Practice owners argue that it’s the clinic taking on a larger amount of risk when switching to universal bulk billing, rather than the individual GP.
Despite the concept of splitting the incoming Bulk Billing Practice Incentive Payment evenly between GPs and clinics being somewhat unpopular among both GPs and practice owners themselves, the Department of Health, Disability and Ageing has made the call to do just that.
Given that this is not usual protocol for an incentive in the PIP program – all seven existing payments go either entirely to the practice or entirely to the GP – it does beg the question: who asked for this?
Because someone did. When Health Minister Mark Butler was asked about the potential of splitting the new BBPIP between GPs and clinics back in July, he referenced working closely with practices and practice representatives.
More specifically, he said “some [stakeholders] are saying that the practice should get the whole lot”, some were saying the doctors should receive the entire PIP and others were “saying it should be divided evenly”.
In narrowing down the pool of potential suspects, the RACGP can be discarded almost immediately; president Dr Michael Wright told reporters last week that the college had “been clear with the government that [its] preference is that this incentive should go to GPs”.
The next most-obvious group to have advocated for the PIP to go to the practice instead of the GP would be the Australian General Practice Alliance, the association representing non-corporate GP practice owners.
This avenue of inquiry was also a dead end.
While AGPA chair Dr John Deery acknowledged that practices would get a slightly better deal under a 50-50 PIP split than they might if the incentive went entirely to the GP, he was also concerned about the implications for payroll tax and the possibility that a split would “create tension” within clinics.
Other practice owners, like GP Dr Max Mollenkopf, also expressed doubt over the logic of splitting the PIP.
“As a GP and a practice owner in general, I would argue that if you are asking the clinicians to take a haircut on bulk billing, I don’t see why we now need to enforce a split in the PIP so that the practice can also take an incentive along the way,” he told The Medical Republic.
“We don’t do that with any other PIPs … we previously have determined that the government wants to incentivise clinicians to bulk bill, so why do the practices then need to take a clip of that along the way?”
Dr Mollenkopf said his personal view was that GPs should receive the entirety of the incentive or it should be up to individual practices to negotiate the split.
With the colleges and small practice owners unlikely to have been the voices calling for a mandated split or for the incentive to go entirely to the practice, the group left with the most at stake are the GP corporates.
ForHealth CEO Andrew Cohen told TMR that, while he thought the government’s decision was “a pretty reasonable conclusion”, the call to split or to have the entirety of the PIP incentive go to the practice had not come from him.
“If I was in [DoHDA’s] shoes, I’d be looking at ‘how do I actually motivate the change to happen?’” Mr Cohen said.
“And I think they’re recognising that both the GP and the practice would need to be incentivised in some form.”
He was also of the opinion that practices took on greater risk than individual doctors in committing to universal bulk billing.
“The GP gets the incentive under all scenarios and is hopefully making more money under all scenarios, but the practice risks losing GPs because some people don’t want to work in a bulk billing practice,” Mr Cohen said.
“When a practice goes to sort of say, ‘Hey, let’s discuss whether we convert’, it’s very unlikely that 10 out of 10 GPs will say, ‘Yes, I think that’s a great idea’.
“What then happens is, if the practice does choose to convert, they actually risk losing one or two GPs.”
Ochre Health co-founder and owner Dr Hamish Meldrum also said that practices would be taking on a comparatively higher amount of risk in committing to universal bulk billing.
“To go 100% bulk billing is a lot of additional risk [for a practice to] take on, arguably more additional risk than the individual doctors, who are perhaps more mobile to move to [another clinic],” Dr Meldrum said.
“I think one of the problems is that a lot of doctors didn’t even realise it was going to be a split … I think that’s probably [led to] some of the disappointment.”
The original modelling released by the department in March worked on the assumption that GPs would receive the full 12.5% BBPIP and remit 30% of total billings to the practice, rather than receive half the BBPIP and remit 30% of total billings to the practice.
It should be noted that the BBPIP is a separate initiative to the tripled bulk billing incentive, the eligibility for which will be expanded to all Australians rather than just healthcare card holders and minors from November.
While any GP regardless of practice billing structure will be able to claim the incentive on bulk billed patients, only GPs at practices where every doctor commits to universal bulk billing will be eligible for the BBPIP.
The BBPIP for each practice is calculated at 12.5% of the total bulk billing income for that clinic, to be paid as a lump sum each quarter.
Both initiatives kick off from 1 November.
