Talking Politics

[year of the tiger]

Thanks for your responses guys, and sorry Sin for my late reply to your question from yesterday.

In my experience, bulk-billing clinics are still viable. My partner and I ran a very profitable rural bulk-billing clinic from 2007-2019, during the freeze period. Sold 3 months before COVID hit . Like a lot of businesses, economies of scale is vital. A solo GP BB clinic is not viable, but a 4+ FTE (full time equivalent) GP clinic is.

The sole reason why we sold was the difficulty recruiting GPs. If there was an ample supply of GPs, we would still have the clinic and most likely would have opened several more around the country. I heard the other day that only 10% of medical graduates are choosing GP as a specialty. That's a disastrous figure and a major reason why BBing is in decline. Graduates can pick and choose where they work, and most choose plush areas in major cities rather than rural areas, and certainly private fee clinics in front of BBing clinics.

Ours was the "walk in walk out" GP model whereby GPs could easily start practicing (everything was provided, the building, staff, nurses, IT, equipment, patients), and when they wanted to move on, they simply gave a few months notice. We provided everything, and all the GPs had to do was practice. We would simply deduct a management fee of around 25-35% of their billings.

We had GPs earning over $450K+ working M-F 9-5...once again, during the freeze period. There was no rorting, overbilling whatsoever but BB GPs need to work harder by utilising higher billing item numbers such as chronic disease management, case conferences (with other providers) and mental health. This actually provides a higher level of patient care, compared to private fee doctors who don't need to engage in CDM etc. as they just generally charge time-based item 23 (6-20 minutes) and 36 (21-40 minutes). My local GP charges $86 for item 23 and $126 for item 36. Our GPs also received a BB incentive of about $12 per consult, but as of November last year, it's increased to about $33.

I never had much to do with the RACGP and AMA, they were more for the GPs. The AMA is an extremely strong quasi-union and have both sides of the government in their pocket. They strongly advocate for private billing to their members, and publish rates in which they should charge patients.

Main reasons why BB is in decline:

1. Doctor shortage
2. Decline in med grads choosing GP as a specialty.
3. Mental health is now the largest presentation at GP clinics, and many GPs don't like, or don't have the quals to deal with it. Dedicated MH clinics, like the recently dedicated Urgent Care Clinics would definitely assist GPs.
4. When we opened our BB GP clinic, the current waiting time for a consult was 3 weeks for a private fee clinic. The only effect we had on the private fee clinics was reducing their waiting time to about 1 week, but that didn't stop them from smearing our clinic, suggesting the BB GPs are inferior to private fee GPs. Complete nonsense of course. We had to lawyer up for a couple. This perception orchestrated by private fee GPs and the AMA turns GP off BBing.

I could go on for hours about this, but the bottom line is the MBS fee freeze didn't destroy bulk-billing. To suggest that it did is lazy and simply incorrect.

If you live in a capital city or major population centre (most of us do), you will have no trouble finding bulk billing for GP visits, pathology and radiology. Are they on every corner? No, but if you are prepared to do some research, and maybe drive/bus/ride 10 minutes more, I guarantee you can get bulk billed.

Thanks Nico, I agree with your points re the decline in BB and GP practices generally but I still stand that the freeze on the Medicare rebates have contributed to this decline - agree it’s complex and there are many factors as you have outlined, not just the rebate.

From the data I have seen, BB is in decline, GP wait times are in the increase and some people now either cant access a GP or afford to go if they access one.

Agree the AMA’s and RACGP don’t necessarily provide an accurate picture, and are no longer representing the industry (in Tas, for example, between 30 to 40% of GPS are members and none from memory who are aged under 35).

I would also challenge, from a Tassie perspective anyway, that anyone can access a fully BB practice, I am not sure any exist in Tas now, there was 2 a couple of years back.

You must have run a special business practice- well done.

 

[Nico]

Thanks Nico, I agree with your points re the decline in BB and GP practices generally but I still stand that the freeze on the Medicare rebates have contributed to this decline - agree it’s complex and there are many factors as you have outlined, not just the rebate.

From the data I have seen, BB is in decline, GP wait times are in the increase and some people now either cant access a GP or afford to go if they access one.

Agree the AMA’s and RACGP don’t necessarily provide an accurate picture, and are no longer representing the industry (in Tas, for example, between 30 to 40% of GPS are members and none from memory who are aged under 35).

I would also challenge, from a Tassie perspective anyway, that anyone can access a fully BB practice, I am not sure any exist in Tas now, there was 2 a couple of years back.

You must have run a special business practice- well done.

Thanks for your reply TOTT. From my direct experience, the Medicare freeze had zero impact on bulk-billing. During the freeze period, our GPs earned good coin, and the clinic earned good coin.

We found it extremely difficult to recruit Australian trained GPs, so we turned our attention to the UK where we recruited approx. 8 GPs over a 5 year period. Our medical system is based on the UK system so registration of UK GPs was quite straight-forward.

