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07 Jan 2015

Transcript: AMA President, A/Prof Brian Owler, 666 ABC Canberra, 7 January 2015

Subject: Co-payments/bulk billing incentives/GP consultations

 


LOUISE MAHER: The Federal Government scrapped its plan for a $7 Medicare co-payment before Christmas but doctors' fees are set to rise due to other changes that were perhaps more quietly announced. It includes reducing the rebate for GP consultations that are under ten minutes by $20 and that's a measure that's due to come into effect on 19 January. To explain what this and other changes are going to mean we're joined now by Brian Owler who's the national President of the AMA. Thanks for being with us on 666 Breakfast.

BRIAN OWLER: It’s a pleasure Louise.

LOUISE MAHER: What is going to be the effect of this reduction in the rebate for short consultations?

BRIAN OWLER: So the effect is not really a rise in doctors' fees, what the effect is, is actually that patients will be having to pay more out of pocket because up until now the consultations that have been based on the consecutive consultations. So a level A rebate was a simple matter, level B required history, an exam and a diagnosis and treatment usually. And now they've moved to a time-based system so it means that for 25 per cent of consultations that take the ten minutes, the fees for that or the rebate for that will be reduced from $37.05 to $16.95 and…

LOUISE MAHER: Well, presumably doctors will recoup that by charging higher fees.

BRIAN OWLER: Well, they'll have to charge more to the patient and they're passing on those costs to the patient because, at the end of the day, many GPs are now working out that the impact in terms of what that's going to have in terms of them being able to cover the costs of running their practice is going to be very substantial, and they've got no choice but to pass that on to patients. Now on top of this, there are two other elements, the first to reach is that from 1 July, the non-concession patients and those over 16, the rebate will actually fall by a further $5, so instead of being $37.05, it will actually be reduced for those consultations less than ten minutes to $11.95. Now that's a massive drop, and something that doctors can't sustain.

LOUISE MAHER: Is this what - is this the government trying to recoup the money or at least some of the money it would have got through a Medicare co-payment?

BRIAN OWLER: Well, that's exactly what it is. There are savings that were in the initial proposal of $3.5 billion. Now, when they took the initial proposal off the table, what they've done is announce further changes which actually still achieve those savings, so what this is all about is actually not about general practice, it's not about preventing chronic disease, what it's about is saving money and making the bottom line of the Budget look better, because the third element to all of this is actually a freeze on patient rebates as well. Not only for GP but actually for specialists and…

LOUISE MAHER: For how long?

BRIAN OWLER: Well, they've already had two years of the rebate freeze essentially and this will go now to 2018 so a further four years. Now the end result is that the Medicare rebate, which is actually the patients' rebate at the end of the day, will actually bear no resemblance to the cost or the value of providing care and general practice, but also for specialists and, at the end of the day, it's likely that there will be more gaps that will have to be passed on to patients, and that is going to be the end result of these changes.

LOUISE MAHER: How many consultations are under ten minutes at the moment? I mean the Government could argue that it's just trying to reduce, you know, a GP for example, just churning through patients?

BRIAN OWLER: And we agree with that so what we're not trying to do is support, you know, six-minute medicine with every patient being churned through. That's not a model that we can support. But what many GPs have said to us, and in fact this has angered GPs more than any of the other proposals, including the initial proposal, is that there are many experienced GPs that have been doing this work for 20 years and in eight or nine minutes they can take a history, have a directed examination formulate a treatment plan and explain to the patient that treatment. And they can do that in eight or nine minutes. Now they're going to have to stretch it out which means that it's a very inefficient way of seeing patients and it also means…

LOUISE MAHER: Well, they'll only stretch it out if they want to be able to claim a higher rebate.

BRIAN OWLER: Well, they'll have to. Or they'll just have to pass the costs on to patients. If they try and stretch the consultation out and do more and more things it just means that the access to GPs, you know, getting an appointment in a timely manner - which is already somewhat of an issue - is going to be longer, and that's going to be more difficult to patients. So, I think the main thing at the end of the day is that patients right across the board will be asked to pay not just $5 out of their own pocket but, in many cases, substantially more. And the other issue is, of course, that I think that there will be a problem with access to GPs, and I think these changes have been poorly thought out.

