Business sustainability has become a major issue for general practice, particularly following the Medicare freeze. Can mixed billing help?
In March, the RACGP hosted a webinar that focused on how to introduce mixed billing into general practice.
Presented by President Karen Price and facilitated by Chair of the RACGP Business Sustainability Working Group Dr Emil Djakic, it outlined the benefits of a mixed billing model and how to manage the transition to mixed billing, including discussing fees with patients.
Below are some of the standout queries from the final Q&A session.
Practice membership fees
Are we able to charge a practice membership fee and bulk bill members?
You cannot charge patients a fee if they are being bulk billed for a consultation. However, one way to incorporate a membership fee into your billing policy is to privately bill the first consultation with a patient each year, and then bulk bill any additional consultations. You could also privately bill more consultations if you like. See Case study 3 in the RACGP’s Billing case studies for an example of how this could work in practice.
Discussing fees with patients
Are there any examples of ways to have conversations with our patients to explain/justify charging a gap?
The RACGP has an information sheet which provides advice on how to communicate with patients about fees, including tips for engaging in conversations about why patients are being charged a gap fee or why their fees have increased.
Many patients are starting to recognise the value of the care they receive from their GP, particularly as GPs have been there for their patients during the COVID-19 pandemic and their doors have stayed open. Patients have also valued the flexibility that telehealth consultations provide. The amount that people pay for general practice care compared to other health services is quite small. Patients who are paying out-of-pocket costs often don’t see this as a problem if they feel they are receiving value for money.
Is there any way for the patient to only pay the gap rather than pay the whole amount and then have to claim back from Medicare?
Unlike other forms of health insurance, current legislation prevents patients from paying the difference between their benefit (patient rebate) and the total fee for the service. Instead, privately billed patients are required to pay the whole fee and subsequently obtain reimbursement for their benefit from Medicare. The Health Insurance Act 1973 provides the legislative framework for the payment of Medicare benefits.
The RACGP recognises that only being required to pay the gap amount would make it easier for patients to afford fees. We have written to the Department of Health to express concern about the continued operation of the 90 day pay doctor cheque scheme. We understand the federal government plans to phase out the cheque system by July 2023.
The RACGP recommends the system be abolished by 1 July 2022, allowing GPs to be paid immediately via Electronic Funds Transfer (EFT) even if the account has not been settled in full. This archaic system is an added administrative and financial burden that GPs and patients simply do not need, particularly during a pandemic.
Unfortunately, there are no plans currently to phase out cheques before 2023 or remove the 90-day timeframe, as the government sees this as supporting bulk billing. This is because if a patient is unable to pay the full amount on the day of the consultation (rebate + gap fee), the GP could be left waiting up to 90 days to be paid. In that case the GP may choose to bulk bill the patient as a one-off.
The RACGP will continue to advocate where possible for this scheme to be reviewed.
It is important that practices clearly advertise their fee policy so that patients understand the need to pay in full on the day of the consultation.
Managing competing views on billing
What if different practitioners in the practice have different views on bulk billing? How do we handle that if one doctor wants to implement mixed billing?
If you are an independent contractor rather than a salaried employee, you should be free to determine your own billing policy, even if other doctors in your practice exclusively bulk bill.
If you are experiencing backlash from other doctors, talk to the practice owner/s about your intention to move away from bulk billing and your rationale for this.
The issue of employee contracts can be complex. GPs and practices should seek legal advice relevant to their situation if they are unsure if they or an individual is an employee or a contractor.
The RACGP’s General Practice Business Toolkit provides some information on the difference between an employee and a contractor in Module 5 – Your practice team. The Fair Work Ombudsman, Business.gov.au and the Australian Taxation Office also provide advice about the differences between employees and contractors.
It is important to remember that billing is a personal choice. If you have strong views on mixed billing but other doctors in your practice don’t feel the same way, they are not obligated to follow your direction and change the way they bill.
GPs who see a high proportion of vulnerable patients may be particularly reluctant to change their billing policy. However, the RACGP does encourage all members to think about your billing policy and whether it is sufficient to cover your increasing practice costs, as well as achieve an optimal work-life balance. Your RACGP membership gives access to a range of resources to help you manage your billing.
