Practice Management: Evolution or Revolution
The Rise of the Business Manager
Dimitri
Welcome to the latest instalment of our Rural Health Webinar series. My name is Demetri and I will be hosting tonight's webinar. Tonight's webinar will explore the key elements of running a successful rural general practice. The webinar is presented by Brett McPherson. Brett is the director of Hogan McPherson Consulting with more than 30 years' experience in healthcare practice management. Brett consults widely to medical practices and is regularly sought out as a speaker around practice business management.
We would like to begin tonight's webinar by acknowledging the traditional owners of the lands on which we are coming together from, and the land on which this event is being broadcast. I would like to pay our respects to the elders, past and present, and would also like to acknowledge any Aboriginal or Torres Strait Islander people who have joined us this evening. RACGP Rural will also like to thank our sponsor, Medical Insurance Protection Society. MIPS membership includes comprehensive indemnity cover for the provision of health care to individual. MIPS exists to promote honourable practice and protect the interests of its members. MIPS provides a range of benefits in addition to insurance covers such as the 24-hour medicolegal support and accredited risk education workshops. We greatly appreciate the support of this webinar series.
Before we begin, a few housekeeping things to cover. The participants are set on mute to ensure that the webinar is not disrupted by any background noise, but of course, we do encourage you to all use the Q&A function to ask questions. When using the Q&A function, we do ask that you address your questions and comments to all panellists and attendees rather than just the panellists, so that everyone can see your questions and comments. Finally, the webinar has been accredited for one hour educational activities CPD. To be eligible, you must be present for the duration of the webinar. We also kindly ask that you complete the short evaluation at the end of the webinar. This should only take a few minutes to complete and will help us to improve the format and content of future webinars. By the end of this webinar, webinar participants will be able to outline the difference between a practice manager and a business manager; identify the key competencies of a practice business manager; identify five key challenges facing managers in the next three years; highlight the differences and similarities between managing a rural practice and an urban practice, and provide some tips and tricks to enhance your effectiveness as a rural practice business manager.
For now, I am going to hand over to our presenter for the evening, Brett McPherson. Thanks, Brett.
Dr Brett McPherson
Thanks, Dimitri, and thank you everybody for attending tonight and taking the time out to do this. Hopefully, you are going to find it useful and beneficial. We have got a lot of information to go through, but what I would say is that a copy of this presentation would be made available to you afterwards, and I am sure Dmitri will be able to circulate those. One of the things is, and then this may not be so much as we are on a webinar as opposed to a face-to-face environment, but I also find that this this slide to me was really powerful when I first saw it and basically just says that we can have alternate views, and that at particular times some of us can be not necessarily wrong and not necessarily right. Just something to remember. As we are heading into 2024, I think that the key thing is that we are going to have to reset, rethink, reimagine. There is no doubt that the pandemic, even though it was a number of years ago, really has had a significant impact on healthcare in Australia. It is about how we deliver healthcare. It is about patients' expectations around how we deliver that care. Also, it has made practices think about the model of what is actually going to make a successful practice. I think if we do not change, we are going to fail. The one thing I forgot to mention at the beginning is if in that Q&A thing that Demetri was saying on the side panel, if you actually just put your name, your role, whether you are a GP, a GP owner, practice manager, and perhaps where you are from, that will give me a good me a good scope of the kind of audiences that we are dealing with tonight. Thank you for that.
