Rorting claims take an emotional toll

Reporting on the ABC and Nine press has exaggerated Medicare fraud by doctors and left GPs, in particular, feeling even more abandoned.

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The ABC and Nine newspapers have reported several concerning (and untrue) statements regarding rorting of Medicare. The most eye-catching of these claims was that 30% (or $8 billion annually) of Medicare money is somehow “rorted” by Australian medical practitioners.

The current system saves the government billions of dollars a year by making general practice clinics de facto Centrelink/Medicare offices – processing claims on behalf of Medicare with absolutely no funding to do so. The government has made the choice that the massive savings from transferring accountability to general practice far outweigh the small leakage from truly inappropriate/fraudulent billing that is only evident at 3% of total Medicare spend based on PSR data.

General practice, and by extension the fee-for-service component through Medicare we represent, is by far the most cost-efficient part of the health system.

The government and Department of Health also have knowingly made the choice to increasingly complicate and confuse Medicare – with the intent to encourage a culture of “underbilling” in general practice. The recent Health of the Nation report released by the RACGP reported 47% of GPs undercharge due to fears of getting complicated Medicare billings wrong.

Medicare is overcomplicated on purpose – if the government and the DoH cared about “waste” through incorrect billing of Medicare they have the power to fix it through simplifying consultation billings (eg to simply block or per-minute billing while keeping total Medicare funding constant). They choose not to do this because they know this will lead to doctors being more confident in their billings and thus actually bill what they have done. The government agenda and ours often diverge – we as doctors are focused on excellent patient care, the government’s main agenda is cost containment. Who can forget the admission by the DoH that GP numbers are intentionally kept down to save on Medicare funding?

We are disappointed that these media outlets have chosen an expert, Dr Margaret Faux, who happens to own a company involved in the managing and advising of Medicare billings. Is there a conflict of interest if, in the event that the process of Medicare billings was changed, her businesses profited? Just four years ago Dr Faux estimated this waste was “$1-$3 billion” in a BMJ article – we are interested to understand how the estimate has increased in such a short amount of time.

We are extremely disappointed that no balance was sought from any leading medical organisation to provide a realistic view of what these problems are. This should be called out for what it is – sensationalism, not accurate journalism.

We have to see this current sensationalism in the political context. We have a newly elected Labor government who has admitted that general practice is in crisis. They have only proposed a 2.7% temporary increase in funding (the Strengthening Medicare fund) for four years. My sources tell me there is no further increase in funding coming for general practice (despite this year alone funding was cut in real terms – a 1.6% increase in Medicare rebate while headline inflation is over 6.1%).

The government can afford to fix general practice – it has just increased childcare funding by over $5 billion annually – more than 50% of the total yearly GP Medicare spend. There is just no political will to do so. Medicare is now worth less than half it would have been if it had just kept up with inflation.

It is therefore very convenient for the government that a suitable scapegoat has now appeared as to why Medicare is failing just one week before a federal budget that will further neglect the health of Australians. It isn’t the fault of successive governments who over decades have ripped $9 billion in funding annually from general practice. It’s doctors who are the problem.

Dr Faux and others also need to consider the real emotional toll they place on my colleagues. Such claims about rorting should not be made spuriously and sensationalised. I spent most of Monday night talking to GPs, some on the verge of tears. Many GPs are on the edge of the precipice both emotionally and financially and real harm is occurring to humans who dedicate their entire lives to their patients. Constantly kicking general practice is not the way to create a long-lasting health system.

I am further saddened that Mark Butler, when hearing of this “news”, ordered a review of Dr Faux’s work first instead of coming to the defence of our profession. Mr Butler, you say it’s “terrifying” that only 15% of junior doctors want to enter general practice – this is not the way to encourage them.

There is waste in any system. There is fraud in any system where money is involved. There is absolutely no evidence that inappropriate billing is anything but low within Medicare – 3% of total billings according to the PSR, and I would argue the true number is even lower due to the complete procedural unfairness of that agency.

There is no evidence that any change to the current system of dealing with potentially inappropriate billings will do anything except cost the government more than it recoups in such a system. There is evidence of waste and underbilling by GPs – the government could solve this if it wishes, but it won’t, as the entire aim is to confuse doctors and create a system based on fear.

Finally, this sensationalised reporting conflates rorting with economic inefficiencies in Medicare and this isn’t explained at all. I assume much of Dr Faux’s more realistic $1bn-$3bn estimate of waste in a $30bn system surrounds issues like unnecessary test duplication (thanks to poor digital communication despite billions and years invested) and procedures like arthroscopy being Medicare-funded despite weak evidence of benefit.

Once again in this issue government is the main problem. The MBS Review Taskforce should be an attempt to rationalise Medicare spend for optimal health outcomes, rather than a cherry-picking cost-cutting exercise (e.g. the decision to remove ecg interpretation rebates for GPs). The taskforce has no moral authority, which hampers the ability to rationalise Medicare. 

General practice needs to be alert as ever. This “waste” will likely be used as another excuse by the government to try to implement capitation and VPE with no increase in real funding. Our leaders must see once and for all that the government has no intention of implementing VPE for any other reason than cost-cutting and increased bureaucratic control. We must become politically savvy and professionally lobby both the public and government if our profession is to survive – and if the health of our country is to be maintained.

Dr Chris Irwin is a Melbourne GP, practice owner and founder and president of the Australian Society of General Practice.