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Ask Dr Dave - October1997
I work in an associateship with several colleagues. I read recently that the ACCC was going to prosecute those GPs like me who charged the same fee for an Item 23. This would apply even had there been no discussion amongst the group on charging any particular fee. As a result, I am reluctant to advertise my charges for fear of being prosecuted. This leaves the patient uninformed about the likely cost of the consultation and therefore has an anti-competitive effect. Can this be right?
Bewildered
Dear Bewildered
The Australian Consumer and Competition Commission oversees all commercial activity in Australia. Competition is essential to the efficient distribution of goods and services and should be welcomed. The Commission is well intentioned but being a government institution its determinations result in some bizarre consequences.
GPs in partnership can agree on fees because they are working under a single entity. Employed GPs are similarly permitted to sacrifice the setting of fees for an agreed wage and solo GPs obviously determine their own fees.
Associates usually agree to cover each other for after hours work and holidays and to share costs equally. This is not prohibited by law. Associates, however, are separate legal entities and collusion on fees is prohibited. Yet the law does not make allowance for the fact that associates within a group practice compete with each other mainly on quality of service and availability. It also does not recognise that when the costs are equal then the fees charged will also tend to be equal. Associateships compete on price mainly against doctors outside the group.
Even more bizarre is the fact that you can collude to bulk-bill. The government simply legislated this exception. Some may say this seems a trifle unfair and it is.
It used to be that the 85% rebate was the floor price. It is now an anchor around the legs of those who continue to bulk-bill, as they drown under the slowly rising tide of CPI and wage increases. Don't expect the ACCC to help cut you free.
DD
Dear DD I keep getting reams of paper from the local health department about services that are new or have changed their contact details or hours of operation, etc., etc. I usually put these in the pending file, which gets thrown out once every three months. Shouldn't there be one central area where this information can be accessed? Infowhelmed
Dear Infowhelmed
The local area health regions have addressed this problem by establishing 'Intake' numbers. A call to this number will redirect you to the service that you want. The North Coast Health Service Intake number is (02) 6620 2967.
A better solution would be for this information to be available on the Health Service's Web site. The information could be easily updated and you would get the right information when you required it. The site could be downloaded to your surgery server for more rapid access and there are Internet tools that can notify you if any changes have been made to the Web site.
The Tweed Valley Mental Health Service has had a Web site (http://onthenet.com.au/ ~pict/mentform.htm) for several years. Establishing a more comprehensive service for the whole of the region is something that the newly appointed GP Liaison Officer may take up with the Health Service.
DD
Dear Amazed
Unfortunately, it is not possible to give the money back to GPs. It has already been returned to consolidated revenue and is no longer available.
Most divisions have been set up as companies limited by guarantee and removing their DPGP funding would have no effect on their structures. The division can only be wound up by a resolution passed at a specially convened meeting or at the Annual General Meeting.
Some have suggested that the true worth of divisions will only be discovered when their Federal funding is removed. Some of the more successful divisions are already independent in this respect. They can now survive on the money they get from their members, drug companies, advertisers, State Health Departments and others. They have succeeded because they offer training and improved communication to members and can sell their services to outside groups.
Do not be too hard on the DPGP. They are well intentioned and hard working men and women with some excellent ideas. Unfortunately, in the public service the bottom line is not the top priority.
DD
Dear Flabbergasted
Some would rather die than pay but they usually don't.
For others Medicare is a religion and you have desecrated the temple of bulk billing. Do not be alarmed, for their number is few.
DD
Dear Guilty Conscience
According to the Australian Medical Association in the last five years the rebate has increased by 3% and practice costs by 15%. Unless you wish to personally finance the social welfare system you have no option but to stop bulk billing. You obviously feel badly about the consequences for some of your patients and you may wish to pursue a political solution. Have you thought of starting an Aboriginal Medical Service in your area?
DD
Dear Frugal
In the last budget the government announced the introduction of 'electronic commerce for Medicare claim processing'. This will allow you to run the patient's Medicare care through an EFTPOS-like machine to claim for the rebate component of the fee. There will still be a delay of several weeks before the government deposits the money in your bank account. (Maybe they are trying to make the banks look good!) You should collect the gap payment from the patient at the time of consultation to minimise your transaction costs.
This is a major step for the government. It is just dawning on the profession and the public that this will be the end of the current Medicare system. An out of pocket payment will reduce the number of services and the gap payment will have to increase significantly to compensate. So far the political damage to the Liberals has been negligible but that may change as experience with the system develops and the next election looms.
The decreased transaction costs from electronic claiming will reap the government a huge sum of money. It currently costs about $1.80 to process a Medicare claim on paper. Electronically it costs about 30 cents. A quick analysis suggests that the government would save about $150 million annually if there were large acceptance of electronic claiming. General practitioners and the computer software industry have suggested that there should be sharing of this windfall. The Health Insurance Commission is agreeable but the Department of Finance would seem to have other ideas.
DD
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