1. Abandoning Bulk Billing
NOT “IF?”
BUT “WHEN?”
AND “HOW?”
Eastbound Clinic - Dr Alan Molloy
12/5/2018

2. “A fair wage for a fair day’s work”
The main issue:
“A fair wage for a fair day’s work”
Eastbound Clinic - Dr Alan Molloy

3. Before bulk billing
Eastbound Clinic - Dr Alan Molloy

4. After bulk billing abandoned
Eastbound Clinic - Dr Alan Molloy

5. Our Reception – with bulk billing
Eastbound Clinic - Dr Alan Molloy

6. Our reception – after abandoning bulk billing
Eastbound Clinic - Dr Alan Molloy

7. Why Clinic Owners are suffering from bulk billing.
As bulk billing increases so do the % paid to Doctor Contractors increase
In % was a good amount to be paid
In 2014 the average is about 60%
What effect does that have on Practice Finances, viability, investment in capital redevelopments, modernisation, etc.
Eastbound Clinic - Dr Alan Molloy

8. For a Doctor to earn $150 per hour how many patients do they need to see per hour and what percentage do they need to be paid ??
BILLING SCENARIOS
BILLING PER HOUR
% PAID TO DOCTOR : INCOME PER DOCTOR PER HOUR
4 PATIENTS PER HOUR: BULK BILLED
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
$160.50
$80.25
$88.28
$96.30
$104.33
$112.35
$120.38
$128.40
$136.43
$144.45
$152.4
6 PATIENTS PER HOUR: BULK BILLED
$240.75
$132.41
$156.49
8 PATIENTS PER HOUR: BULK BILLED
45%
$321.00
$176.55
$192.60
$208.65
4 PATIENTS PER HOUR: EASTBOUND PRIVATE BILLING POLICY
$290.10
$145.05
$159.56
$174.06
$188.57
Eastbound Clinic - Dr Alan Molloy

9. Prior to Copayment
Bulk billing approx. 80% of patients for HCC holders/pensioners
Private fee at approx. the AMA rates
Eastbound Clinic - Dr Alan Molloy

10. When copayments were introduced
Copayments introduced for HCC holders/ Pensioners April 1998
- $5 Surgery consults
- $ All home/hostel/nursing home visits
- $10 After Hours at Surgery
- $10 Procedures
Eastbound Clinic - Dr Alan Molloy

11. Current Co-Payments $29 HCC and Pensioners
$70 for Home Visits and Aged Care facilities
$32 After hours consults at Clinic
$79 Private Patient fee for Item 23
Eastbound Clinic - Dr Alan Molloy

12. Effect of billing policy on income
YEAR

13. CPI ,Average weekly earnings, etc
Eastbound Clinic - Dr Alan Molloy

14. The Main Fears Drop in income Losing patients to other clinics
Too hard to administer
Patients cannot afford it
Eastbound Clinic - Dr Alan Molloy

15. The Outcomes Income goes up Patient numbers stable
Administration requires computerised billing software/hardware
Patients can usually afford it
Eastbound Clinic - Dr Alan Molloy

16. Do You Lose Patients to Other Clinics ?
Pre copayment survey
Lose 10%
Eastbound Clinic - Dr Alan Molloy

17. Do You Lose Patients to Other Clinics. Diagram circa 2000 – 15 clinics
Do You Lose Patients to Other Clinics? Diagram circa 2000 – 15 clinics. Where have all the Doctors gone ??
Centre Rd
Jasper Rd
Tucker Rd
Mackie Rd
1km radius
2km radius 8 5 1 4 2
(100%)
EB Rd
Within 1km 10 GP’s
Within 2km 42 GP’s
Eastbound Clinic - Dr Alan Molloy

18. Current local GPs - 9 clinics Practices that have closed : Dr’e De Crespigny (1) , Alan Hoskin (1), Dennis Morgan (1), Cheltenham Rd Clinic (on South Rd) (2-3 doctors), Centre Rd Medical Clinic (5 FT doctors) has been reborn, Martakis (2), Greek Doctor in Centre Rd (1), McKinnon Sports Medical clinic (3), Abbeysinghe (2) reducing hours.
2km radius
Within 1km > 10 GP’s
Within 2km > 30 + GP’s
Eastbound clinic
<- Centre Road ->
Eastbound Clinic - Dr Alan Molloy

19. Do You Lose Patients to Other Clinics ?
Patient numbers initially a slight drop off but then increased
Increase fee per patient = increase profit
Increased time per patient = Increased quality
Eastbound Clinic - Dr Alan Molloy

20. Do You Lose Patients to Other Clinics ?
Special groups
Home visits - lose none
S.A.H - usually no loss
Nursing homes - lose considerable number
Eastbound Clinic - Dr Alan Molloy

21. “Too Hard...”” Requires computerised billing/receipting at front desk
Cost per copayment - $1 extra
Cheque encashment - 40cents
Reply paid facility $20pm
Eastbound Clinic - Dr Alan Molloy

22. “Too Hard…”
Must have Medicare / HIC Online for claiming, it is not difficult.
Staff time increased a little
Lost rebate cheques, bad debtors - very rare. We recover 99% of Pay Doctor cheques. Average time is 2-3 weeks.
Eastbound Clinic - Dr Alan Molloy

