Report shows potential for targeted general practice investment

Targeted changes to bulk billing incentives and Medicare indexations have helped to arrest spiralling bulk billing rates, according to a new analysis of general practice billing trends.
 
Released on Tuesday, Cubiko’s 2023 Touchstone General Practice Industry Report analysed 811 general practices across Australia, focusing on their practice performance, billing methods, and the patient experience.
 
Its data shined further light on the financial pressures facing general practice, while also showing a direct and immediate correlation between funding and the ability to provide patient care.
 
The report revealed in January 2022, 60% of the practices it investigated bulk billed, compared to 26% less than two years later.
 
But November’s tripling of the bulk billing incentive for concession card holders also coincided with an increase in billings per hour for GPs, as well as an increase in the bulk billing rate across affected patient cohorts.
 
It labelled this a ‘remarkable turn’, with the increase in billings per hour in November the largest rise in a single month across the past two years.
 
‘An increase in billings per hour signifies an improvement in financial sustainability for practices, and overall, the triple incentive to bulk billing has seen a dramatic improvement to practice sustainability,’ the report said.
 
But while the stabilisation appears to have helped ease access issues for vulnerable patients, it has far from solved the problem.
 
Instead, RACGP Vice President Associate Professor Michael Clements told newsGP the statistics show that government can improve access through additional funding – and that similar investments must now be considered.
 
‘This is a good example of policy that works – they wanted to give more people in different demographics and in rural areas access to care, and they incentivised it and they got the behaviour,’ he said.
 
‘The data shows quite a stark turnaround, so for the people who hold a concession card, or pensioners, or a child, or those in more rural areas, they had a much bigger change in behaviour compared to those in urban areas, which makes sense for this incentive.
 
‘We need to recognise this was a bit of a test case for the Government and it’s proven the concept that where they choose to fund, we will see a change.’
 
RACGP immediate past Vice President Dr Bruce Willett was quoted in the report and described the change as a ‘desperately needed shot in the arm for practices’ but said rates of subsidised care are unlikely to ever return to their former peaks.
 
‘Previously, GPs have subsidised from their own pocket services to these groups, which generally require the most complex care and are the least able to pay,’ he said.
 
‘As expected, the tripling of the bulk billing incentive has not lifted the universal bulk billing rate.
 
‘In the future, governments will struggle to make an impression on the universal bulk-billing rate.’
 
The report states that the high number of practices making the switch to mixed or private billing in the past two years – more than half those captured in their research – reflects a ‘necessary response’ from owners to ensure the viability of their practice.
 
‘The decline of bulk billing and the increase in out-of-pocket fees isn’t just affecting regular patients, but it’s also having an impact on the concession card holders who are most in need of subsidised healthcare,’ the report said.
 
It also pointed to increased private fees across the industry but said this trend has been key to the survival of general practices nationwide.
 
‘If practices can’t keep their doors open, patients’ access to primary care is jeopardised, potentially leading to additional strain on the hospital system,’ it said.
 
‘A healthy and financially sustainable general practice industry is essential for ensuring viable healthcare access across Australia.’
 
Associate Professor Clements said recent Federal Government investment suggests it is focused on targeted funding commitments, rather than broad-based spending.
 
However, he said the key to success will be ensuring that additional support, on top of what has already been funded, flows to general practice.
 
‘There needs to be new money – the current overall health spend on primary care needs to increase as a percentage of GDP and as a proportion of the money that’s spent on hospitals as well,’ Associate Professor Clements said.
 
‘We are at a really critical time, and it feels like Medicare and the current system was left to rot, but it only failed because it was underfunded.
 
‘Funding needs to go towards the general practice model of care with GPs at the centre, conducting traffic and providing that holistic care.’
 
The report added that when the MBS is indexed, private fees do not increase at the same rate and patients are left better off with lower out-of-pocket fees.
 
‘Overall out-of-pocket fees for patients have steadied or reduced in some cases, leading to more affordable primary healthcare for patients,’ the report said.


The data shows Medicare rebates do not cover the costs of patient care – an issue the RACGP is calling to be resolved as part of its pre-Budget Submission 2024–25.
 
The submission calls on the Government to rollout a 20% increase to all Medicare rebates for Level C and D consultations with an additional increase applied to MMM 3–7.
 
It also is calling for a 20% increase to Medicare rebates for general practice mental health items.
 
Ultimately, the report highlights the need for state and federal governments to adequately fund general practices, with many operating as small businesses trying to make ends meet.
 
‘The evolving landscape of healthcare has seen notable shifts, shaped by changes in policies, resource allocations, and evolving patient needs,’ the report said.
 
‘As the industry has gone through this tremendous transition, and an adjustment in patient expectations, we see a positive outlook for practices as they move further towards sustainable models.’
 
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