Medicare rebate is fine, say 3% of GPs

A quarter of GP respondents told the RACGP they were planning to retire within five years.

---

Only six in 10 GPs aged 45-54 still intend to be practising in 2032, and almost three-quarters of all GPs have experienced job-related burnout in the past year.

All is not well among the next generation, either: 80% of GP trainees say the complexity of Medicare is something that worries them outside of their workday.

This is the bleak portrait of general practice painted by the RACGP’s Health of the Nation 2022, which dropped today.

The report comes exactly a week before 100-odd GPs and stakeholders converge on the nation’s capital for the RACGP’s crisis summit.

When GP’s are struggling to keep trading due to falling Medicare rebates (relative to inflation) many have no choice but leave. If the Medicare rebates cannot cover the costs of running a GP practice then, of course doctors will not trade whilst insolvent…jail is not worth it.

— Louise Middleton (@LouiseM6531) September 28, 2022

Last year, in Health of the Nation 2021, the college revealed that, for the first time in at about two decades, growth in bulk billing rates dropped below zero.

“The RACGP has long predicted the growth in bulk billing of general practice services would halt or reverse, meaning more patients would face an out-of-pocket cost to see their GP,” it said.

The rate fell again this year.

“We’re also finding that the level of red tape and compliance issues in Medicare is becoming a real challenge for GPS,” RACGP president Adjunct Professor Karen Price said today.

“Nearly 47% are not charging appropriate levels [to] Medicare because they’re worried about the authorities coming to investigate what they’re doing and having to go through a lengthy compliance process.”

Four in 10 of the 3219 GPs who responded to the survey this year reported that they avoid claiming certain Medicare items even though they legitimately provide the services.

“These results suggest that Medicare compliance activity might be reducing patient access to care,” the report reads.

“This is likely to be significantly more pronounced for care that is perceived to be the target of compliance, such as complex care or longer consultations.”

Exacerbating this is the fact that, for the sixth year in a row, GPs reported that psychological issues like depression, anxiety and mood disorders – which are known to be both long and complex – were the most common presentations they saw.

“While the MBS does allow for mental health items to be co-claimed with other items, the Department of Health recently undertook a high-profile compliance activity targeting high co-claiming of mental health items, which has likely impacted GP concerns regarding co-claiming these items, further demonstrating the unintended consequences of Medicare compliance activity,” the college said.

When asked to list the reasons they bulk bill at all, six in ten GPs said it was because their patients couldn’t afford to pay for their own care, one in six said it was because they worried their patient would leave for another practice and 3% said it was due to patient complaints or pressure.

Just 3% said they bulk billed because the rebate was sufficient to cover the cost of care.

“Poor remuneration of patient rebates and increasing costs of practice and personal practice costs are making bulk billing no longer viable,” one respondent said.

“I’m feeling torn between having vulnerable patients and stuck because I don’t feel I can continue providing them care without complete burnout and also unable to charge fairly for the service I provide.”

The only way forward, Professor Price argued, was through funding reform.

“We keep looking for magic solutions, but GPs have been telling the government for a long time that this is about funding,” she said.

“We need to resource patients, because Medicare is the patient’s insurance – they need to fund patients to be able to access high quality healthcare, regardless of their own income and regardless of where they live.

“That will go a long way to restoring the challenges that we’ve seen now in general practice.”