Gap fees rise as GP viability is thrown into question

4 minute read

Patient costs for a standard level B consultation have risen by 8% in the last year to over $44.

Don’t expect a knight in shining armour in the shape of rising Medicare rebates, says the RACGP’s expert committee on funding and health system reform, as gap fees for level B consults rise by 8% in a year.

According to the new quarterly Medicare data, published by the Department of Health and Aged Care earlier this week, the average gap fee for a level B consultation in the first quarter of this year was $44.12.

This marked a more than 8% increase since the same quarter last year.

The rise was even greater for level C consults, rising 11% compared to January-March last year, to $62.73.

But bulk-billing rates remained fairly consistent at around 73% for level B, C and D consults and around 85% for level A.

Speaking to The Medical Republic, Dr Emil Djakic, a member of the RACGP expert committee on funding and health system reform, said there were a number of reasons for the rise.

“Obviously, this is occurring on the background of the rising cost of delivering services,” he said.

“Medical practices have had to look at their own business viability pretty carefully. They’ve had to deal with rent rises, employment cost rises around staff, consumables costs and beyond – that’s no different to the rest of the population.”

But beyond the challenges facing the population, practices are also facing other unique challenges.

“There’s also been a substantial change that medical practices have had to engage with which has been about their long-term viability full stop, independent of the various cost of living pressures.

“This is wholeheartedly being driven by the failure of the insurers involved with primary health delivery.

“Predominantly that’s Medicare, as the biggest insurer in our system, that has not been adjusting background insurance for patients appropriately over a period of 10 or 12 years. “That lag and delay has reached a point where it has become the straw that has broken the camel’s back.”

Last year’s Medicare rebate rise was indeed “woefully below the existing Consumer Price Index rise”, said Dr Djakic.

“So practices, as small businesses, or some of them as large businesses or corporates, rightly had to be answerable to their accountants in the end to say, ‘what are you going to do about this?’,” said Dr Djakic.

“The RACGP, with our role in the funding and health system representative spaces, obviously spent quite a few years trying to bring members into the understanding of their own responsibility for their business viability or business success as the only way we’re going to see viable continuation of general practice as we know it.”

With the introduction of the tripled bulk-billing incentive for healthcare cardholders, while achieving significant outcomes for this population group, the government has also inadvertently revalued a standard consultation to around $74 (the standard rebate plus three incentive), added Dr Djakic.

Therefore, many general practices may be increasing their costs for a standard consult to reflect the new “real cost of service”.

“It’s a case from the government of ‘be careful what you wish for’,” Dr Djakic said.

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“They succeeded for those who are on healthcare card, but they also succeeded in increasing the cost burden to the – we’ll use the cliché – ‘working poor’.

“And that group is experiencing more out-of-pocket cost fees.

“The government chose actively to discriminate towards the healthcare card group, and they will happily celebrate that.

“But there’s a big group in the middle, who have also as a result, been burdened by increasing out of pocket costs and that is showing up in these long-term data.”

Dr Djakic said it was unrealistic to expect sufficient rebate rises from the government, but that moving forward the emphasis should be on education of practices on viable management and on being transparent with the public on the value and cost of care.

“If we’re expecting the government to arrive as a shining knight on white horse they’re not coming.”

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