GPs want to do the right thing by their patients, but it is becoming increasingly difficult to sustain a successful general practice by bulk billing. We need to show our politicians that primary healthcare needs greater government investment, particularly to support patients who need longer consultations for more complex care.
Competing with corporate owned medical centres that bulk bill is difficult for small practices. Can our college lobby the government to stop these giants from eating up smaller practices? Shouldn’t we as a GP group cooperate to fight this type of bulk billing?
The RACGP does not have a position on corporate general practice. Our focus is on ensuring members are properly equipped to deal with funding constraints and manage their finances accordingly. Encouraging more GPs to privately bill (where appropriate) without fearing the implications is also a key priority.
Research suggests the trend towards larger corporate owned general practices may affect access and quality of patient care, however there is considerable debate about the impact of corporate practices. The RACGP recognises that our members work in a variety of settings, including corporates. If you work for a corporate practice and are an independent contractor rather than a salaried employee, you should be free to determine your own billing policy, even if other doctors in the practice bulk bill.
Universal mixed/private billing
Should we find a way for all GPs to unite and start applying fees at the same time or on the same day?
The RACGP’s position is that billing is a personal choice and there are many circumstances that can influence how a GP bills. We do not support a shift to mandatory mixed billing due to the potential impact on vulnerable patients.
We do not currently have plans to encourage a universal shift towards private billing, including for a set period (eg privately billing all patients for a day/week).
What change to the bulk billing rate will be needed to get the federal government to take any notice?
The RACGP believes the government will take notice of any reduction in the bulk billing rate, however it is likely that a consistent trend in reduced bulk billing will need to emerge to prompt action on primary care funding.
We would like to get support from the RACGP to have a team to support and address our billing issues and questions.
The Funding and Health System Reform team, which sits within the Policy and Advocacy business unit, is best placed to assist with queries about billing. You can contact the team via email@example.com and they will do their best to assist.
Members also have the option of joining RACGP Specific Interests Business of General Practice. For more information, contact RACGP Specific Interests via firstname.lastname@example.org.
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business sustainability Medicare Mixed billing
Certainly! The article delves into several key aspects related to business sustainability in general practice, particularly concerning the concept of mixed billing and its implications. Let's break down the main concepts addressed:
Mixed Billing Model: This involves a billing approach where a practice can both bulk bill certain patients while also privately billing others. The article highlights the benefits of this model, such as managing practice finances, but it also discusses the challenges associated with transitioning to mixed billing.
Practice Membership Fees: The article explains the possibility of incorporating a membership fee within a billing policy. It suggests privately billing the first consultation annually and bulk billing subsequent visits, showcasing Case Study 3 in the RACGP’s Billing case studies as an example.
Communicating Fees with Patients: There's a focus on effective communication strategies with patients regarding gap fees or increased charges. The RACGP provides guidance on engaging in conversations explaining the value of services provided by GPs.
Gap Fees and Medicare Reimbursement: The discussion revolves around patients paying the entire fee upfront when privately billed, instead of just paying the gap amount and later seeking reimbursement from Medicare. It outlines the limitations imposed by current legislation and advocates for the removal of the 90-day pay doctor cheque scheme to ease patient affordability.
Competing Views on Billing: It addresses scenarios where practitioners within a practice may have differing opinions on bulk billing. It emphasizes that individual practitioners, particularly independent contractors, have the freedom to determine their billing policies.
Corporate Practices and Universal Billing: The article touches on the challenges faced by smaller practices competing with corporate medical centers that predominantly bulk bill. It underlines that the RACGP does not take a stance against corporate practices but focuses on equipping members to handle funding constraints and billing decisions independently.
Government Notice on Billing Trends: It discusses the impact of changing bulk billing rates and how consistent trends might prompt government action towards primary care funding.
Member Support: The RACGP offers support through its Funding and Health System Reform team to address billing queries. Additionally, it suggests joining specific interest groups within the RACGP to access further guidance on the business aspect of general practice.
The article essentially underscores the complexities and nuances involved in billing practices within general practice settings, highlighting the need for individualized approaches while considering broader implications on patient access and practice sustainability.