Copayment Realities

Medicare Dismantling

By Mike Fitzsimon

 Tuesday, December 23rd, 2014 at 23:42

It’s not just Medicare that is being dismantled; the very existence of General Practice is also at risk.  It’s not just asking patients to pay $5; it’s THE CHAOS on the other side of the reception desk.

There is no way a GP can bulk bill, and accept the Medicare rebate for, a consultation up to 10 minutes after January 19.  To do so would mean they are operating below cost price.

It’s bad enough that the Rebate paid to GPs was frozen for another 4 years at the 2014 budget.  There is certainly no corresponding freeze on practice costs; receptionist and nurse wages, surgical dressings, rent, electricity, phone calls, IT services, laundry, etc.  These all increase relentlessly.

And sure, the reduction is not as severe for longer consultations.  But with costs increasing, any reduction is not sustainable.

And before anyone says, “Yeah, but doctors make a lot of money”, let me tell you: GPs who own their own practice DO NOT.  You might be thinking of employee doctors who are contracted and paid a fixed fee per consultation, hospital doctors on a salary, or specialists.

URGENT Action Now

As far as anyone in General Practice knows, this horror will be visited upon our nation’s primary care system on January 19.  It will be introduced “by regulation”.  This means it will not go before the Senate.  There are no Senators to be lobbied, this time.

It can only be stopped by a massive flood of complaints to sitting LNP members.

Phone, email, write to your local member of parliament.  Point out how their attempt to crush Medicare will also kill General Practice.

Email to our Local Member

My wife, Maureen, is a hard-working family medical practitioner with 35 years experience.  The last 33 years have been in our local area.  She is now treating the grandchildren of the people who were her first patients.  She does home visits and continues treating patients in nursing homes.  Proper family care.

She is extremely busy and rarely takes time out to address politics, but now it is serious.

This is the email she sent tonight to our local LNP member for Forde, Bert Van Manen.

From: Maureen FitzsimonDate: 23 December 2014 20:56:52 AESTTo: Bert van Manen <bert.vanmanen.mp@aph.gov.au>Subject: Medicare dismantling

Dear Bert,

Are you aware that your government has slashed the Medicare Rebate for consultations up to 10 minutes with GPs from $36.50 (frozen for the last 3 years), to $11.95, for the patients of all GPs who have undertaken 3 extra years of study, and thousands of dollars in course fees to gain post graduate qualifications?

 Meanwhile, a nurse practitioner, who studies for 1/3 of this time, attracts a $16.95 rebate, and a GP who has not bothered to gain these qualifications, attracts a rebate of $21 for the same time spent.

I’m furious, and the patients are going to be contacting you in droves when this slug hits them on 19th January.

Government expenditure on General Practice has risen just $60 per person per year, over a period of 10 years. If the government wants to save Medicare dollars, I have a myriad of suggestions.

For instance, other specialists training for around the same time as postgraduate GPs are often seeing patients for only a couple of minutes, and attracting Medicare rebates of $120 and more.Most specialists also demand a new referral every year, (usually unpaid work for us), so that they can charge patients as a “new patient”, when clearly they are not. If we refuse, and insist on a 5 year referral, we are seen as unreasonable, instead of them being fraudulent.Many specialists hang on to patients and see them for minor complaints, easily managed cheaply by GPs.

Child psychiatrists demand a referral for the mother, father, and child, and most of them charge for each one. When GPs see a child, we do not charge Medicare for seeing the parents as well as the child.

Many of the areas in which GPs hold skills are not rewarded at all. For instance, I prevent numerous referrals to rheumatologists, costing Medicare considerably, by performing joint injections. The Medicare rebate was reduced to zero a few years ago for this GP service. I continue to do this procedure, as I am skilled in this, and patients cannot afford $450 for a visit to a rheumatologist.

Ditto diabetes. I have done several advanced courses in diabetes management, as have my nurses. Endocrinologists in Brisbane charge $450 for a consultation. With my colleagues, we save the Federal and State Governments countless thousands of dollars by managing chronic conditions, such as diabetes, for a pittance.

Similarly, I have postgraduate qualifications in Psychiatry, and rarely refer, saving more dollars to the patient and taxpayer.

I could go on and on. Demolishing general practice will result in massive blow outs in the health budget. No young doctor is going to study for 12 years, and incur a massive HECS debt, to be valued at less than a nurse, trained for a third of the time.

Australia spends 9 per cent of GDP on Health (and not much of this is on general practice). The USA, which does not have a universal health scheme, spends over 17 per cent of GDP on health. The USA is moving towards a family doctor model of practice, while your government is kicking GPs into oblivion.

Your Government talks about a “price signal”. Then, after announcing this latest version of health policy “on the run”, Mr Dutton announced that GPs would now be able “to bulk bill 8 million Australians”. He was referring to freezing the rebate for card holder rebates for another 3 years. Where is the “price signal” in that? I know this chap was a public servant formerly (and still is!). As such, he does not seem to have a clue about small business. How does he think GPs are going to do this promised non price-signalling bulkbilling with rebates frozen for 6.5 years? Wages, insurances, rents, accreditation, drugs and dressing etc., are rising all the time.

I could go on and on. I have 35 years’ experience of this topic. The politicians making these policies, which are disastrous, short-sighted, and very, costly - not cost saving- , have not had time to even look at these issues for more than hours. Ignorance reigns!

Currently, I do a MINIMUM of 2-3 hours of unpaid work every day. That’s enough.So, in summary, the career politicians, inexperienced in the real world, who make up the leaders in your government, are going to cost this country dearly.

Any questions and complaints will be referred to you, as their local member, and the new health minister, Sussan Ley. GPs are not prepared to cop the flack from these cutbacks. If your government wants to cut rebates by up to 67% - as detailed above- for common GP consultations, you will need to defend it. 

Dr Maureen Fitzsimon

Sadly, the only response was from Bert’s “Out of Office” message advising that his office would be unattended until January 5.  This goes “LIVE” 14 days later!

This post originally appeared on Mike Fitzsimon's blog "MikeFitz with overflow bit set..." under the title Medicare Dismantling. It has been reproduced here with Mike's permission.