One of the main things I would like to say is that we now need to realise that medicine is a business, and your practice is a small to medium enterprise. Depending where that practice is based, that can be a significant component of the community. When I first started out in management, I was managing some corporate radiology practises across Tasmania. Some of those practices were quite large within rural areas, and we actually realised that we were actually a fairly large employer within the region. You are actually utilising local businesses, so you did have an impact as to where you were based. Over time, as health has developed, practices have developed. We have come to find that historically people running businesses were known as practice managers. Over the last, I think, probably five years more so there has been a change in the role of a practice manager as it evolves into become a business manager. What we are saying here is that the practice manager tends to be more around the operational management within your organisation within your practice. The business manager is actually working more on the business and looking more at your development of the practice. From my experience, more so what we are now seeing is that practices may have a business manager, and they may have an admin coordinator and a nurse coordinator, so that those particular people are looking after particular aspects of the business whereas as I said, on the management side of things, the manager of the business is actually starting to look at how you are actually working on developing the business, and that is increasing in the recognition of the roles that the managers of your business. If you are an owner of a business, that is something to consider about people running your business. If you are actually a manager in a business to consider, whereas in fact, you are actually a practice or a business manager, combination of both. The other thing is that I think it is important to consider that what are the roles that, as a manager in the business, you actually undertake? As I said, as a small to medium enterprise, we are actually as managers, and I am talking now from a manager because my main experience has been in managing practices and consulting around managing and practices. There is nine key responsibilities and components that go into making that overall role, and they vary from Financial, HR, Management, IM, Compliance and Business Operations. I think the thing is, as if you are a manager or you are employing a manager, these are the type of things that you are wanting your manager to undertake during their daily work and their monthly work. Probably we may not be good at all of them. Some of us will excel in Financials. Some of us will excel in Business Operations, some are really good at HR. I think it is important as a manager, we identify those skills that we have and are strong at, and then what we need to do is either improve our capacity and our skills in those that we are not or we outsource to others that allow us to understand or contribute. We might get a bookkeeper in around Financials. We might engage a HR management consulting group externally, so where you are strong, you are strong. I think it is not a weakness to identify that we are not as strong in that area, but we need to be able to ensure that we cover all of these particular skills.
What do I see as our major challenges within a practice over the next three years? It used to be five, but I think that health is such a constantly changing environment that to think longer than that we may think longer to five years on a really high level, but I think a realistic is probably more three. The realistic nature of health within Australia is that some of our health policies are linked to the cycle of the political environment, so that as politics may change and political parties may change, then obviously the structure of the policies, the direction of health may also change. My five, and I will talk about these tonight, are listed there, but they are talking about leadership. They are talking about sustainability and workforce direction, innovation and reform.
Now, the first one I want to talk about is planning and leadership. I suppose as a premise of this is when I think of people and I say, well, how did you get here today? You have obviously made plans to be here tonight between, 7.30 and 8.30 in those states that have daylight saving. If you are in Western Australia, it is different and that sort of thing, so you have actually had to do some sort of planning in order to join tonight's session. Now, you may not think that is amazing, but that is kind of a really small plan as to how you get here. It kind of mirrors why you would need a plan in your business because if you think about it, to be a successful business, you obviously need some sort of plan. Remembering back that we now recognise that we are a small to medium sized enterprise, we need to adopt some business principles in how we actually run and operate our business.
Why a business plan? Having a business plan could be another whole session. It could be anywhere from three hours to a day about creating a business plan, but I like to just think about it as it is a bit like when you get in to your car and you are going somewhere. You have got the destination in mind. These days all we do is we tend to plug in the destination to our satnav or something like that, and it tells us where to go. That is actually just an IT type of business plan that is taking your plan that is getting us from A to B. Along that way, we might find that there might be unavoidable traffic delays, there might be barriers, we might have to take detours, but in the end, we are going to get there. In the old days, for people who can remember, we used to have the A-Z. We used to have the Melways, we used to have that sort of thing that would allow us to create a plan. In your day-to-day roles, we actually do need a business plan because what that does is it focuses where we are going. It actually provides your manager or the manager there with some sort of focus as to where they are going or what they need to do. It also has some agreed goals, targets and the outcome, if we achieve it, it is actually going to increase our performance and increase our profitability. Going back to focus. What we think about is a lot of the times, and this is where the manager or practitioner or anything, I kind of like this because the thing is, there are so many things out there that are constantly bombarding us from the side. If we think about it, what really matters is that around the patient experience, is it around financial profitability? It is what you have decided are the ones that really matter. There are also those things that we can control. As much at all as we may not agree with the MBS rebates or the MBS interpretations, the thing is, we cannot control them. We need to live with them. Therefore, we can expend a lot of energy trying to think or not being happy with them, but in reality we are not going to change them. That focus is where what matters and what we control intersects, and that is where really we should be focusing our energies.