When that route dried up, we saw the writing on the wall and started looking for a buyer. Due to the lack of supply, GPs were in the driver's seat and made ridiculous demands which we couldn't meet. This made the bulk billing model unviable. Again, if there was a steady supply of GPs, I would still have the clinic and would have expanded nationally.

Regional areas suffered the most in attracting GPs, including smaller states such as Tassie.

Why would GPs bulk bill when they don't have to? Tasmania is a good example. Massive shortage of GPs, bulk billing requires more work than private fee GPs. Why would they bulk bill? They can write their own ticket. If there was an oversupply of GPs, there would be bulk billing all over the place. It's simply supply and demand.

YOTT, you can still stand that the Medicare freeze has contributed to decline in bulk billing, but after 12 years of bulk billing, I can categorically state that the decline of bulk billing is due to the shortage of GPs, not the freeze. It's a complete cop out.

You do realise that the first Medicare rate freeze was by the Gillard government in November 2013? Just saying. Of course the LNP continued it, but the freeze was introduced by the Labour Government.

 

[Nico]

The scary thing is that it doesn't surprise me having worked with and around a lot of doctors.

The stories I could tell.

 

[K3]

More tax payers money from the Feds, to *smile* up against the wall by Victorian Labor .

No. Just it being moved from one state to a different state.

You really should read more than Murdoch press machine tabloids.

 

[K3]

 

[bengal tigers]

No. Just it being moved from one state to a different state.

You really should read more than Murdoch press machine tabloids.

What are you saying that the Victorian Government doesn;t *smile* tax payer's money up the wall,there record speaks for it self.

 

[frickenel]

No. Just it being moved from one state to a different state.

You really should read more than Murdoch press machine tabloids.

K3, what media have you been watching?

Labout are pissing over 200 billion against the wall for a suburban rail loop. Have tey looked at the white elephant the Chinese built, that the Chinese govt is trying to offload to their provinces who want nothing to do with it?

If nobody uses this inferstructure, then you ca't use it to move freight or anything else! So why build it, particularly as all this money is helping fuel the inflation beast?

Well, it runs through soem key liberal seats, so land get confiscated for the project, high rise developments go up on the stations, and people who tend to rent or live in dense population centres are overwhelmingly left.

Why would labour want to improve your life and help you become middle class comfortable? Those people are usually conservative, better you drive everyone into the dirt. You will own nothing and be happy!!!

 

[K3]

What are you saying that the Victorian Government doesn;t *smile* tax payer's money up the wall,there record speaks for it self.

No. I'm saying that the money isn't "new". I believe it is a redistribution of GST revenue that was going to other states who, most likely, also wasted a truck load of it.

 

[K3]

K3, what media have you been watching?

Labout are pissing over 200 billion against the wall for a suburban rail loop. Have tey looked at the white elephant the Chinese built, that the Chinese govt is trying to offload to their provinces who want nothing to do with it?

If nobody uses this inferstructure, then you ca't use it to move freight or anything else! So why build it, particularly as all this money is helping fuel the inflation beast?

Well, it runs through soem key liberal seats, so land get confiscated for the project, high rise developments go up on the stations, and people who tend to rent or live in dense population centres are overwhelmingly left.

Why would labour want to improve your life and help you become middle class comfortable? Those people are usually conservative, better you drive everyone into the dirt. You will own nothing and be happy!!!

The rail loop should have been built decades ago, but all govts in that time were too short-sighted and self-serving to get stuck into it. If they had people would be able to live along it, house prices may be a bit lower, and it would have cost a bucket load less than it is now. Both major parties are responsible for the lack of infrastructure throughout our city and state, but at least Labor hasn't sold off masses of state owned orgs to try and balance a budget they have screwed up for years and years while in government, thereby reducing the state's infrastructure.

Hopefully, people feel the same and vote for their local independents, instead of either major, indebted, self-serving party!

 

[Sintiger]

The rail loop should have been built decades ago, but all govts in that time were too short-sighted and self-serving to get stuck into it. If they had people would be able to live along it, house prices may be a bit lower, and it would have cost a bucket load less than it is now. Both major parties are responsible for the lack of infrastructure throughout our city and state, but at least Labor hasn't sold off masses of state owned orgs to try and balance a budget they have screwed up for years and years while in government.

Hopefully, people feel the same and vote for their local independents, instead of either major, indebted, self-serving party!

The suburban rail loop is fantastic. The modelling shows it would be the most used rail line in the city. When you look at the route it has nothing to do with who votes for who along it. It is logical in the way it links up suburban hubs along the way.

That’s doesn’t mean we can afford to build it of course.

 

[Baloo]

The suburban rail loop is fantastic. The modelling shows it would be the most used rail line in the city. When you look at the route it has nothing to do with who votes for who along it. It is logical in the way it links up suburban hubs along the way.

