The recommendation to increase the cost of the average GP consult up to $100 in the AMA’s latest update to ‘The Fees List’ has caused a minor furore, with concerns that given the tough economic environment many Australians now face, practices may face backlash for passing on the increasing costs of healthcare.
Especially given change to Medicare item 23, one of the most used billing codes for GPs, which is due to take effect on 1 November, equating to a paltry 20c increase to the rebate for a standard consult, while imposing what is effectively a six-minute time limit for that consultation – if the practice managers are inclined to pursue profit.
“A minimum service time will be introduced to general practitioner consultation items, with items 23, 24, 5020, 5023 and 5028 applying to a consultation service lasting at least six minutes and less than 20 minutes,” the MBS statement said.
“New MBS items will also be introduced to the general medical services table (GMST), which provide services to patients requiring a consultation of 60 minutes or more (also known as level E consultation items) with existing 40 minute or more consultation items (also known as level D consultation items) being amended to include a maximum attendance time.”
Medical Republic’s Laura Woodrow spoke with GP advocate and Australian Society of General Practice president Dr Chris Irwin on 23 October, who described the changes as a ‘cynical’ move that could constitute a real funding cut of around $5500-6200 per GP.
“The level E consult is making moves to recognise the expert and complex work that some GPs do, especially with disadvantaged people that need more time, but the disgustingly low rebate for level E consults doesn’t encourage practices to treat complex, long-term patients,” Dr Irwin told TMR.
“Instead, the rebate for level E consultations of an hour or more, $183, constitutes a 26% cut in funding when compared to six item 23s billed in an hour, for providing arguably more complex care.”
He said the changes potentially pitted so-called ‘good GPs,’ who spent more time with patients, against ‘bad GPs’ who had shorter consultations, “while not actually fixing the funding problems that cause many GPs to practise short consultations.”
Vice President of the AMA, Dr Danielle McMullen, fronted the Today Show this week, given the arduous task of pointing out to a national audience that many Australians would recognize that it was ‘difficult to do anything’ in the current economic environment and that the cost of providing healthcare had also ‘skyrocketed’ over the last few years.
“And even the Government recognises that… Medicare has not kept up,” she said.
“They are doing an extra round of indexation of the Medicare rebate and bringing in things like a tripling of the bulk-billing incentives. So yes, as part of an indexation there may be an increase to fees but of course every practice makes their own decision based on their local community and what fits best with their practice.”
“But certainly, the cost of care keeps going up: wages increase, electricity increases, and things like our registration’s fees went up 16% this year, and with Government chipping in just some of that, unfortunately we do need to pass some of those costs onto patients.”
The jump in fees on 9th August this year for medical practitioners outside NSW – from $860 to $995 per year – was to cover the cost of regulation, but even the MBA acknowledged that the increase was “coming at a tough time for many doctors, but without any government funding, we have no other option to pay for regulation.”
“GP fees have just been so far behind for so many years, as patients will know, that we did some catchup work,” Dr McMullen said.
“Prices vary across the country, our current recommendation is $98 and certainly not all practices are charging that… GPs take an individual’s ability to pay into account as much as we can, and it’s worth remembering that still 80% of GP services are bulk-billed.”
However, an infographic summary of GP non-referred attendances per patient bulk billing ranges for 2022 -2023, released in August, showed that only 51.7% of GPs always bulk billed (down from 65.8% the previous year), while the proportion that never bulk billed climbed from 4.2% to 10.5% in the last 12 months.
WA practices ranked sixth in terms of always bulk billing at 45.2% and had the third highest percentage of practices that never bulk billed, at 13.7%. Significantly, Perth’s Northern suburbs had the third lowest proportion of GPs who always bulk billed nationally in terms of PHN, with Curtin the electorate with the lowest percentage – just 36.9% – putting us just behind Canberra.
And the reason for the decline, though arguably negligible, is that the percentage of MBS funded services for GPs is at its lowest rate (85%) in nearly 20 years, according to the latest monthly data released by the AIHW.
The last time it hit 86% was back in February 2004 and December 1991, when GPs were providing 0.39 and 0.37 services per person, respectively – compared to 0.51 in July 2023 – yet pathology and diagnostic imaging services were the only classifications to attract higher rebates this year at 86.1% and 94%.
Which begs the question, just how much ‘catch-up’ is still required to adequately renumerate practices, and how much flexibility is left in the system to counter growing GAP fees and fund GP services to a level where patients will actually find it more affordable to access primary care?