Half of bulk-billing GP practices switched to private billing in two years

The amount of GP practices bulk-billing 80% of appointments or more fell by half in the past two years, a report by billing software company Cubiko says.

It is painting a very different picture from the Federal Government’s bulk-billing statistics, which Cubiko attributes to the way it has counted bulk-billing practices.

The report defines a ‘predominately bulk-billing’ practice as one where 80% of invoices or more are bulk-billed.

“This approach offers the most accurate representation of bulk-billing across the industry as it often reflects the percentage of appointments that are bulk-billed,” the report said.  

The data from 811 of GP practices using Cubiko software showed that 60% were ‘predominantly bulk-billing’ in January 2022.

By October 2023, the number had fallen below 25%.

Following the Federal Government’s tripling of bulk-billing incentives, it rebounded slightly to 26% by December 2023.

The report also looked at bulk-billing specifically for concession card holders.

It found that around 90% of GP appointments with concession card holders were bulk-billed in January 2022, but this fell below 80% by October 2023.

“This suggests that the decline of bulk-billing and the increase in out-of-pocket fees isn’t just affecting regular patients, but it’s also having an impact on the concession card holders who are most in need of subsidised healthcare,” the report said.

With the boosted bulk-billing incentives for concession card holders and children, the rate rebounded to around 84% within two months.

Bulk-billing for under-16s followed a similar trend, starting at around 90% in early 2022 and then falling below 80% by late 2022.

It remained below 80% in December 2023 despite the bulk-billing incentive changes.

The report also found that fees for a standard consultation had risen from an average of $79.92 in 2022 to $81.21 in December 2023.

Practice management consultant Riwka Hagan said at a Cubiko webinar about the report that practices shoulder consider smaller but more frequent fee hikes.

“There is no point setting a fee then leaving it alone for the next three or four years,” she said.

“I know most practices look at their practice fees maybe once a year, sometimes not even that. 

“I’d encourage practices to think at least twice a year about amending the fee, because it’s a smaller increment.

“Twice a year is going to be a far easier sell than a bigger increment at a less frequent time … Don’t make a big song and dance about it.”

The report said the fee hikes, which typically occurred around July, were smaller than Medicare indexation.

“When there is an MBS indexation, private fees do not increase at the same rate, and therefore, patients are left better off with lower out-of-pocket fees,” it said.

“Private fees for standard consultations have continued to rise but not at the same pace as other cost pressures felt by patients and practices alike.

“Therefore, practices’ increase in fees have been well justified as their cost pressures have increased.

“Notably, with the MBS indexation, overall out-of-pocket fees for patients have steadied or reduced in some cases, leading to more affordable primary healthcare for patients.”

Cubiko said practices from its own state of Queensland were over-represented in the data (31% of practices), although NSW (24%) and Victoria (22%) were also well represented.

More than half of the practices were based in major cities, and all were using Best Practice software.

First publised on Australian Doctor on 3rd April 2024 

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