The death of Bulk Billing as we know it


According to the Government over 80% of GP services are billed directly to the Government – what is known as “Bulk Billing”

In a GP clinic this service would typically be provided by:

  1.  A Vocationally Registered GP who typically has a minimum of ten to twelve years of formal training – the majority of consultations
  2. A non-Vocationally trained GP (about 10% of the GP workforce) who typically may have the same training but some of it was overseas and a further Australian examination or assessment needs to be done
  3. Nurse Practitioners or Practice Nurses

Many patients consider bulk billing an essential right – the so-called “Universal Healthcare” argument – they usually have no idea and frankly do not care what this actually means in $$$ terms to GPs who are running small businesses.

For Practice Owners like myself it is however a very important and real issue so let’s look at the $$$.

Our standard fee for a 5-20 minute consultation is $77.00 but what does the Business get when we elect to discount our fees to a Bulk Billed consultation?

Let’s see:

 VR GPs:

Currently:

  • Consultation less than 5 min generates $16.95 for the Business
  • Consultation 5-20 min generates $37.05 for the Business ( a 51% discount !)
  • Consultation 20-40 min generates $ 71.70 for the Business
  • Consultation longer than 40 min generates $ 105.44 for the Business
  • If the patient is a child under 16 or has some sort of concession card a bulk billing incentive is pad – at our location this is $ 9.25 per service

From 19/01/15:

  • Consultation less than 10 min generates $16.95 for the Business
  • Consultation 10-20 min generates $37.05 for the Business
  • The rest remains the same

From July 2015:

  • No changes for concessional card holders or children under 16
  • Consultation less than 10 min generates $11.95 for the Business
  • Consultation 10-20 min generates $32.05 for the Business ( a 58% discount !)
  • Consultation 20-40 min generates $ 66.70 for the Business
  • Consultation longer than 40min generates $ 100.44

non-VR GPs:

Currently:

  • Consultation less than 5 min generates $11.00 for the Business
  • Consultation 5-25 min generates $21.00 for the Business ( a 73% discount !)
  • Consultation 25-45 min generates $ 38.00 for the Business
  • Consultation longer than 45 min generates $ 61.00 for the Business
  • If the patient is a child under 16 or has some sort of concession card a bulk billing incentive is pad – at our location this is $ 9.25 per service

From 19/01/15:

  • Consultation less than 10 min generates $11.00 for the Business
  • Consultation 10-25 min generates $21.00 for the Business
  • The rest remains the same

From July 2015:

  • No changes for concessional card holders or children under 16
  • Consultation less than 10 min generates $6.00 for the Business
  • Consultation 10-25 min generates $16.00 for the Business ( a 79% discount !)
  • Consultation 25-45 min generates $ 33.00 for the Business
  • Consultation longer than 45min generates $ 56.00 for the Business

For those who employ Nurse Practitioners:

Currently:

  • Consultation less than 5 min generates $9.60 for the Business
  • Consultation 5-20 min generates $20.95 for the Business
  • Consultation 20-40 min generates $ 39.75 for the Business
  • Consultation longer than 40 min generates $ 58.55 for the Business
  • If the patient is a child under 16 or has some sort of concession card a bulk billing incentive is pad – at our location this is $ 9.25 per service

(Bizarrely this is in longer consultations more than if the patient saw a non-VR GP)

From 19/01/15:

  • Consultation less than 10 min generates $9.60 for the Business
  • Consultation 10-25 min generates $20.95 for the Business
  • The rest remains the same

From July 2015:

  • No changes that I am aware of

If we believe the Government the changes starting on 19/01/15 is to stop 6 minute Medicine sausage factory consults at large Corporate clinics and to be honest there is a measure in truth in that claim.

When does ethical GPs like myself however charge short consultations – sometimes it is for a simple ear infection or a blood pressure check and script but more often than not it is to dress a wound or something similar. Very often these consultations involve the use of consumables that could easily amount to $20 or more – all part of that Bulk billed fee which, as things stand, already means that we are often making a loss when we Bulk bil a short consultation.

Let’s get back to those Sausage factories – like them or not, they deliver approximately ten percent or more of all GP consultations in Australia and these changes have an enormous impact on their business models and it would be miraculous if they would continue their current bulk billing model.

Lastly we should not ignore the fact that the annual indexation of MBS rebates have been frozen until 2018 at least – this means that the rebate would have changed by a total of 2% from 2012 to 2018. I wish I could say the same for the costs of running a Business.

A recent Facebook comment stated that a bulk billed short consult, less than 5min,  in 1992 was worth about $20.40. In July 2015 s bulk billed consult of up to ten minutes would generate $ 11.95 for that Business. I did try to confirm these figures but the powers that be has made sure that the stats are very well hidden.

These changes are going to hurt GP clinics of all sizes and this will roll through into hurting all of our patients – in their pockets and potentially have a detrimental effect on their health.

Now is the time to protest RACGP petition

Get typing folks – time is running out

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