Then the other thing coming back to the practice manager and the business manager. There is a real difference between leadership and management. There are significant and multiple articles available around this. I think Peter Drucker, who is a world famous management and leadership consultant or advocate from the US is when you think about management is doing the things right. We get a list of things and we just do it, but leadership is about doing the right things. We have actually had to filter about yes, no, we can do this. No, we cannot do this. Yes, that is the right thing to do, and then we can delegate that to the management side of things such that they are then able to look at and lead our groups as opposed to managing our groups. The successful practices will have a leader that can be your manager, that can be the owner, that can be a significant GP within the practice. That leader is the one that kind of directs things the way we are going. They are really driving, and then our manager is making sure that we are just doing those things. One of the other big things I think about that is really confronting practices at the moment is around the workforce and sustainability, especially in the rural setting. My history is that that for a number of years, probably 20 years, I was based in Melbourne. Prior to that, I was in northern Tasmania doing corporate radiology. I hae now relocated back to southern Tasmania in the Huon Valley. For those who may know where that is, it is about 30 minutes south of Hobart. We are really based in a rural area of Australia. My wife manages practices, and she manages the two most southern general practices in Australia. I have a really good understanding around the traumas, troubles, struggles that we have in recruiting through rural areas because we are really battling to get GP's into a rural setup. As an anecdote, one of the sides in Tasmania, which is a problem is that a number of years ago, when they reviewed the MM ratings, Tasmania became and it is now called DPA, Tasmania was a total DPA. It does not matter whether you are on the West Coast or in the major city of Hobart, it is the same. I understand that is being reviewed at the moment and hopefully, dare I say, some sort of sanity may come back into how they categorise particular areas and where and how we can get practitioners to come in. What I would say is that if you are looking to try and get a GP into a non-urban area, one of the key things that you need to remember is that you are actually recruiting the family. For the actual practitioner that is coming, whether they work in a practice, Melbourne, Sydney, Brisbane, Hobart, Port Hughes and Huon Valley, Adelaide and Barossa Valley. Once you are actually in the practice, they are probably going to have a significant similarity in what is practiced, but the critical thing is, whilst they are at work, what is their spouse doing? What is their family doing? It is important when you are thinking about recruiting that you are actually thinking about not just the GP, but those that are associated with them. The family that comes with them. What are you selling? Are you selling the lifestyle? What are the educational opportunities that exist where you are? What are the opportunities with employment for the spouse? Those are the sort of things. A number of years ago when I was working in radiology, we actually went to South Africa to recruit radiologists to come to Australia. One of the key things was what is the lifestyle? What can then happen? Nowadays, and I will use my wife as an example. She had a registrar visiting yesterday that she picked her up from the airport with her mother, took her through, showed her the whole area, around the Huon Valley, took her to the practice. What's available? Where are they going to stay? What is the community? Everything else. It really is just outside of a putting an ad in. It is actually what is going to happen when they arrive. Similarly, with registrars. We are now talking about the new training programs. FSP, the international graduates and remembering that at the moment, Australia really is struggling with a GP workforce. If you go back to the pandemic, a lot of that was because for three years, we virtually took no IMG's into Australia. We have got that backlog of not having overseas doctors coming into the country, and now we have a significant number of practice across the continent now trying to recruit and attract those doctors into their practice. I am saying if you if you can actually, and I think registrars and training is a long-term investment because you are actually training them. If you give them a good experience, and it is not only the clinical experience, but I think also utilising the manager as to running sessions on how do you actually utilise the MBS? What is general practice outside of the clinical aspects. It is actually showing them more than just the clinical training that they get to undertake within their formal training. As I said, the other thing is also about we have recruited the family, but what does the GP actually want to do. What do they actually want to know? What is their clinical, they will have clinical aims, they will have financial aims. They may have speciality aims. They might be wanting to do Skin, they might be into procedural work. They might like the acute work that generally comes and the diversity that comes with rural. What I would say as a manager and for owners, this is where your manager can become exceptionally important about knowing the figures in your practice, and I will talk about that in a minute because it is not just about the clinical. It is also about, obviously there is a financial component. Then once you have actually got them recruited, we have then got the whole issue around red tape. We have got now the DPA, we have got AHPRA, we have got the RACGP. One of the struggles that we have at the moment and one of the other things is that they are actually sitting on one of the RACGP Advisory Groups and we actually had a meeting last week and we were talking about, some of the barriers that Australia currently has. From my own personal experience now running practices here in Tasmania, we have recently got a UK GP that has arrived. It has taken 12 months and a significant financial commitment. Apparently, attracting overseas doctors, we have real competitors in Canada and New Zealand because a number of those doctors can actually achieve recognition, registration and relocation within three months at a significantly reduced financial commitment. We need to be aware of that as to what we are battling.
