DoHDA is still mulling over how practices and GPs should split the extra cash from the incoming bulk billing incentive payment.
From 1 November this year, practices that commit to bulk billing all patients will receive a 12.5% loading payment on all bulk billing income via the Practice Incentives Program.
The government expects up to 75% of practices to sign onto the program.
One major detail which is yet to be ironed out is who, exactly, receives that money – the practice or the doctor.
When questioned on the matter earlier this week, Health Minister Mark Butler said he was working closely with the sector.
“I’ve had meetings myself, certainly my department is consulting with individual GPs and their representatives, but also with … practice representatives as well,” he said.
“We’ll make a call … some are saying that the practice should get the whole lot, some [are] saying that the doctors should get the whole lot [and] some are saying that it should be divided evenly.
“We’ve had a very good process of consultation on that and I’ll make a call on it over coming weeks.”
There are currently seven payments within the Practice Incentive Program, which fall into three categories: practice payments made to clinics participating in certain programs, service incentive payments made to individual GPs and rural loading payments made to practices.
The rural procedural GP payment, for instance, goes to the individual doctor while the GP teaching payment goes to the practice.
Some practices choose to pass on some or all of a practice payment to the individual GP.
In late 2024, a controversial briefing paper from the government proposed creating a simplified PIP payment architecture that would require patients and practices to participate in MyMedicare and direct all funding to practices.
At the time, Rural Doctors Association of Australia president Dr RT Lewandowski warned that channelling money directly to the practices ran the risk of turning younger doctors away from rural practice.
RDAA CEO Peta Rutherford told The Medical Republic that the organisation would be engaging with members to guide it on what it considered to be a fair and reasonable split.
“We are also conscious that … a split may not be appropriate in some cases, e.g. where there are now single employer models in play as well as salaried positions within the general practice,” she said.
Ms Rutherford also flagged that the bulk billing requirement for practices participating in the BB PIP only applied to GP non-referred attendance items, meaning that procedural items can technically be privately billed.
Technically, patients could see a GP at a practice participating in the BB PIP and be bulk billed for a consult but pay out of pocket for a procedure.
The RDAA will be calling for a robust public education campaign to ensure patients understand this distinction.
“Rural and remote general practices have a significantly higher rate of procedures performed in community based general practice than their metropolitan colleagues, so this will be particularly important for rural and remote communities,” Ms Rutherford said.
Canberra GP Dr John Deery, president of practice owner advocacy body Australian GP Alliance, told TMR he feared if the government mandated the BB PIP be split a certain way, it would work for neither practices nor GPs.
“I don’t think it’s the place of the department to figure out what the split is,” he said.
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“At the individual practice level, GP payments [tend to go] through 100% to the practice and then they negotiate after that, rather than the department coming up with some magical number … I think that if there is a split, it is going to cause a lot of friction in between practices [and GPs].”
At the same time, he said, both practice owners and GPs had a vested interest in calling for their relevant group to receive 100% of the BB PIP.
“I think if it’s 100% to the practice owners that it will be practices thinking, ‘this makes sense’,” Dr Deery said.
“If it’s 100% to the GPs, owners are going to go ‘no way is this working’.”
Dr Deery also questioned the planned payment mechanism and said the current MyMedicare-linked incentive payment for aged care had been difficult to access and manage.
“The money comes through to the practice as just a [lump sum] amount, but you don’t actually know for which patients the money’s been paid,” he said.
“And so, it’s impossible to split it because you don’t know who’s getting paid for what.”
If the BB PIP money were to come in this way, he said, the lack of transparency may cause further practice-GP friction.
