Is GP bulk-billing making a comeback?

Article published 6 November 2023

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Bulk-billing looked dead but new incentives paid to GPs from 1 November 2023 may breathe life into no-out-of-pocket GP consultations.

BULK-BILLING rates have declined substantially over the past two years, with many general practices across the country moving towards mixed and private billing so as to maintain profitability.

Why bulk-billing died

From 1995 to 2022, the Medicare Benefits Schedule has had an annual average indexation rate of 1.1 per cent, whereas the average annual changes to the Consumer Price Index (CPI) were 2.4 per cent.

As a result of these long years of inadequate indexation, the Medicare rebate, which underpins bulk-billing, became significantly lower than the actual cost of consultations.

Many doctors say they had no choice but to scrap bulk-billing, although until recently some still gave it to concession cardholders.

New lease of life for bulk-billing

Measures announced in the last federal Budget in May took effect on 1 November.

Indexation of 3.6 per cent was applied to most items on the Medicare Benefit Schedule. An additional half a per cent is added to most general medical services items, including ordinary GP consultations. So, that’s 4.1 per cent all up, and it also applies to most diagnostic imaging services (but excluding nuclear imaging) and some pathology items.

It’s easy to see that indexation alone, when the rate of inflation is significantly higher than the rate of Medicare Benefit indexation, will not make it any more attractive for GP practices to restore bulk-billing.

That is why the Government tripled bulk-billing incentives paid to GPs for visits by concession card holders and children. With three-out-of-five GP consultations falling within the tripled bulk-billing category, the Government’s measure is a significant one.

The incentive for a GP to bulk-bill for an ordinary GP consultation has now risen from $6.85 to $20.65 in metro areas, and from $13.15 to $39.65 in very remote areas. Again, this only applies to visits by concession cardholders and children. The GP bulk-billing incentive for visits by anyone else will be $6.85.

In major cities, a doctor will now get one-third more for a standard bulk billed consultation of under 20 minutes, taking the Medicare payment for eligible patients to $62.05.

In regional and rural Australia, a doctor will get around half more for the same visit, taking the Medicare payment to between $72.80 and $81.10, depending on location.

A new Medicare rebate for GP consultations of 60 minutes or longer also started on 1 November, giving patients a rebate of $191.20 and doctors the time to provide better care for people with complex physical and mental conditions.

Tripled bulk-billing incentives do not apply to all Medicare Benefit Schedule items provided by GPs and can only be claimed for face-to-face general attendance, GP and telehealth consultations. It also applies to out-of-rooms consultations and consultations provided in nursing homes and after-hours.

As well as the bulk-billing incentive, the Government has also tripled the Veteran Access Payment (VAP) for some GP services.

On the face of it, there is now plenty of scope for GPs to help the Government achieve its aim of restoring bulk-billing for concession cardholders at least.

Payroll tax to spoil the party?

However, recent taxation activity at the state and territory level may derail this.

GPs estimate that a payroll tax ruling by Revenue NSW will add $20 per GP visit to the cost incurred by medical centres.

The ruling says that any business (which includes medical centres) with a payroll of more than $1.2million (which covers both salaried and contracted staff) is  subject to payroll tax.

The Revenue NSW ruling obviously applies in NSW only, but CPSA News understands a similar ruling has been made in Victoria.

The ACT, South Australia and Queensland are making similar moves.

Concession cardholders in Western Australia, Tasmania and the Northern Territory may be luckier benefiting from bulk-billing as a result of the tripled bulk-billing incentive. In those jurisdictions, all GPs are exempt from payroll tax.

Also read:

Universal for some: specialist medical care

Specialists still free to charge fees as they please


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