Finally, within your practice, what is your competitive edge? It may be a manager. It may be where you are. It may be the type of service you are doing, but understand what makes your practice different than other practices that that particular GP may be looking at. I am going through that at the moment with regard physically where I am here about the practitioner in southern Tasmania versus a practice in the north of the state. You have got to understand where you are. When I was talking about understand your figures, what I am saying is one of the common conversations that we have when recruiting a practitioner or dealing with registrars is around the percentage service fee. Could I ask you, perhaps, to think about an alternate conversation, which puts it back onto the potential GP as to say, well, what is it financially that you would like to achieve as an annual net income. We said, well, okay, this particular person wants to achieve $275,000. We then say, well, how many hours a week do you want to work? How many patients per hour do you want to see? How many weeks per year? Now, if we know that 4 patients per hour, 27 hours, that is just under 5,200 patients per annum. If we know what our average fee per patient is, and say it is $90, and that is not an unreasonable amount these days. Then based on that we would expect that practitioner to gross $460,000, and if there was a service fee of 65%, they would achieve $300,000. So, they are exceeding their annual net income. The conversation can go that look, we would expect that if you are able to see that number of patients per hour, work that number of hours per week, bill as most of the doctors, we would expect you to achieve that. We have not spoken anything about percentages. I think that is important. And then the other one would be, in order to achieve that, $275,000 means that they are going to have to bill around about just over $210 per hour. If we know that our average hourly rate per GP is #360, then 65% is $230 per hour. Once again, if you understand and know your practice and know your figures, you can have the conversation and confidently speak to practitioners and say, look, we honestly believe that you can achieve that if you achieve, and do what you are going to say. The other thing which now we are also utilising is as a component to, I have not mentioned it here, around attracting GP's or retaining GP's is, well, okay, we may have stepped incomes such that if they achieve a gross billing of up to a certain amount, the service fee is 30%. Once they achieve that service fee might be $300,000, the service fee drops back. It gives them an incentive to perform, and it allows you to provide an incentive to the practitioner to work and receive income for the practice. How do you achieve this? I am not sure if many people know, and there may be a number of people on tonight's seminar who actually have been and seen this tool, but one of the items we actually undertook as part of our subcommittee and business sustainability was developing the billing calculator, a really powerful tool. What it does is, this is a tool that is on the website that actually allows you to put in figures to say, well, if my desired income is X $200,000, my service fee is that, you can then go through the sessions. It will actually come up and tell you if that is an achievable outcome, and you can play around with this. There are plenty of opportunities. The second thing is you can also then work out well, okay, if desired income, how many item 3, 23, 36, 44 are you doing, and by working with that once again, you can do the same sort of thing as to how you achieve. A really powerful tool. It is available and for members of the college, it is freely available on the website. The way that it works, for example, here with a level B is that, you can put in what your practice fee, private fee is, how much pay would you expect? Item 23 is to be of the workload, it might be 60%, might be 70%. Once again, you can you can fiddle around and try different scenarios to give you realistic outcomes, but what it also allows you to do is, well, okay if I converted one of my level B's to level C, what would that imply? I will talk a bit about that a bit later on as well. That is where the website, as I said, is available, and this will be included in the handout afterwards.