We have a new Health Minister, and obviously the new Minister's getting across her portfolio at the moment, but we would hope that common sense will prevail. Now, these changes are due to come in on 19 January. Parliament can disallow them when they come back in early February, so they will be introduced before Parliament has the chance to make the disallowance, but when they come back, the AMA and the other groups will be campaigning very strongly to make sure that these changes are stopped.

LOUISE MAHER: I was away in the lead up to Christmas so I wasn't really across these changes but it seems to me there hasn't been much publicity about them at all.

BRIAN OWLER: Well, there was quite a lot just before Christmas, and then of course not long after that we had a change of Minister, and now things have gone quiet.

LOUISE MAHER: Do you think people have understood the impact of them though?

BRIAN OWLER: No, I don't. And one of the things is that people - you know, naturally enough, don't understand what level A and level B rebates are. So, what we've done is produced information and sent it to GPs right across the country that they can assist - [indistinct] and actually explain to patients - because they're going to have to be the ones that explain the changes to patients, and why the patient is being asked to pay more out of their own pocket. It's provided them with posters for their waiting rooms but it's very likely that early in the New Year there are going to be a number of public meetings of GPs that are actually for them to air their grievances, because we've received more feedback on this issue from GPs than probably any other issue that's affected GPs in the past decade…

LOUISE MAHER: There’s not a…

BRIAN OWLER: it’s the level of…

LOUISE MAHER: is concern, yeah.

BRIAN OWLER: out there.

LOUISE MAHER: There’s not a lot of bulk billing in the ACT at the moment, but what impact will these changes have on the bulk billing that is available?

BRIAN OWLER: Well, clearly people's ability to bulk bill is going to be reduced. Now, for those patients that are not on concessions and over 16 and have the ability to contribute to the costs of their care, we don't have an issue with a modest co-payment for those patients. In fact, the AMA put forward in an alternative proposal that did have a co-payment for those patients who could afford to contribute. But what we are still concerned about is vulnerable patients, and although they might be excluded from the $5 co-payment that comes in under the new proposal, all of these other changes means that the rate of bulk billing for vulnerable patients are also likely to decrease and that overall, for many patients, they are going to be paying a lot more out of their own pocket and…

LOUISE MAHER: Yeah.

BRIAN OWLER: They’ve got billing rates - well, not just for a small amount but in fact quite significantly.

LOUISE MAHER: And, just finally, there could be another way around this, if doctors are receiving less from the Government, is there a way they could tighten their own costs? Their own practice costs to avoid passing on this to the patient.

BRIAN OWLER: Well, not to this magnitude. I mean, at the end of the day, what we should be doing is actually investing in general practice. I mean, I was in the United States when the changes were announced and one of the reasons I was there was to look at how they were dealing with primary care and they've - they've learnt that you have to invest in primary care if you're to contain costs in other areas like the hospitals in our health system, and until we invest in general practice and actually put a proper value on general practice, there is going to be an issue with sustainability. So, GPs cannot afford to absorb those costs and, in fact, we're actually seeing in the NHS in the UK at the moment, they're in a real crisis because of the failure to invest in general practice. So, we need to learn those lessons and instead of talking about dollars and minutes, what we should be doing about - doing, is talking about health policy, how we're actually going to build a health system, how we're going to invest in general practice to actually do the chronic disease management and prevention that is so important for the future health of this country.

LOUISE MAHER: Brian Owler, thanks for joining us this morning.

BRIAN OWLER: It’s a pleasure Louise, thank you.

LOUISE MAHER: Brian Owler is the National President of the AMA and you might want to talk to your own GP about some of these changes due to come into effect - some of them anyway, from 19 January.

 


7 January 2015

CONTACT:         Odette Visser                       02 6270 5412 / 0427 209 753

                          Kirsty Waterford                  02 6270 5464 / 0407 726 905


Published: 07 Jan 2015