Changes to Medicare Payments for GPs

UPDATE 15 JANUARY 2015.

The short appointment (10 minute) change has been abandoned. This means that the fee will remain the same for short appointments (the plan was that the fee would have been cut from $37.05 to $16.05. This part of the changes has been abandoned. Link here: http://www.abc.net.au/news/2015-01-15/medicare-government-shelves-propsosed-rebate-cut-changes/6018990 

Changes to the Medicare rules – posted Wednesday January 14th

Australia has announced some changes to the money GPs will receive from Medicare for patient consultations. The main ones are:

  • Indexation freeze at current rates until 2018
  • Reductions in some “level B” consultations. The major one is a $5 reduction for a “standard” consultation (from $37.05 to $32.05) for adults. This means a reduction of between $3 and $3.25 on these types of consultations
  • A 10 minute minimum timeframe

These changes are yet to become law but it seems likely that they, or something similar, will come in.

So, how will they affect income for GPs?

The answer, contrary to what it might look like on first reading, is probably not a lot.

  • Although the rebate for a standard adult consult may end up being reduced by $5, it is staying the same for the elderly, children, veterans and other concession card holders. These patient groups make up a significant proportion of the consultations (in some areas these groups can represent 80% of patients seen)
  • Medicare payments for areas such as health checks, mental health plans and chronic disease plans are not being changed. Care plans such as these, where doctors provide on-going coordinated care for patients are particularly lucrative in terms of income for doctors
  • Pathology and diagnostics are exempt from the $5 reduction
  • And there’s a further point. There is an established principle within Australia that GP surgeries are allowed to charge a “Gap Fee” to patients to cover any shortfall between the Medicare rebate and the what it costs the practice to provide the service. Thus, it may well be that surgeries, in conjunction with their GPs agree to a Gap Fee to cover the $5 reduction.

So, while the headline standard consult fee may be dropping, it is for a minority of patients and it won’t affect the fees charged for diagnosing medical issues (beyond the initial consult) or their treatment. Plus, there is always the opportunity to introduce a Gap Fee to cover the shortfall, if needed.

I’m indebted to our Australian partners for the detailed background information on this. They’ve also commented as follows:

“Our experience is that these kinds of systemic tweaks are par for the course in Australian health policy cycles.

Changes are rarely (if ever) revolutionary, and the GP fraternity has proven time and time again to be resilient and adaptable to these kinds of policy amendments. Indeed, the Australian healthcare system is lauded worldwide and is consistently high ranking in terms of OECD population health outcomes. Good doctors will continue to enjoy the opportunities, lifestyle and professional rewards of practising medicine within Australia.”

I’m very happy that I initially contacted EU Health Staff to guide me through the whole process of finding and starting GP work in the Northern Territory, Australia. I experienced a very personal and informative service from everyone involved, and was guided through the process of registration step-by-step. This made the whole thing a lot less stressful and daunting. Prompt email responses, informative written material and even a welcome phone call on arrival were signs of a high class service. I would certainly recommend and use the company again. Many thanks.
Dr N. E.