The other thing to remember, if we are a rural practice, is do not forget when you are talking about income that we talk about the WIP incentive and the Doctor Stream. Depending upon the rurality of where you are and the MM location and how many years you have worked at that, you have actually got, an added income boost that goes directly to the doctor. Just be aware that there are changes coming in from 1 January 2024 or what it is going to mean is that basically if there will be now a differential between VR's and non-VR's. VR's will get the full amount. VR's is going to be around about 80%. Once again, if you have got a doctor that has worked in particular spaces, and remember to actually get your registrars to sign up with this, because the registrars can start including their experience from the terms that they spend in rural practices. They can start doing that and it gets added up.
That is the financial side of things. I also mentioned about consistency of message. In actually running a practice, this is one of the most, I think, important aspects for both internal for your staff and external to your patients. You have got to ensure that you promote and deliver a consistent message, so that all of your staff are delivering the same message all the time every time. I speak to receptionists and they are aware and patients and they are aware. There may be that one receptionist that you have in your practice who is just not quite as positive or affirmative or confident as others, patients know them really well, and what they will do is they will target those particular reception people to try and get what they want, but if we can say and we have the support of the others around them consistently, know this is the message that comes down to policies, training, support for that and as managers and owners, we have got to lead by example. We are the ones that they will look up to. Especially in the recent probably 12 months with the big move, I think from bulk billing to mixed billing, there has to be that consistent message whereby when a patient is booking for an appointment, there is that consistent message to say, we cannot guarantee you are going to be bulk billed. There is every likelihood that you are going to have an out-of-pocket expense. The out-of-pocket expense will be between X and Y, so that what happens is the patient then knows that there is an expectation of that out-of-pocket money. They come, they book, they go into the doctor, they see the doctor, they say, can you bulk bill me? All the GP that has to say is what were you told when you booked the appointment? Oh, well, there might be a thing. Well that is right, so you have turned up. There is nothing more disheartening from my experience dealing with receptionists when they have consistently passed on that message of, we are not a routinely bulk billing practice. You may have to pay. There will be an out of fee. They get to the practice. They book their appointment. They have been told that sort of thing. They walked into the GP, they come back out and they say, I have been bulk billed. The easiest thing to ask as a GP is, and I know that a lot of GP's do not like saying no, but it is what were you told when you booked the appointment? And if there was a gap, that is it, so really critical thing and that is what I am saying, within a practice, we have a lot of different people and roles from the owners to the practitioners, nurses, admin, different staff, different roles. What I would say to both managers and owners is please do not undervalue what your receptionist can actually tell you. They hear everything. They are the first people that people come to. They are the ones that patients lose the steam with. They are the ones that they tell the real thing, so make sure you know that you listen to your own staff and ask them, because they are the ones that actually see and understand what is going on. We are talking about consistency, now these people here are a group known as Dabbawalas, I do not know if people out there know about or have heard of Dabbawallas, but what I am going to say to you about consistency and quality. Dabbawalas are in Mumbai, 5000 of them and they deliver 200,000 tiffins per day, no computerisation, and a tiffin is, I suppose if you think an Indian version of a takeaway, it is that aluminium stacked takeaway. Their delivery system has been awarded six Sigma efficiency. Six Sigma is an American quality program, and to get Six Sigma is an extremely difficult achievement, but what it means is for these people that they make one mistake in every 6 million deliveries. Think about it, no computerisation, 6 million. Imagine if your practice was operating at that level of consistency. Hard to believe, but something to aim for.