23. Our System Collect copayment $29 after the consultation
Finalise billings and annotate any blended billings, eg associated Item Numbers, eg 721
Send claim to Medicare online
Rebate cheques arrive in 1 to 5 weeks and are banked
Eastbound Clinic - Dr Alan Molloy

24. “$2.15…THE PRICE WE PAY TO SEE THE DOCTOR” THE AGE 23/10/2000
Can Patients Afford it?
“$2.15…THE PRICE WE PAY TO SEE THE DOCTOR” THE AGE 23/10/2000
Eastbound Clinic - Dr Alan Molloy

25. Can Patients Afford it?
“Australians paid almost nothing last financial year to visit their doctor. On average, Australians paid $11.36 for GP care for the year” THE AGE 23/10/2000
I believe it is now about $80 per annum in 2014
Eastbound Clinic - Dr Alan Molloy

26. Can Patients Afford it?
“The Medicare statistics reveal that on average Australians pay $2.15 per GP visit. “
THE AGE 23/10/2000
Sorry cannot find out what we pay now but it is not much…
Eastbound Clinic - Dr Alan Molloy

27. Can Patients Afford it? Central Bayside CHC Podiatry - $10.00 for HCC
Physio - $10.00 for HCC
Dental - $ for HCC
Podiatry - $10.00
Other services $25.00 private pts
Eastbound Clinic - Dr Alan Molloy

28. Implementing Copayments
Convince yourself of its necessity
Convince your staff of its necessity
Begin planning, staff meetings, educating patients, training staff
Eastbound Clinic - Dr Alan Molloy

29. Clinic Billing Policy

32. Implementing Copayments
Begin with most uneconomic services - AH’s & HV’s
When system bedded down introduce copayment for all surgery consultations
Eastbound Clinic - Dr Alan Molloy

33. For a 100% B/B Clinic
$20 Copayment for non-HCC holders - all services (2 months)
$5 for HCC After Hours (2 months)
$5 for all HCC consults (2 months)
$10 for all HCC After Hours
After 6 months:
$30 for non HCC or privately bill
$10 for HCC , then annual increases
Eastbound Clinic - Dr Alan Molloy

34. Is it all too hard?
Throw in the towel! Walk away and close up shop, eg Dr Moses in Poath Rd
Try to sell your practice. A 100% Bulk Billing practice is not worth much because good will has become dependent on price.
Get Primary Health Care to give you a big payout to join them!!! – however you only get 50% ongoing and have to work atrocious hours, 5 yr contract, could be nasty…
Aggregate with a local clinic that has already done the transition successfully, viz a viz Eastbound Clinic.
Eastbound Clinic - Dr Alan Molloy

35. Corporatisation: Why is it succeeding?
Gradual erosion of profitability of running a GP clinic
“Why bother running it? I am better off letting someone else run it and me just be a doctor.”
Eastbound Clinic - Dr Alan Molloy

36. Otherwise: Give in and let someone else run your life
Corporatisation:
Pros and cons
If you want to fight it: Make your business profitable to run. Make your effort worthwhile.
Otherwise: Give in and let someone else run your life
Eastbound Clinic - Dr Alan Molloy

37. Why is the Govt introducing a copayment?
Cost to Govt of bulk billed patients
Assumption is that half the patients seen are not on Health care cards so do NOT attract the Bulk Billing incentive of $6.15 and the other half are on a Health Care Card or Pension so do attract the Bulk Billing Incentive of $6.15 per consult
No of Patients seen per hour
Cost to Govt 4
$160.50 6
$240.75 8
$321.00
The simple solution is to reduce the number of consultations seen by a doctor to dramatically reduce the cost to the Govt
Eastbound Clinic - Dr Alan Molloy

38. Do you have a sense of humour? The Movie “Siam Sunset”
Eastbound Clinic - Dr Alan Molloy

39. Does your clinic look like this??
Eastbound Clinic - Dr Alan Molloy

40. The Bulk Billing GP in the movie
Eastbound Clinic - Dr Alan Molloy

41. How he earned a bit of extra cash on the side…..
Eastbound Clinic - Dr Alan Molloy

42. How he reached his grissly end..
Eastbound Clinic - Dr Alan Molloy

43. The moral of this gruesome tale…if there is one..???
The public, the media, movie makers and thinkers in our society are not fools. They know what is going on.
There is a need for quality in all industries to ensure long term success.
In medical practice if you strive for quality, good value for money and overtly care for your patients, then you will be fine.
If you are just competing on price alone, then you are no different from a cut price service station offering a bigger fuel discount. As your discount diminishes then your customers will leave you.
Eastbound Clinic - Dr Alan Molloy

44. How can Eastbound Clinic help?
Running seminars on topics of interest to local GPs
Specific training seminars for practice staff
On site assistance / consultancy to clinics
Eventually would like to become an RACGP Accredited CME provider to run Continuing Education for GPs and other Staff.
Eastbound Clinic - Dr Alan Molloy

45. What we shall be doing next at Eastbound?
Practical session for practice staff on how to privately billy. For practice staff to train them. There will be a cost. Aim for late October / early November.
Social media and Facebook in General Practice. Get your Facebook page up and running. Will need a Facebook account prior to coming.
Will register as a CME provider with the RACGP
Eastbound Clinic - Dr Alan Molloy

46. Thanks for coming…
Have a nice day…
Eastbound Clinic - Dr Alan Molloy