1. THE HEALTH BUDGET MANAGING THE IMPACT IN GENERAL PRACTICE 2014 AMA National Conference Dr Brian Morton AM Chair Council of General Practice

2. FEE FOR SERVICE IN GENERAL PRACTICE - NOW  Standard GP Attendances for 2012-13 = 115,510,216 services  Bulk billing rate 82%  VR GP – Level B - Item 23 – (most common consultation)  Private Billing AMA Fee Rebate$73  Bulk – billing Schedule Fee (100%)$36.30  Concessional Card Holders & Children under 16yrs  Bulk – billed- Schedule + Bulk-billing Incentive$36.30 + $6.00 = $42.30  Rural Loading - $36.30+ $9.10 = $45.40 AMA National Conference 2014 - Council of General Practice 2

3. THE BUDGET CHANGES FOR GENERAL PRACTICE – JULY 2015  Patient Rebates cut by $ 5 for:  Standard GP consultations (A1, A2, A11, A22 & A23 MBS Items)  Pathology - for each episode of care – out of hospital  Radiology – out of hospital  Patient Co-payment of $7 will apply for above services which would have previously been bulk billed.  Level B - $31.30 + $7 = $38.30 ie $2 more for GP than now AMA National Conference 2014 - Council of General Practice 3

4. THE BUDGET CHANGES FOR GENERAL PRACTICE – JULY 2015  For Concession card + under 16yrs only  Will only have to pay $7 co-payment for first 10 services - $70 maximum co- contribution  Only services with $7 co-payment will count towards the 10 services  GPs will get “low gap” incentive if co-payment charged at $7 – no more no less  When threshold reached patient rebate reverts to $36.30  “low gap” incentive applies if additional services provided to patient at no charge AMA National Conference 2014 - Council of General Practice 4

5. GP BILLING OPTIONS AFTER – JULY 2015  Non Concession Card Holders :  1. Waive co-payment GP takes a loss of - $5 14%  2. Privately billAt AMA rate$73 Patient rebate to $31.30 – patient OPC Charge an appropriate fee to cover lower numbers + admin costs +bad debt  3. Charge co-payment $31.30 + $7 = $38.30  Concession Card Holders  W aive co-payment take a loss of - $13 2 9 %  rural - $16.10 34%  Charge co-payment $31.30 + $7 + $6 = $44.30 After $70 threshold $36.30 + $6 = $42.30 AMA National Conference 2014 - Council of General Practice 5

6. CLINICAL IMPLICATIONS AFTER – JULY 2015 Who are your vulnerable patients? ( Aside from concession card holders and under 16s)  What indicators will you use to determine  What perimeters will you set Impact of a minimum $7 out of pocket cost for patients  Will patients ration their health care services  Managing the patient you now see less AMA National Conference 2014 - Council of General Practice 6

7. PERVERSE OUTCOMES AFTER – JULY 2015 Ingenious work-a-rounds that push compliance boundaries Decline in immunisation rates Decrease in RACF visiting GPs from 20% of GPs to ? 0 % Preventative health even more discretionary Delay in presentation General Practice as a career even less attractive AMA National Conference 2014 - Council of General Practice 7

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9. OPPORTUNITY FOR CHANGE AFTER – JULY 2015  To focus on quality general practice  To put the value back into GP care  To ensure practice viability through the value patients place on the care they receive and away from a reliance on high patient throughput or MBS item maximisation  Change is always difficult – need to make this change good for the health system, our professionalism, and patient care  Will encourage greater patient engagement in their health care AMA National Conference 2014 - Council of General Practice 9

10. REJECTING CO PAYMENT?- CONSEQUENCES? AFTER – JULY 2015  Rebate freezing  More draconian Medicare changes  Expanded scopes of practice for lesser trained health care practitioners AMA National Conference 2014 - Council of General Practice 10

11. FRONT DESK COSTS AND REQUIREMENTS AFTER – JULY 2015  Workstations - space at the front desk – renovation?  IT capability – sufficient server + desktop capability  Staffing – 0.25 of extra receptionist  Cash management & safety  EFTPOS  Equipment Rental Fee - $35/month  Transaction fees – 1%  Bank Merchant fees – 0.4%  Dedicated telephone line – only data transfer AMA National Conference 2014 - Council of General Practice 11

12. COMMUNICATING WITH THE PATIENTS AFTER – JULY 2015  Review billing policies  Assessing ability to pay  Counselling re “continuity of care”  Medicare changes – Thresholds; Medicare Safety Net  Recall and follow-up; ( + Medico-legal responsibility)  Preventive care needs  Pathology & Radiology implications AMA National Conference 2014 - Council of General Practice 12

13. WAY FORWARD Real opportunity to ensure the value of general practice and in so doing attract a future GP workforce Must ensure:  Adequate support for vulnerable patients  No financial penalty for GPs when waiving patient fees in exceptional circumstances  Measures to support transition and underpin viable high quality General Practice  Minimal compliance costs Health Care determined by health professionals not economists AMA National Conference 2014 - Council of General Practice 13

14. SO WILL YOU LISTEN TO THE PROFESSION OR IS IT JUST THE ECONOMISTS ? AMA National Conference 2014 - Council of General Practice 14 Courtesy The Sydney Morning Herald