The next part about is IT and Innovation. My view is that I think, and I have been espousing this for a number of years, that I really believe the future of healthcare is going to exist in mobile devices. It is starting to happen. COVID, certainly promoted an accelerated the use of telehealth, both video and telephone, but I think now that it has been utilised and embedded, it is going to be very difficult to draw back, but I think we have actually got to realise that the historical or conventional patient sits on one side of the desk, the GP sits on the other side of the desk or side-by-side is not going to be the long terme future of general practice or healthcare in this country. We are actually going to have to adapt and develop. Yes, there still will be that, but there are going to be so many other things that come that we are going to have to embrace, confront, modify within a practice. If we just look at what is currently available to assist practices in what they do, we have got all our clinical software. We have now got things such as accounting software, we have got MYOB, we have got our Xero. You have got that sort of thing. Now, the integration which brings from our billing software into our accounting software. We have actually got data analysis. We have got things such as, which have been around for a while, but things like Dragon Dictate, which allow you or practitioners to actually dictate notes and consult notes from spoken straight into clinical notes. I remember I worked with a GP back in 2010 who started doing this, and some people thought it was a bit strange to do it, but he was an innovator, and patients actually loved the fact that he would be face-to-face with them instead of on a computer, and they could see their notes going straight into to the clinical notes. It is a real advantage and that has improved dramatically. We have all these sorts of things. We have got better console which allows patients to fulfil or fill out pre consult items. I know some GPs have some issues with that, others enjoy it, modify it to your needs. The other thing I was saying within your practice is that perhaps on your website you might have things that are saying these are actually helpful apps which you might find useful as a patient, so we might have better health, we might have the travel documents, we might have, promote Medicare, myGov, that sort of thing. These are the things we start to need to be thinking about that how we can utilise technology that is going to benefit us and that is the thing. We need to actually embrace the technology and utilise it so that it benefits us as a practice. As I have said there, it is important we are going to find a way, if it is not, we will find an excuse, but in working with practices, and they say to me, what is the best online appointment system or what is the best script requesting system. What I always say is, as a practice, sit down and work out what you want to achieve. Then once you have worked out what you want to achieve, then go to potential vendors and say, how can you deliver this for me? Because then what they are doing is they are meeting your expectations and your needs, as opposed to buying something and saying, well, okay, now we have to modify to fit them, so take the time to work out what works for you. In the future, there is going to be a lot of telehealth and there is going to be a lot of video. One of the things I did before my current role was working with a GP in New South Wales who has set up a remote video Telehealth consult, but combined with that is what the GP would do. He said, I will go and do a locum at a particular location, which then means that he gets to become part of that community, but then once he once he moves away, he is able to continue to offer telehealth, and he could offer telehealth to a number of locations. He might have done a locum in Western Australia, one in the Northern Territory, one in Tasmania, but it starts to enhance the service that you as a practice can offer, and as patients are expecting that sometimes they actually physically do not need to come into the practice, then that could be an alternative, so we are starting to think outside the box, and then we have got things such as iHealth. We have got blood sugar monitors, we have got ECGs, we have got all these sorts of things which are now starting to supplement, which can be uploaded, and that is going to be the next challenge. We have best practice and our medical directors, how can they integrate Smartphone, Android phone devices and medical measurements straight back in to the clinical software, so this is the stuff that will be coming. The technology already exists, and the final thing is that we are going to start to see drones delivering. They are already doing in areas, so there is nothing to say that pharmacists whatever cannot, we have now got these scripts. They actually fulfil the script and they can then drone and deliver. Sounds farfetched, but if you remember back, one of the things we also talk about, those of you who may remember, going back to the comic, to the comics in the 60s and Dick Tracy would talk-in to his watch and everyone thought that was crazy, that is reality. It is not as far away as we may think, and then we got reform and this has started now, so basically my Medicare has started, and it started in a slow way, and I think that is a deliberate way from the Government to make sure that it actually works, but what I will say to you that we know that come November 2024, as part of chronic disease reform and as part of my Medicare, it is likely that you are going to have to have registered patients. What I would say to you, why not change your process now. If you have a CDM process, health assessment process within your practice that involves the practice nurse, why not get the nurse to say to the patient, can we register with you, or can we get you to register with my Medicare now? So take that trauma and uncertainty away from the patient and include it as part of your process, so you are doing it between now and November, that is 11 months. You have got time to do that, so there is not going to be a mad rush come next October to register all your patients. It is thinking, planning, that is part of your business plan to register our CDM patients. We will get them so they are already there. We know CDM reform is coming, and that is likely to be fairly radical from the Medicare review, but part of that is going to be with regard to the registered patient and my Medicare. It is also going to be the GP led team camp, so we have to start thinking how is that going to be incorporated without within our practice. It is to be successful, going to need to be GP led, but how do we incorporate nurses? How do we think about if we are in a rural area, we cannot get nurses or GP? What about nurse practitioners? What about looking at taking the long term? Maybe one of our nurses? Can we fund and help that nurse actually develop into a nurse practitioner? Combined with that, once again from November, we will have the triple bulk billing incentive. I am going to talk about that in a moment, but it is going to be, in order for practices to succeed, we have to have that financial sustainability, and that is critical.
