So why did the DoHDA wait until just two weeks before go-live to pull the pin?
Last Thursday, following weeks of speculation, the Department of Health, Disability and Ageing announced that it would be delaying the worst and most difficult of the scheduled assignment of benefits changes.
There are two ways that GPs can feel about this.
The first and most obvious choice is relief and gratitude.
Originally, the changes would have forced GPs to start obtaining and storing a physical or digital signature from each patient recording their consent to be bulk billed before or after every single occasion of care from 1 July onward.
It would no longer be an option to indicate that a patient could not sign their consent or that the patient had verbally consented to being bulk billed.
If your practice was set up correctly, your patient base had a high level of digital literacy and you bulk billed a minority of patients, making these changes would have been – at worst – really bloody annoying.
But if you were a universal bulk biller with lots of patients living in residential aged care, the changes had the potential to be devastating on an administrative and financial level.
It’s no wonder, then, that the prevailing reaction to the government’s announcement that verbal consent would be permissible for another year and that enduring assignment of benefit provisions would be fast-tracked was one of relief.
There is, however, a second way to feel: angry.
Reason to be angry #1: Lessons from the past show this was never going to happen
You don’t have to be an oracle to have predicted last week’s about-face – just go back to where this whole mess started.
The requirement for a doctor to collect a patient’s consent to be bulk billed is built into the legislation which governs Medicare and theoretically prevents doctors from fraudulently racking up fake consults under a patient’s name.
Whether this has ever actually happened as much as it is meant to, is up for debate. But once the covid era ushered in telehealth and verbal consent, these rules fell by the wayside for many clinics.
In early 2023, with the country slowly emerging from lockdowns, the Australian National Audit Office put out a review which (to put it mildly) absolutely ripped the DoHDA a new one for having allowed verbal consent for bulk billing in the first place.
With its tail firmly between its legs, the DoHDA abruptly ended verbal consent provisions in September 2023. Verbal consent was allowed to continue, but now it involved a paper form.
Cue one week of unfettered GP outrage.
Federal health minister Mark Butler stepped in almost immediately and promised to find a fix ASAP.
Crucially, he announced that DoHDA would not be pursuing broad compliance campaigns looking at patient consent to be bulk billed until streamlined arrangements were in place.
This debacle alone demonstrated that the government was readily able to step in and change assignment of benefit rules when it suited.
It also shows that the DoHDA knew exactly how contentious any changes to assignment of benefit would be.
The fact that, this time around, it took far longer than one week to act is probably worth a bit of your ire.
After all, Best Practice Software told The Medical Republic earlier this week that it, along with the Medical Software Industry Association, had spent time earlier this year explaining exactly why these changes were not ready for 1 July.
Which brings us to the second reason why you should be at least a little bit mad at the DoHDA’s part in all this. Â
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Reason to be mad #2: Don’t forget who this action actually saves
Assignment of benefit changes were the hot topic at last month’s RACGP practice owner’s conference.
Following one presentation, I was party to a group of prominent GPs discussing their fears for how the new rules would impact their ability to bulk bill aged care patients who were not mentally fit enough to consent.
There was a general air of despair over what this would mean for their ability to provide care.
That’s when one GP – a well-known reform advocate – softly suggested that the government would not allow that to happen.
As he rightly pointed out, GPs being suddenly unable to bulk bill aged care residents and other vulnerable patients because of a regulatory change is a very, very bad look for the government.
Yes, it would have been a disaster for GP finances. But for an administration which built its most recent, successfully election campaign on bulk billing being available? That would be a difficult one to come back from.
This delay benefitted more than just general practice.
The fact that the government was able to put through this delay in such a way that the industry ended up being the ones thanking it is actually a stunning PR move, when you think about it.
Reason to be up in arms #3: where was the preparation?
Far be it from me to feel pity for a tech company, but one has to feel some anger on behalf of the GP software vendors.
Even though making sure Medicare claims are correct is the responsibility of each individual doctor, the actual preparation for the new workflows fell largely to the practice management software ecosystem.
Developing new workflows means spending time working out a solution, spending time making that solution work and then spending time educating the end users on how to navigate it.
Anecdotally, most GPs don’t seem to have become aware of the incoming assignment of benefit changes because they received a direct communication about it from the colleges or from the department itself.
Most people seem to have first become aware of the changes because their practice management software provider told them about it.
Some providers already had new assignment of benefit workflows created, tested and rolled out to practices when the government pulled back last week.
They won’t get compensated for any of that work.
Some will even have to spend more money creating and distributing emergency patches so that the new workflows don’t automatically come online in July.
It’s a kick in the guts, and it was completely avoidable.
Get a little bit more mad.
