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until the public consultation next year. The AMA is encouraging transparency. But we have already made a number of submissions that you need to be talking about the funding as well as the structure.
AD: But won’ t there be an assumption in the review that the changes have to be done on a cost-neutral basis?
If its proposals inflate the Medicare budget, then suddenly it becomes a political issue, a Treasury issue and that suddenly makes it more vexed.
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Dr Danielle McMullen.
Dr McMullen: Vexed, but not impossible. We certainly think that approach is consistent with saying there needs to be more funding in general practice.
The costings in our solution were around $ 4.5 billion over four years, which is less than they spent in the election. The bulk-billing incentives were priced at $ 8 or $ 9 billion.
So yes, our solution has an expense, but it is not excessive. And we don’ t think adding extra funding should be off the table.
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what a member-based organisation with a part-time economist can do.
You also need to remember, when it comes to time-tiered items, you are including home visits, nursing home visits [ and ] after-hours care.
There are a lot of different items that can be impacted, including those for telehealth.
AD: Can I ask about BEACH? This was the longitudinal study run through the University of Sydney tracking what was actually going on in these consults— management of heart failure, mental health and asthma, as well as the work done outside of face-to-face consults.
It was defunded under then-health minister Sussan Ley back in 2016, but it has never returned, so we don’ t have a particularly accurate picture of what GPs are doing across the various time tiers.
Dr McMullen: Yeah. It also means that you end up with that accusation, that question from policymakers:‘ What exactly are you doing for all that time in general practice?’ BEACH involved doctors writing out what they had done following the consult. It was filling in pieces of paper.
But in 2025 there should be a smarter way to extract some de-identified data about what it is that we’ re doing. And if that helps to demonstrate to government the complexity of care, then that’ s useful.
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we will push for‘ as speedy as possible’, but it won’ t be overnight.
AD: We talk about this as a fundamental change for general practice— the modernisation of fee-for-service.
But there will be many reading this who will say this is nothing to do with GPs.
Dr McMullen: I think it is exciting that government is at least taking a look at it. We’ ve been banging on for years about how Medicare isn’ t fit for purpose.
You are right, at the end of the day, it’ s about fair rebates for patients.
Is it likely that they’ ll shift the funding and the structure so much that there are no more gap fees for any patient?
That’ s unlikely, but it would make a significant difference to patients if they got a fair rebate for the length of their consultation and didn’ t have to worry about those extra few minutes to talk about say, preventive health issues.
But it is an issue for us too. Every day as GPs, we face decisions about whether to charge a fee to the patient, how much of a fee to charge, and whether we should fit in those extra few items which will then tick over into a longer consult.
A lot of GPs find that constant thinking about rebates hugely stressful. If we had a better system, a better structure, then it would take the burden out of that as well.
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