‘I am concerned’: Practices warned about patient memberships

A growing number of GP clinics have begun charging membership fees for patients to access bulk billing, as the cost-of-living crunch makes practice viability tougher than ever.
 
However, the trend has drawn a concerned response from the RACGP, which is reminding clinics such fees are not allowed and could be exposing GPs to significant risk.
 
According to new Cleanbill data, released this month, 98 medical centres across Australia now offer bulk billing to all their non-concession adult patients, on the condition that they have paid a membership fee – contrary to unambiguous guidance on the Medicare Benefits Schedule.
 
‘If a practitioner bulk bills for a service the practitioner undertakes to accept the relevant Medicare benefit as full payment for the service,’ it states.
 
‘Additional charges for that service cannot be raised.’
 
Practices captured in the Cleanbill data are charging on average $77.94 per year, but these fees change significantly depending on state or territory.
 
The lowest are in South Australia, where a singular clinic is charging $60, while at the other end of the scale, patients in Tasmania are being asked to pay as much as $167 per year to access bulk billing.
 
Around 40 clinics in Victoria charge an average of $70.79, while the average is $86.31 across 30 clinics in New South Wales, and $72.94 among the 18 Queensland clinics requiring memberships.
 
The Department of Health and Aged Care (DoHAC) confirmed to newsGP that practices charging an annual administration or registration fee to guarantee a patient bulk billed services are breaching the Health Insurance Act.
 
‘The department takes allegations of non-compliance very seriously, and where concerns are raised, they are reviewed in accordance with the department’s compliance assessment procedures,’ a spokesperson said.
 
The department also noted that practitioners must accept the assigned Medicare benefit as full payment of the medical expenses for the service, and additional charges for a bulk billed service cannot be raised.
 
RACGP Vice President Associate Professor Michael Clements said the research serves as a warning to GPs and practice owners alike given the Government’s guidance is clear – there cannot be an out-of-pocket fee as a prerequisite for a bulk billing service.
 
‘What concerns me is that if a practice was investigated, the Government would be seeking to recoup the Medicare rebates from the doctor who billed them, not from the practice,’ he told newsGP.
 
‘I am concerned that doctors who are working in practices who have a practice policy to charge these fees are actually at risk.
 
‘This means a lot of our members are certainly at risk of being caught out if they’re part of a practice that’s been doing this.’
 
The rise in membership fees comes as non-referred bulk-billed GP services continue to drop, reaching 76.5% from July to September last year.
 
At the same time, the number of patients who delayed or did not see a GP due to cost doubled in 2023, with young people the hardest hit.
 
Associate Professor Clements said the membership fees come in the wake of practices facing rising costs at the same time as being busier than ever before.
 
‘Not only have some practices been charging these membership fees, but they’ve also been charging consumable items,’ he said.
 
‘I’d certainly encourage practice owners to review their billing procedures with their medical defence organisations in light of the additional media attention on this issue.
 
‘It’s certainly something that we know the Government is aware of and will be easily discoverable through an audit.’
 
At the same time, the RACGP’s latest Health of the Nation report laid bare the reality facing practice owners, with 81% now concerned about their clinic’s viability.
 
Apprehension over the short-term viability of practices also almost doubled in one year, up to 22% of owners in 2023, with their main concerns being profitability and increasing business costs.
 
But according to Cleanbill researchers, while the membership fees may appear to be an equitable way for clinics to remain economically viable, they can instead limit new patient accessibility.
 
‘Under a membership fee structure, the out-of-pocket fees that would ultimately be paid to the clinic over a course of care are concentrated in the cost for an initial appointment,’ their report concludes.
 
‘While this is preferable for regular patients, any new patient seeking a one-off appointment has to cover a significant upfront cost to access the clinic that might otherwise be defrayed over multiple appointments.’
 
The DoHAC encouraged GPs wishing to clarify bulk billing requirements to contact the AskMBS advice service on askmbs@health.gov.au.
 
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Benefits billing bulk Cleanbill MBS Medicare Schedule