Patients at Brisbane-based clinic Evercare don’t pay a gap, but they’re not bulk billed.
As practices move away from universal bulk billing in search of a business model that won’t send them broke, the idea of charging patients a monthly or yearly subscription fee in return for bulk-billed appointments has become increasingly attractive.
The only problem is that they tend to be illegal.
Under section 20A(1) of the Health Insurance Act 1973, when doctors bulk bill they must accept the Medicare rebate as the entire fee; i.e. raising any additional funds for that service goes against the law.
It’s an issue that GP clinic Evercare, which currently has one location open in Brisbane’s inner north, has managed to sidestep.
Patients pay a $45 monthly fee to the clinic and are technically privately billed; but the doctors only charge an amount equal to the patient’s Medicare rebate.
While money leaves the patient’s account – which it would not do if they were bulk billed – the exact amount is then repaid by Medicare within two days.
Their monthly fee also covers access to Evercare’s app, which handles the booking process, facilitates telehealth and stores patient scripts, medical certificates and test results.
It’s a model that practice owner Steve Dahl, who was previously with GP corporate SmartClinics, spent close to two years developing.
“We wanted to come into the market and do something a little bit different, given how challenged the market has become for clinic operators, particularly since covid,” he told The Medical Republic.
After time spent talking to Medicare – and a “reasonable amount of money” spent on a health regulation and legislative legal firm – Mr Dahl opted for the no-gap private billing model.
The way he explains Medicare’s reasoning is that if you were to fraudulently bill a patient privately for made-up services they would probably catch on pretty fast and alert the authorities, because they would see the money missing from their account.
But when patients are bulk billed, they might not necessarily notice that a doctor is claiming for fake services because the money doesn’t actually leave their account.
“There is potential there for Medicare to be incorrectly used if you’re just bulk billing patients, and that’s why Medicare is a lot more cautious and wants to put more restrictions around people who are bulk billing,” Mr Dahl said.
Evercare has now been up and running in the Brisbane suburb of Clayfield for one year and has around 2000 patients in its subscription base.
Patients, Mr Dahl said, had gotten the hang of the payment system relatively quickly.
“Once patients understand the flow of funds and how it comes out and it goes back in, they’re very comfortable and very happy with how that model works,” he said.
It’s also been a boon for the clinic’s GPs, who have a capped number of patients on their books.
“Part of our value proposition to patients is that they can get an appointment with their doctor in a very reasonable space of time … so patients are really loving the accessibility,” Mr Dahl said.
“The doctors are also reporting that, because they’ve got a defined and regular patient base, they’ve got a lower cognitive load.
“Because they’re seeing the same patients more frequently, the appointments are therefore slightly shorter.
“They’re also slightly safer, because they’re not seeing all of these new people all the time.
“The stress levels among the doctors are lower, and they’ve been reporting that they’re enjoying working.”
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The GPs also keep 100% of their billings.
“Because we’ve created a new revenue stream [with the subscription payment], we’re able to uncouple the billing side of [the business] from the membership fees,” said Mr Dahl.
Each doctor manages their own billings, meaning they receive their fees instantly rather than waiting for the clinic or an intermediary service to do reconciliations or take a cut.
While Mr Dahl has visions of taking the Evercare model nationwide, he told TMR the next phase of the practice would be firmly rooted in southeast Queensland.
“The next test for us will be to get the model working in a multi-site environment within a fairly manageable distance from the current clinic,” he said.
“Then there would be no reason why we couldn’t pop up other clinics in in other cities and other states.”
