Bulk billing only at urgent care clinics

4 minute read

It will be a hard day’s (and night’s) work for GPs staffing both the state and federal-run clinics.

The NSW and Victorian state governments will only cover the additional practice operating costs for urgent care clinics, with the GPs staffing them expected to bulk bill only.

Announced last week, the 50 urgent care clinics in Australia’s two most populous states will be opened in addition to the 100 clinics Labor promised to implement nationwide.

The Medical Republic has been asking federal Health Minister Mark Butler for more information on funding ever since the Labor election policy was announced.

Thus far, the extent of the detail has been that existing GP clinics will be able apply for grant funding to be an urgent care clinic and that every patient will be seen with no out-of-pocket costs.

Both states were reportedly reassured that the workforce has the capacity to carry out these plans by the fact that GPs were able to offer additional hours to staff respiratory clinics early on in the pandemic.

NSW Health told The Medical Republic that it was still working with Primary Health Networks to determine the most appropriate commissioning, staffing and remuneration arrangements.

Victoria’s health department, meanwhile, confirmed that urgent care clinics would be operating up to 16 hours every single day and that GPs staffing the clinic would be expected to bulk bill every patient that comes through the urgent care clinic.

Each clinic is expected to see around 300 patients per week for a trial period of about one year.

Existing GP clinics will essentially be hired as contractors as part of the commissioning process, and they will be expected to deploy their existing workforce to staff the centre, as well as keep up with their regular volume of primary care patients.

While nursing staff may be able to take on some of the work, at least one GP will be required on site at all times.

Agreeing to bulk bill the urgent care patients – and therefore have each doctor accept the Medicare benefit as full payment – will be a condition of each clinic receiving funding to be an urgent care centre.

Victoria has committed a total funding package of $70.8 million for 25 urgent care centres, which is set to cover the establishment and operational costs.

Assuming that each centre gets the exact same amount, it adds to $2.8 million in grant money per practice for the year.

It’s not clear whether the GPs themselves will see a dime of this money.

Under Section 20A of the Health Insurance Act 1973, it is illegal for a doctor who bulk bills to receive any other payment for that service. The Department of Health recently published this fact sheet to remind doctors and the public of this.

You cannot, for instance, bill a separate yearly subscription fee or bill for consumables like wound dressings without violating this law.

Dr Margaret Faux, a lawyer who did her PhD in Medicare claiming and compliance, said that the devil will be in the detail of the grant agreements, which are yet to be released.

“State funded public hospitals are already legally permitted to bulk bill certain services through ‘right of private practice’ arrangements, and there are also what are known as ‘Section 19(2) exemptions’ granted to small regional public hospitals, which enable GPs to bulk bill,” Dr Faux told TMR.

“However, I have also seen scenarios where the Department of Health has specifically provided written advice to certain grant recipients that they cannot bulk bill.”

If not done carefully, she said, this may open a Pandora’s box of confusion and compliance issues.

There is the potential that GPs will be able to keep more of the patient rebate than they do regularly, on account of having clinic operating costs covered by the state government.

Exactly how much of a pay rise this represents, though, is anyone’s guess.

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