Killing (bulk) bill will cause pathology prices to rise

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Funding TheHill

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Julie Lambert

Patients are seizing the chance to say no to co-payments for pathology services

 

Patients are seizing the chance to say no to co-payments for pathology services

Plans to axe bulk-billing incentives for pathology tests and diagnostic imaging, revealed in December, will appear in the May federal budget as a saving to government of $650 million over four years.

But the industry says the step will be the last straw for beleaguered providers, forcing them to charge co-payments that will ramp up patients’ healthcare costs and deter them from potentially life-saving tests.

The Don’t Kill Bulk Bill campaign led by Pathology Australia is off at a canter, collecting signatures from patients at more than 5000 collection centres for a petition demanding the government drop the plan.

Only six weeks into the campaign, Dr Nick Musgrave, the peak body’s president, says more than 400,000 patients have signed up and momentum is building.

“The pick-up rate is nearly 100%,” he says.

“I took a call today about a cancer patient in Darwin, very concerned because she has fortnightly bloods and she is asking about the implications for her. Those patients who have frequent tests – patients on chemotherapy, diabetics, transplant patients – are going to suffer.”

The bulk-billing incentives due to be chopped on 1 July involve small amounts – just $1.60 to $4 per pathology test and 10% of the Medicare rebate for imaging – compared with $60-plus for the average test fee.

But the loss will force labs to raise a multitude of fees in a costly and complex process and bear the expense of creating entirely new systems for billing, collecting payments and chasing up debts, Dr Musgrave says.

“What is ludicrous about this is we now have an extremely efficient system where patients ascribe the Medicare payment to the provider by signing a form,” he says.

“It’s really very short sighted.”

In addition, patients will need to make upfront payments before claiming on Medicare, possibly shelling out hundreds of dollars depending on the test.

Defending the cost-cutting plan, announced out of the blue in the Mid-Year Economic and Fiscal Outlook, Health Minister Sussan Ley has focused on profitable industry leaders such as Primary Health Care and Sonic. (Both majors said they would introduce some form of co-payment to stay viable.)

But the industry points out that some 30% of pathology providers are small and medium-sized operators whose margins have been squeezed relentlessly by rising costs and a 17-year rebate freeze.

A noted recent casualty was Border Pathology, which was set up by a group of medical practitioners in Ms Ley’s electorate of Farrer in 2009, the same year Labor introduced the incentives to shore up bulk-billing rates and measures to encourage competition.

The Albury-based company closed its doors on Christmas Eve last year, after being swallowed by a larger competitor, the third such consolidation in recent months, leaving the region with just one provider.

Pathology Australia says the opposition campaign is doing particularly well in regional areas, indicating it will play out well in marginal seats ahead of the next election.

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Dr Lou Lewis
Dr Lou Lewis
8 years ago

Normally I would not comment on what the government does with regards to multi-million-dollar stock-exchange-listed companies, such as Sonic Healthcare and Primary Healthcare, but, in this case, I feel that we, as GPs, should rally against the abolition of the bulk billing incentive for pathology testing, not out of sympathy with these companies but because of the adverse flow on effect that will happen to both patients and general practitioners.

Before I proceed let me remind everyone that when the dreaded copayment, with reduction of the rebate for general practice services was mooted by the Abbott government, the AMA was deafening in its silence against it, but when it was also suggested that a copayment was going to affect pathology and radiology then the AMA went on the attack. I do not recall the pathology companies and the radiology companies rallying with us GPs, until they were to be adversely affected.

Having said that, I feel that we, as GPs, MUST protest the removal of the pathology bulk billing incentive. Even though it is only a few dollars but when you multiply this by millions of tests annually then we see that the loss of income to these pathology companies will be dramatic and as such they will then be economically forced to start charging patients.

This will, in my opinion, not lead to more responsible pathology ordering by GPs ( as we are already practising responsible ordering of pathology) but will adversely affect patients from having essential blood tests for ongoing medical management if they are going to have to pay a fee every time the doctor orders a test.

This will generate two adverse reactions:

1. The patient will somehow blame the GP because they have to pay for their pathology that was previously done under Medicare.
2: the pathology companies will end up with lots of bad debts and will be forced to send out debt collectors to retrieve what is rightfully theirs and, as we all know, even not paying a bill for a couple of months can have an adverse affect on a person’s credit rating.

What a lot of people do not comprehend is that the reason the major pathology companies have collection centres in doctors surgeries is a purely competition business decision, namely if you don’t offer the patient a convenient service and your opposition does then you will lose business to the opposition. That is a reality and unfortunately owners of these medical centres where there are pathology collection centres are bleeding the pathology companies dry, and if the bulk billing incentive goes then we will see a lot of collection centres in medical centres close, leading to a loss of jobs of thousands of employees.

I personally disagreed with the fact that collection centres were able to be located in a medical centre or practice but the reality is that they are there and the patients find it convenient to utilise one that they don’t have to drive to or catch a bus to and so on.

So far I have only mentioned the major pathology companies but there are lots of smaller pathology companies that rely on the bulk billing incentive, do not have collection centres in medical centres, and I feel they will go to the wall if this bulk-billing incentive is removed.

One final thing: if the government decides to exempt pensioners, health cardholders, children and other disadvantaged people, then all I can see is more work for us, the general practitioner, in that there will be more forms to fill in and if we inadvertently do not click the appropriate box then our patients will be privately charged, and as I mentioned earlier, we, the GP, will cop all the blame.

I urge other general practitioners to write to the government expressing their concerns about the adverse flow on effects of removing the bulk billing incentive for pathology, because, once again, the person who will really suffer from this will be the patient, especially those who have a chronic medical condition that needs regular pathology. The short-term benefits to government coffers will without doubt be negated by a blowout in costs in the long-term, with people getting sicker and putting more of a strain on our health system because they did not do their essential follow-up pathology. That is human nature and all the pontificating about how people should be more responsible in managing their own health really does not apply in these chronic complex medical scenarios.

Regards
Dr Lou Lewis

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