THE HEALTH BUDGETMANAGING THE IMPACT IN

GENERAL PRACTICE2014 AMA National Conference

Dr Brian Morton AM

Chair Council of General Practice

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FEE FOR SERVICE IN GENERAL PRACTICE - NOW

Standard GP Attendances for 2012-13 = 115,510,216 services

Bulk billing rate 82%

VR GP – Level B - Item 23 – (most common consultation)

Private Billing AMA Fee Rebate $73

Bulk – billing Schedule Fee (100%) $36.30

Concessional Card Holders & Children under 16yrs

Bulk – billed - Schedule + Bulk-billing Incentive $36.30 + $6.00 = $42.30

Rural Loading - $36.30 + $9.10 = $45.40

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THE BUDGET CHANGES FOR GENERAL PRACTICE – JULY 2015

Patient Rebates cut by $ 5 for: Standard GP consultations (A1, A2, A11, A22 & A23 MBS Items) Pathology - for each episode of care – out of hospital Radiology – out of hospital

Patient Co-payment of $7 will apply for above services which would have previously been bulk billed.

Level B - $31.30 + $7 = $38.30 ie $2 more for GP than now

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THE BUDGET CHANGES FOR GENERAL PRACTICE – JULY 2015

For Concession card + under 16yrs only

Will only have to pay $7 co-payment for first 10 services - $70 maximum co-contribution

Only services with $7 co-payment will count towards the 10 services

GPs will get “low gap” incentive if co-payment charged at $7 – no more no less

When threshold reached patient rebate reverts to $36.30

“low gap” incentive applies if additional services provided to patient at no charge

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GP BILLING OPTIONS AFTER – JULY 2015

Non Concession Card Holders: 1. Waive co-payment GP takes a loss of - $5 14% 2. Privately bill At AMA rate$73

Patient rebate to $31.30 – patient OPC Charge an appropriate fee to cover lower numbers + admin costs +bad debt

3. Charge co-payment $31.30 + $7 = $38.30

Concession Card Holders Waive co-payment take a loss of - $13 29% rural - $16.10 34%

Charge co-payment $31.30 + $7 + $6 = $44.30 After $70 threshold $36.30 + $6 = $42.30

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CLINICAL IMPLICATIONSAFTER – JULY 2015

•Who are your vulnerable patients? (Aside from concession card holders and under 16s) What indicators will you use to determine What perimeters will you set

• Impact of a minimum $7 out of pocket cost for patients Will patients ration their health care services Managing the patient you now see less

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PERVERSE OUTCOMES AFTER – JULY 2015

• Ingenious work-a-rounds that push compliance boundaries•Decline in immunisation rates•Decrease in RACF visiting GPs from 20% of GPs to ?0%• Preventative health even more discretionary•Delay in presentation•General Practice as a career even less attractive

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OPPORTUNITY FOR CHANGEAFTER – JULY 2015

To focus on quality general practice To put the value back into GP care To ensure practice viability through the value patients place on the care they receive and away from a reliance on high patient throughput or MBS item maximisation

Change is always difficult – need to make this change good for the health system, our professionalism, and patient care

Will encourage greater patient engagement in their health care

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REJECTING CO PAYMENT?- CONSEQUENCES?

AFTER – JULY 2015

Rebate freezingMore draconian Medicare changesExpanded scopes of practice for lesser trained health care practitioners

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FRONT DESK COSTS AND REQUIREMENTSAFTER – JULY 2015

Workstations - space at the front desk – renovation? IT capability – sufficient server + desktop capability Staffing – 0.25 of extra receptionist Cash management & safety EFTPOS

Equipment Rental Fee - $35/month Transaction fees – 1% Bank Merchant fees – 0.4% Dedicated telephone line – only data transfer

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COMMUNICATING WITH THE PATIENTSAFTER – JULY 2015

Review billing policies Assessing ability to pay Counselling re “continuity of care”Medicare changes – Thresholds; Medicare Safety NetRecall and follow-up; ( + Medico-legal responsibility) Preventive care needsPathology & Radiology implications

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WAY FORWARD

•Real opportunity to ensure the value of general practice and in so doing attract a future GP workforce

•Must ensure:Adequate support for vulnerable patientsNo financial penalty for GPs when waiving patient fees in exceptional circumstances

Measures to support transition and underpin viable high quality General Practice

Minimal compliance costs

•Health Care determined by health professionals not economists

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SO WILL YOU LISTEN TO THE PROFESSION OR IS IT JUST THE ECONOMISTS ?

Courtesy The Sydney Morning Herald