities of healthcare.
 
To mitigate the increasing risk of fraud, he urged for ‘significant attention’ to be paid to vulnerabilities in the system, and included 23 recommendations in his review.
 
They were bracketed under four broad definitions: governance and structure, operational processes, modernising technology and strengthening legislation, with Dr Philip also highlighting the need for improvements in the education available to clinicians.
  
He said clear rules and more of a focus on pre-claim and pre-payments would reduce the likelihood of non-compliance. He also cited shifting MBS requirements as a particular concern.
 
‘Changes occur to these items at a frequency which is difficult for individual practitioners to keep up with,’ he noted in the report, saying that around 3000 Medicare items have altered in the past 2–3 years.
 
‘In this environment, communication of changes to health professionals themselves needs to improve.’
 
In the RACGP submission to the Philip Review, the college also called for ‘educative processes focusing on prevention of incorrect claiming, rather than punitive measures and blunt instruments’.


Dr Higgins took up a similar theme.
 
‘With more than 6000 MBS items, it can be a fiendishly complicated system – and one that is prone to change,’ she said.
 
‘Advice can be hard to access or contradictory, and there are way too many examples of poorly targeted compliance campaigns that can make GPs’ lives much harder than they need to be.
 
‘My biggest worry has always been this burden of compliance makes it more difficult for our wonderful GPs to focus on what they do best: look after their patients’ health.’ 
 
In October last year, Dr Higgins welcomed an approach that saw only a fraction of GPs contacted in a compliance campaign surrounding the 80/20 rule, with 146 letters reportedly sent to those at risk of exceeding the limit.
 
‘This is a much-improved approach,’ she told newsGP at the time. ‘This is an opportunity to reflect on practice. It’s an educational approach versus a punitive approach.’
 
The Philip Review was called in response to a joint Nine Newspapers and 7.30 investigation in October 2022, which initially placed general practice processes at the heart of allegations of Medicare fraud and non-compliance claimed to total more than $8 billion each year.
 
That figure met fierce resistance from GPs, many of whom raised the issue of underbilling, which was not featured in most media coverage.
 
In a subsequent poll, almost all newsGP readers said they had lost income due to underbilling, with 97% of 1425 respondents saying they missed out due to under-claiming available patient rebates.
 
Dr Higgins said she is optimistic a better way of working can be achieved.
 
‘I hope the reforms lead to some substantial improvements in the way the system works, and we are engaging constructively to work out ways that could happen,’ she said.
 
DoHAC was approached for comment.
 
Further resources and links on the MBS and Medicare compliance are available on the RACGP website.
 
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