A big new tax ruling affecting GPs, a crackdown on bulk billing consent and a former columnist doubles down. Season’s greetings.
If you’re on the Strengthening Medicare Taskforce and you were still intending on keeping your promise of getting back to GPs before years’ end with something heartening about the future, you could probably now be excused for letting things slide a bit longer and leaving GPs alone to enjoy what they can over the holiday break.
Any minor holiday hope that the Taskforce may have been able to bring to the profession would surely now be extinguished by Thursday’s release by the ATO of a comprehensive draft ruling on who is an employee, Tuesday’s discovery that Services Australia put out an update with a 31 December deadline on GPs needing to go back in time and get a signed release from patients every time they bulk bill, and Wednesday’s return to contrived GP bashing by Nine newspapers – “Little Frauds” – complete with a video of Dr Margaret Faux suggesting we should all cease asking her and Nine how they actually got to a figure of 30% of Medicare being rorted by doctors.
Good grief.
How to hold Medicare together: more and more red tape will do it
I argued just last week that asking state revenue offices to change the law around payroll tax just for GPs was not likely a winning strategy for the RACGP and AMA. Dr Bruce Willett from the college’s Queensland branch subsequently commented:
“I do not think we should raise the white flag on this issue. I make no apologies for putting in hundreds of hours trying to improve the situation here. This is a massive problem for private general practice. Applying payroll tax to general practice in this new manner threatens the viability of private general practice”.
Initially I was going to write back to Dr Willett to point out that SROs weren’t changing the law on anyone, the law was just being clarified and applied.
But I would have been missing his point entirely I think. His point is: “this is a massive problem for general practice”.
And it’s just one of many “massive problems” now building for general practice.
The new draft ruling this week put out by the ATO on how you decide if you are an employee or contractor is just the ATO trying to make the law as clear as it can. But like payroll tax, it just so happens that the clarification and ruling is largely not along the lines of how most GP practices have structured themselves over the last couple of decades.
What other clarifications are coming GPs’ way this holiday season?
Well, this week someone finally read the last line (feels like fine print) on a subclause of an MBS update put out by Services Australia:
You need your patient’s agreement to bulk bill the items, before we can pay you the Medicare benefit.
You can get their agreement either:
- in writing
- by email
- verbally during the consultation.
If you get verbal agreement from your patient, you must write:
- ‘unable to sign’ in the Patient signature field
- why the patient is unable to sign in the Provider field, for example COVID-19.
You must keep a record of the agreement.
Getting verbal consent is a temporary policy measure. This finishes on 31 December 2022.
(Our emphasis).
This regulation isn’t something entirely new to GPs. But revisiting it with this clarification with a deadline within a few weeks when it’s been let slide for so many years is not cricket.
The likely reason Services Australia is doing it is legal ass-covering. They are plugging a possible loophole they could get caught out on based on the payment flows of Medicare, where essentially patients need to be seen to be assigning the money Medicare gives them to GPs.
So Services Australia has gone to the cupboard, got out another roll of red tape, and is wrapping it around that part of Medicare that it thinks might be a bit too loose still.
One more example of the goings-on from this week.
Yesterday, TMR released a guide around 8000 words long on why it probably is a good idea for tenant GPs to get themselves a decent public-facing website and how to do it (click on this story to request a copy). The guide isn’t that long just because I’m hopeless at being succinct (which I am). It’s that long because we had to explain how some pretty obscure detail of several federal and state court cases, woven together, does lead to the conclusion that having a website is actually worth the trouble you will need to go to.
Getting your own website isn’t that big a deal, is it? (Our guide attempts to guide you through the process, which isn’t by itself that big a deal or cost).
No, but when the majority of GPs working in practices don’t have a website you’re looking at most GPs in the country having to worry about it and add it to their rapidly building list of red tape things to do, some of which, as Dr Willett points out, aren’t as simple or inexpensive as getting your own website.
Something not as easy as a website but not as hard as restructuring your whole practice for payroll tax compliance – per the new interpretations of the law of most SROs, and now, per the new ATO ruling this week on employee versus contractor – is having to reorganise your practice administration to make sure you have a signed patient consent form every time you bulk bill, and that the patient has their own receipt.
If you are going to meet this revisited but new red tape demand, as Services Australia is asking you to do, by 31 December, well, that’s quite a bit of work, worry and expense.
Not to forget the ongoing time and expense it will add to your practice, which will be one more bite out of your profit in perpetuity (if you still have any).
Uncoordinated governance demand is killing general practice
Taken by themselves, many of these new demands from a state and federal regulatory bodies to meet their expanding need for compliance are usually doable (payroll tax compliance is possibly not doable for everyone depending on their circumstances).
But taken together, the convergence of demand and need really is starting to suffocate general practice.
A key problem is that none of these government bodies are doing any co-ordinating on what they are asking from GPs.
