Health minister Mark Butler has released modelling purportedly showing that GPs who universally bulk bill will make more money than their mixed-billing colleagues.
New modelling released by the Department of Health and Aged Care predicts that GPs working at a universal bulk-billing practice will make around $5000 more in annual earnings than their mixed-billing candidates.
It has not been enough to address the scepticism swirling among GPs since the $8.5 billion policy was announced in February.
The initiative, which was announced by Labor but has been matched by the Coalition, will extend the tripled bulk-billing incentive to all Australians and add a new PIP for practices that universally bulk bill.
From the offset, GPs and peak bodies across the board expressed doubt that bulk-billing levels would bounce to the predicted 90%, even in rural areas, and said that the funding injection would not be enough to tempt most private billing practices back over the fence.
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Almost immediately, federal health minister Mark Butler was defending Labor’s modelling at press conferences.
An extension of that modelling has now been released.
In a media statement on Wednesday, Mr Butler’s office noted that the analysis was “provided in response to requests from GPs and practices for detailed information about how the bulk-billing investment will impact their practice”.
The central claim of the document was that, according to calculations made using the General Practice Registrars Australia GP earnings calculator, metropolitan GPs that bulk bill all patients will go from making around $465,018 in billings per year to making $576,864 in billings per year.
Assuming the practice takes 30% of billings, that GP’s income goes from $325,633 to $403,805.
For a clinic that bulk bills the average number of Medicare services, the analysis estimated that metropolitan GPs currently earn around $371,390 after practice fees are deducted.
It predicts that this would rise to $398,448 under the tripled bulk-billing incentive, meaning that universally bulk-billing GPs would out-earn their mixed billing counterparts by $5357 each year.
“We’ve said from the beginning that this [investment] will help the sustainability of fully bulk-billing practices and [that] some practices who had just started introducing small out-of-pocket fees that they may choose to return to fully bulk billing,” AMA president Dr Danielle McMullen said.
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“That was not argued.
“But what we have said from the beginning, and reiterated yesterday, was that [those are] not all practices, and every individual practice will be looking at their billing practices, their revenue and what these new incentives mean for them, to make an individualised decision.”
Crucially, the assumptions baked into the GPRA calculator are that GPs deliver four services per hour, work 3.8 hours per session and 10 sessions per week, minus four weeks of annual leave per year.
DoHAC’s other assumptions were based on averages from Medicare data.
It assumed that the proportion of services delivered to concessional patients by mixed billing practices was 53% and that this cohort was bulk billed 90% of the time.
It also assumed that non-concessional patients were bulk billed 62% of the time and that the average patient fee was $97.15, $54.30 of which was Medicare rebate.
“The averages mean that [this data] isn’t representative of every individual, and this is a very individualised announcement in terms of the practitioner or the practice perspective,” Dr McMullen said.
“Everyone is weighing up what it could or would mean for them.”
By its own admission, this is not the regular way that DoHAC conducts modelling; according to the analysis paper, it made calculations down to the individual level for 6500 GP practices.
These have not been released.
The other big criticism of the $8.5 billion investment is that it injects cash into a flawed model without addressing those flaws.
“We need to make sure that this funding commitment helps multiple practice types,” RACGP president Dr Michael Wright told The Medical Republic.
“We know that the incentives favour shorter consultations, when the college has been arguing for more support for longer consultations.
“We really need to better understand how these measures can support GPs who work in different types of practices.”
Dr Wright reiterated that the funding was welcome, but that the decision to change billing behaviour fell to the individual practice or doctor.
“Some GPs have told me that they’re really supportive of the changes and these new measures will help them, but most have indicated that … they don’t intend to increase bulk billing,” he said.
“I want to continue to advocate that any changes need to support people who need the care most.
“We will work with government to make sure that funding goes to benefit the patients who need it and the GPs who are looking after them.
“Both sides of politics have got more work to do to convince GPs that these funding announcements are going to deliver the benefits they’ve promised.”