As I said, the iHealth and the IT, iHealth is here to say, telehealth is here to stay. We are going to start to see virtual reality. AI is going to come in and already to a certain point, if you use a product such as Healthshare, they utilise AI and algorithms, and whilst it is positive in some areas, some of the GPs that that I work with have said depending on questions may lead you in a particular way, which may not necessarily be correct, but if that is the case, what I would say is feedback to the vendor or the provider to say, look, I have got issues with this. Google Glass, which is supposedly the big thing and probably in the mid 2015 or so is going to have a renewed interest whereby GPs will be wearing these things, and images of scans, results, etc. are going to be portrayed in front of them. These are the type of things that are here which are going to be incorporated, I believe, into health sooner rather than later. For some people, that is a challenge, but what I am saying is, if you have a good management team and a good manager, they are the sorts of things that we can be starting to say, but look, by 2025 and the 2024, these are the sorts of things that we need to be planning for to be incorporating into a successful practice. Because the adoption of technology, the adoption of telehealth, it is ultimately what the patients are going to be demanding of us, especially in those rural settings. Why is a patient going to drive an hour, potentially wait 20 minutes, for a 15-minute consult that they physically did not have to be attending to, and then drive an hour back, and what I would say to that is that do not be afraid to bill for that service, because there is the cost of time, but is of benefit to the patient, and in order, if we understand our processes, and we can actually identify what makes our particular practice, our particular business unique. Once we have got that, that creates that unique advantage that we have and we cannot fine tune it. We need to measure it, for most people I know will be measuring, we have SMART goals. SMART is just an acronym for Specific, Measurable, Achievable, Realistic, and there is plenty of information about those. The other thing about benchmarks, all I would say is that we have external benchmarks and we have internal benchmarks. I tend to focus a lot on internal benchmarks because that is what we as a practice have set for our budget and what we want to achieve, and if we are achieving those, then we are being successful. If we choose to pay our staff 20% above award, so be it, that is our benchmark. Yes, we need to know what may be happening out across the whole of general practice, although I would say that external benchmarks are not done well in health, so it is important that we, as our own practice, set particular roles, what percentage of my budget do I want my staffing to be? What percentage of DNA's do I want to have? All those kinds of things can be achieved and measured internally, and that is going to mark your success.
Coming to the end, what I want to talk about is mixed billing and those who have not moved to mixed billing, and a lot of times I find doctors think that we have got to change a whole lot of things, all I am going to say, where are you now? Where do you want to be? So, if you are at the moment bulk billing 90% of your patients and you want to get to 40% of your patients, you only have to change. Currently you are privately billing 1 in 10 where you want to bill 6 in 10, so what it means is we have to bill 5 out of our 10 patients. It is not everybody. It is just a number of patients who we need to target, 1 in 2. The other thing I mentioned also about the triple bulk bill, and many of you may be aware of this, but what I would say to you is that having moved to mixed billing, and if you have an out-of-pocket expense for those patients who are not bulk billed, or even if they are bulk billed, if your out-of-pocket is currently $40, then none of those triple bulk billing incentives will actually achieve that, so all the hard work you have actually done in converting patients from bulk billing to mixed billing, potentially could be undone if you adopt that. What it has meant is that in particular circumstances, if you do choose to bulk bill, then the loss is not as significant. In closing down, the four things that I would like to say, and this is about improving your income, if it is a practitioner, you can do one extra consult per day or as a practice manager, you can get your practitioner to do one. We will say the average fee $85 once a day, four days a week, that is about $16,000 a year. If you can convert an item 23 to an item 36, and I know a lot of lot of practitioners become wary and hesitant about potential audits and that sort of thing, but if it is only one, it is not going to make a difference, but basically you have got nearly a $40 increase in the rebate, and potentially most practices have a higher gap, so there is kind of a double whammy in increased rebate and increased gap, and it is only moving one patient a day with 23 to 36. We are talking $15,000 a year. What about if you could get your practitioners to do one home medicine review a week? Found to be an extremely useful tool in medication events