They have a need and they want GPs to fill it. They aren’t noticing all those other needs criss crossing theirs, the conflict, and the evolving dysfunctional big picture.
The ATO is making new rules which partly co-ordinate with the state revenue offices but mostly don’t co-ordinate well.
The state revenue offices aren’t co-ordinating with anyone, not even other states.
And then various relevant government departments, such as Services Australia, the Department of Health and each state health department are exercising their own agendas, again with little thought about the combined load that is being placed with increasing momentum on the profession.
The sum of the parts of all this convergence of governance demand on GPs is why Dr Willett was arcing up and suggesting we are just going to have to change the law for GPs.
He, I’m guessing, is a bit overwhelmed and wants to start somewhere.
It’s probably still not the way to do it – you tend to get the public and governments offside when you ask to change the law just for your profession – but the problem is very real.
Back to the Strengthening Medicare Taskforce
In the context of the above, I hope the Strengthening Medicare Taskforce is thinking a lot more laterally and holistically than they have been so far.
Please, take the holiday break to think a bit more about this broader problem facing the GP profession because it’s pretty clearly a structural problem with the system and Medicare, not to be solved by a bit of funding here and a bit of rule changing there.
Somehow the federal government has to contemplate what is going on for GPs in every jurisdiction that has power to have impact on how they work and come up with something that fundamentally shifts the system away from the current death by thousands of unrelated cuts.
That’s not going to be easy. The Taskforce hasn’t actually been given such a remit. It means stepping back, looking 10 years out, and making a plan for the whole system that includes all jurisdictions co-ordinating around general practice, rather than eating it bit by bit in separate and unco-ordinated sittings.
Margaret Faux doesn’t want anyone to work out that 30% thing
The problems with week’s “Little frauds” story by the Nine newspapers are outlined well by Dr Imaan Joshi in her piece this week in TMR.
In her critique of the story, Dr Joshi left well alone the video commentary by Dr Margaret Faux that Nine posted with the story. But I’m not going to.
As many readers will know, Dr Faux has written for TMR in the past but we agreed with her to part ways soon after the original Nine doctor rort stories started breaking.
In the first week of those stories breaking, TMR wrote directly to Dr Faux and to Adele Ferguson and asked them some very simple questions, including:
- how did you calculate the 30% figure?
- why did your PhD claim the figure was only 5-10% and how does that relate to the 30%?
We got no answer from either party but Dr Faux’s video this week reveals a little bit more as to why we probably didn’t get an answer.
She opens boldy (and defensively) with this: “I stand by my estimate of up to 30% of Medicare leakage.” She goes on to explain that the size of the Medicare problem wasn’t the topic of her PhD so she didn’t need to calculate it.
Qué?
The whole country is reading 30% and the fat figure of $8 billion, which she came up with, but she doesn’t need to tell anyone where it came from?
She then explains she was “required to estimate the size of the Medicare problem to justify” her research. Which doesn’t seem to gel with her opening statement that she didn’t need to calculate it.
OK, at least tell us how you do that estimate for your supervisors as a form of justification for your PhD sailing through?
“By reading extensively … ”
If you watch the video, you’ll probably be a tad gobsmacked at this point.
That’s it.
She did a lot of reading.
There’s no data, no logic, nothing. Only that it measures up with what two other people have said – one being the former director of the PSR – and other estimates from overseas.
Cool – but any chance you could maybe spend a few more hours and do some basic maths and research and give us something more on how you actually came up with 30%?
Because “I read a lot” doesn’t feel like a great way to jump from 5-10% in your PhD to 30% of doctors are rorting the system blasted across major national newspapers and the ABC for eight weeks straight this year.
Dr Faux also tries to correct what she says is a misinterpretation of the reporting: that $8 billion was being rorted, when in fact only some proportion of that was rorts. But have a look at the wording of the intro to this original story and see whether that wasn’t the impression the newspaper was trying to give.
If her university really did require her to justify her research with an estimate, and they accepted “I read a lot” as logic for a figure that has now damned a whole profession for a generation in the public’s eye, maybe that university needs to have a good hard look at its assessment procedures.
Anyway, Dr Faux wants us to stop asking how she got to $8 billion (about eight minutes in) and just suck it up: “We also know that it is less important to worry about trying to exactly measure the size of the problem than it is to just accept that the problem is huge and it’s billions of dollars.”
Dr Faux’s strange logic continues.
“The abstract of my or any PhD is just an invitation to read. And for those of you who made it to the end, you will know that I basically concluded that Medicare is out of control.”
If Medicare is really 30% “out of control”, Dr Faux, I’d dearly love to understand how, on the basis of something just a little bit better than “trust me, I’ve read a lot about this stuff”.
Nine newspapers should grow up and think a little harder on this important public interest issue as well.
