Bulk Billing:GP Costs

Health & Body
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Edit: New readers to the topic can join it as of August 2023 by clicking here.

Government has recently been quoting high and climbing rates of bulk billing. Locally there are a few bulk billing clinics but they are far out numbered by non-bulk billing clinics having typical charges for a basic consult around $85 +/-.

This study explains why the stats are high and why they are wrong, and claims the actual bulk billing rate is closer to 30% than the government’s nearly 90%.

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While the Government refuses to pay medical professionals adequately through Medicare, they will find creative ways to do their billing.

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That they will, but possibly not nearly as creatively as the government, that seems to be happy with its own accounting to extol how well bulk billing is going so no worries and no problems with its status quo :frowning:

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Faux seems to be something of a crusader, her comments on the weaknesses of Bulk Billing are all over the place. What I cannot find is any critique of her work. I hesitate to dive into this myself. One of her items is titled “Wading into the molasses”. I would much rather read an expert view than start from scratch myself.

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Considering the disparity in the numbers of bulk billing clinics and doctors versus those that charge $85 per basic consult, all being equally busy and I know some of the $85 set who are booked a month out, at least around NE Melbourne, the contention makes sense against what I see locally.

I accept any single locality is not Australia, and any single individual’s experience is not authoritative proof on the veracity of a wider claim. Yet it passes my pub test.

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My practice often bulk bills me, despite saying they are not a bulk billing practice. I believe their GP’s decide in each instance, sometimes on the complexity and time.

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Partly caused (in rural areas) by the lack of doctors.

Our small town has a clinic owned by the Council and rented cheaply to a one doctor practice. This was to serve a population of 800 mainly elderly, there being no public transport and the nearest doctor and hospital 30min down the highway. I don’t know what the agreement was, but you could not sign up unless within a certain geographic area, all were bulk billed.

She retired (dedicated, gave over & above, really cared) and sold the practice for a pittance. The two doctors couldn’t get enough business to keep both employed, so it went to one doctor and 4 days. Then doctors in the larger towns started retiring and unable to sell their practices. Within 6 months over 3,000 patients were looking for a new doctor, many with Private Health. This month, our little clinic became a Mixed Billing $65/visit (unless Pension or DVA) and had gone up to 5 days and two + part-time doctor, no geographic limit, now unable to take any new patients.

Talking with people in the bigger towns, they are desperate to find a doctor (repeat scripts, referrals) and willing to pay & travel. Some elderly friends have medication that they have to see a doctor once every fortnight and stressed out trying to find an appointment. It is a big issue in those towns. Reception staff fielding calls & visits from people looking for appointments, vaccines, setting up new patients, means more staff, longer hours for existing ones etc.
Some of the more popular clinics are now charging all new patients (with some discretion) to slow the rush - saving their sanity. Our doctor is now more stressed, running behind time and trying to push us through quickly and took two calls in the middle of our consult and the waiting room is overflowing. Unfortunately bulk billing (free) got some people to regard a visit to the doctor as another social event, to call in for a chat with someone who cared.

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The problem is that the Government are not paying GPs at all. Medicare is a reimbursement scheme for patients.

The GP charges the patient a fee for the service, and the patient can then claim a fixed amount for each specific service (called an item) back through Medicare. This has become complicated in several ways:

  1. The patient can assign the rebate to the GP to claim directly. The main reason for this is to avoid the patient having to pay the entire fee up front and then claim it back from Medicare, although it does avoid issues where the patient pays the difference between the fee and the rebate (the gap) and a cheque for the rebate (payable to the GP) is sent to the patient, who then has to forward it to the GP. Unsurprisingly these cheques get lost very often. This process is called “bulk billing” because the practice claims the rebates in bulk at the end of the day. Medicare requires the GP to accept the rebate as the full fee for the service, so for patients, bulk billing appears to be “free of charge”.
  2. Medicare, pays a small extra amount of rebate if the GP bulk bills some types of patient (children and concession holders). This is to encourage “bulk billing” where the patient has no out of pocket cost, for patients on low incomes.
  3. It then looks to patients that they are paying nothing or a minimal fee for these highly skilled professional services so they tend to see them as having no value. Patients often demand that GPs see them and charge only the Medicare rebate which is almost literally like the GP taking cash out of their pocket and giving it to the patient. The GP still has to pay wages for reception/admin staff, nurses, rent for the premises, consumables, insurance etc.
  4. The Medicare items are very complicated with many rules about when they can be claimed (although these are basically unknown to the patients who are claiming the rebates), Medicare itself refuses to give legally binding or consistent advice on what items are appropriate to be claimed for what services and if they then don’t agree with how you interpret it then they are judge, jury and executioner, reclaiming the rebates from the GP, in some cases for years of work, with no right of appeal.
  5. Even though the Government don’t employ or pay GPs they put rules in the Medicare system to try to force them to do things. For example you cannot claim a rebate for a COVID19 vaccination if the GP has charged you a gap, so many GP clinics have lost substantial amounts of money providing a vaccination service because the rebates do not cover the actual costs of providing the vaccination.
  6. The Medicare rebate itself often doesn’t cover anywhere near the actual costs of providing the service, especially with recently added costs like buying PPE for COVID19, and stupid politicians making announcements on TV suggesting that everyone should call their GP the next day, causing all the reception staff to spend their entire day on the phone instead of booking in patients etc.
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In regard to point 1. there has never been a gap payable when bulk billing. It has always been illegal to charge a gap in this case.
R

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Hi Richard,
thanks for the clarification. I’m not able to find precise dates, but what about the co-payments which were charged with bulk billing? They are mentioned in the Wikipedia article: Bulk billing - Wikipedia.

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There was a 3 month period in 1991 when they charged a $2.50 copayment with bulk billing. There was also a proposal in 2014 for a $5 copayment which never happened.
R

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Ok, so there was a time where there was a “gap” payable = the copayment? Regardless, I’ve edited my comments above to be clearer.

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Bulk billing is getting some press ahead of the balloting, although many may have already gone postal. Pun intended. Will the real information stick to those who spun and spin it?

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I was aghast to read that Medicare was not fully capturing the out of pocket expenses of patients. Consequently where those costs are not reported to Medicare consumers may be missing out or taking longer to qualify for the safety net provisions of our health care system.

Assuming the government pockets any savings. Are consumers paying a ‘hidden’ tax (one does not know about), or is it better likened to a theft?

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Does Medicare capture these amounts if the patient provides them with proof of payment?

From the Services Australia website “If you have unverified costs, you’ll need to pay them, and give us the receipt. We can then add these costs to your Medicare Safety Nets threshold.”

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A gotcha is the patient has to be aware of what was, wasn’t, and might not have been reported, and perhaps a bit obsessive compulsive to keep track?

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I was astonished to find a bulk billing practice which is geographically close to me. My usual GP of 7 years standing suddenly up stumps and went to Lismore, I was seriously annoyed because he was a goodie (though expensive). Anyway, the new doc seems to be just as good and even though I was forewarned that I would be up for a $75 fee at the first visit, he bulk billed me anyway. Bulk billing is available at that clinic for all health care and pension card holders, but not usually for the first visit.

There is also pathology, podiatry and other relevant services there… v pleased.

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2 posts were merged into an existing topic: Medical centres forcing patients to share their personal data

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While bulk billing is becoming extinct as quickly as any creature the gap rises every year.

Fortunately a lot of clinics do not follow the AMA recommended RRP but most continue to track a few dollars behind it. The one I attend was bulk billing until a year ago and now trails the AMA RRP by some $20. Not looking forward to their response to this ‘recommendation’.

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The “doctors union” is commonly called “The greedy doctors’ Association”, however with high running costs, bulk-billing doctors seem to be underpaid nowadays.