and what patients actually have and can be incorporated as part of your chronic disease health assessments and that sort of thing, another 8000, and then if we start to build medical consumables, and if we did $50 a day from getting back from nurse time, from dressings, from whatever, and bill the patients, and recently a practice that I am working with, we have actually started to increase, and what the patients have actually said is I am surprised you have not done that before, so do not be afraid of patient what they might say, but what that means is those four items have basically meant, and this is per GP, the individual GP has increased their take home income $25,000 a year, and the practice is around $23,000 a year. That is based on the assumption that the medical billings will come directly to the practice. Most or the average practice I think is around 4.4 GP's, so you are actually talking about nearly an additional $100,000 per practice. We have not changed the fees. We have not put up fees. All we have done is worked a bit smarter with our practitioners as to how that can do, so both the GP benefits and the practice benefits, and as I said, we have not put fees on, so what am I saying about rural practice? Basically the challenge is you have a limited supply of services, it is difficult to get GPs, it is difficult to get nurse practitioners, it is difficult to get support staff. A lot of admin and management staff have actually left as a result of COVID, extremely difficult, far more difficult than in an urban practice. Your cost to deliver the service is higher. You have reduced options in providers. Communications can be challenging. How good is your internet? It is based on the fact that we depend so much on internet, and whilst it may be really good between 9 and 3, when all the kids get home from school at 3 o’clock and they all get on, there is a dip in the way that your system starts to perform between 3 and 5. One of the benefits is as part of the community, the community relies on you to provide services, and so what I think you need to do is and one of the real things that I found out from rural areas is you tend to be far greater or better at innovating and ingenuity. You actually become solution focused. You actually look at ways to do things, and that is one of the real benefits I think in rural, one of the real benefits is that sense of worth and contribution, and that can be one of the things you actually promote to potential people or doctors coming in.
In summary, what I would say is be informed, understand your practice. If you have got a manager, make sure that they understand those things around what is the average hourly billing rate, what is the average fee per patient because you can turn that conversation around away from service percentages to income generating. Identify the opportunities that exist within a rural area and the community that it does. You will have to challenge the norm. Think outside the box. Going back to telehealth, going back to how we can do it, and then the other thing is actually make a decision. Think about what you need to do, and actually one of the big things is if you are an owner of a business, please act promptly. What I would say is, even if the decision is no, it is much better to say no because that can actually be a positive decision and then for those people coming exceed their expectations. The example I will use, as I said, practice manager down here I know picked up a potential GP from the airport, drove them around all the way to the practice, spoke about, showed them schools, showed them community and it was all about lifestyle outside. It was having locums that come down, having a welcome hamper or something like that that means their first night they are there, they have got food, that is what they will remember, and that gives you that potential to actually recruit.
I will leave you with that thought from Barack Obama because we need to be the ones that are going to influence change. As I said, resources are available. There are some of the resources available from the RACGP on their website. This will be made available, so you can check those things. In the end, I would just like to say thank you to MIPS for making these and providing these sorts of things. Dimitri, I am going to hand back over to you.
Dimitri
Fantastic. Thank you so much, Brett. That was an extremely informative webinar. As Brett mentioned, RACGP would like to thank our sponsor again, Medical Insurance Protection Society. Their details are on this slide. A reminder to please complete the evaluation that will pop up in a moment when the webinar closes. It will only really take no more than a minute to complete. Certificates of attendance will become available on your CPD statements within the next few days. For any non-RACGP members who would like a certificate of attendance, please email rural@racgp.org.au, and lastly, our webinar schedule for 2024 will be available on our website soon, so do not forget to tune in to our other free monthly webinars, which are held on the first Thursday of every month, and on that note, I would like to end the webinar for everyone. Thank you all for attending and have a wonderful evening. Thank you and good night.