That’s doesn’t mean we can afford to build it of course.

The NBN is living proof of what happens when a government tries to save money and cut corners for much needed infrastructure. Instead of having worldclass internet connectivity to most homes, Australia is still using copper wires, technology that was first used for phones in the 19th century.

List of sovereign states by Internet connection speeds - Wikipedia

en.wikipedia.org

If you're looking for Australia in the last of global average internet speeds, you'll need to scroll down a bit, ranked 94th in the world.

 

[K3]

The suburban rail loop is fantastic. The modelling shows it would be the most used rail line in the city. When you look at the route it has nothing to do with who votes for who along it. It is logical in the way it links up suburban hubs along the way.

That’s doesn’t mean we can afford to build it of course.

Do you know if they ended up overcoming complete stupidity and join the new loop line to the rest at South Yarra?

 

[Sintiger]

Do you know if they ended up overcoming complete stupidity and join the new loop line to the rest at South Yarra?

Don’t really know, you mean in the metro tunnel ?

This is the map of the suburban rail loop

suburban rail.loop map

 

[DavidSSS]

Do you know if they ended up overcoming complete stupidity and join the new loop line to the rest at South Yarra?

From memory they didn't end up putting a station in at South Yarra, which is silly since I think it runs right under there. Missed opportunity.

As for the state and federal debts, woopy wow. Some seem to think that government budgets are like a household, but then they probably also believe the flat-earth economics peddled by the likes of the IPA.

DS

 

[TigerMasochist]

but at least Labor hasn't sold off masses of state owned orgs to try and balance a budget they have screwed up for years and years while in government, thereby reducing the state's infrastructure.

Are you somehow referring to all that State owned stuff that Joffa boy Kennett sold off years ago to try n balance the books because the Labour Govt had left the State in a totally debt crippled mess???? Victoria wasn't designated the rust bucket state at the time because of the brilliant fiscal management over the Cain / Kirner years.

 

[K3]

Are you somehow referring to all that State owned stuff that Joffa boy Kennett sold off years ago to try n balance the books because the Labour Govt had left the State in a totally debt crippled mess???? Victoria wasn't designated the rust bucket state at the time because of the brilliant fiscal management over the Cain / Kirner years.

As someone who knew people who knew people, the above was relayed to me in quite a different manner.

 

[IanG]

Are you somehow referring to all that State owned stuff that Joffa boy Kennett sold off years ago to try n balance the books because the Labour Govt had left the State in a totally debt crippled mess???? Victoria wasn't designated the rust bucket state at the time because of the brilliant fiscal management over the Cain / Kirner years.

Don't believe anything you read/hear. The debt at the time was perfectly manageable.

 

[TigerMasochist]

Don't believe anything you read/hear. The debt at the time was perfectly manageable.

Does this mean that I shouldn't believe you IanG ?????? Or anyone except myself as long as i don't mutter n mumble to loud.

 

[Ian4]

1. Doctor shortage
2. Decline in med grads choosing GP as a specialty.
3. Mental health is now the largest presentation at GP clinics, and many GPs don't like, or don't have the quals to deal with it. Dedicated MH clinics, like the recently dedicated Urgent Care Clinics would definitely assist GPs.
4. When we opened our BB GP clinic, the current waiting time for a consult was 3 weeks for a private fee clinic. The only effect we had on the private fee clinics was reducing their waiting time to about 1 week, but that didn't stop them from smearing our clinic, suggesting the BB GPs are inferior to private fee GPs. Complete nonsense of course. We had to lawyer up for a couple. This perception orchestrated by private fee GPs and the AMA turns GP off BBing.

I could go on for hours about this, but the bottom line is the MBS fee freeze didn't destroy bulk-billing. To suggest that it did is lazy and simply incorrect.

If you live in a capital city or major population centre (most of us do), you will have no trouble finding bulk billing for GP visits, pathology and radiology. Are they on every corner? No, but if you are prepared to do some research, and maybe drive/bus/ride 10 minutes more, I guarantee you can get bulk billed.

Thank you for answering in such detail. My GP has started charging $75 for a face to face consult ($41.40 rebate). He is yet to charge me for Telehealth, but I am expecting that to change at some point.

In the past I have switched GP’s when they have started changing extra for consults, but I trust my GP and I will be staying put for now. That may change if I do find another clinic locally that bulk bills. I will add that this medical centre has multiple GP’s on site as well as a dentist and psychologist.

I do have a question though… If you are claiming that you were profitable enough without having to add extra charges, and freezing charges had no impact on bulk billing, then why are we seeing more and more clinics with extra consult charges?

You said there are less GP’s coming through. So larger clinics are struggling to find staff? Is that what it is? Or are larger clinics just getting greedy?

SIA is a chain of clinics all over Melbourne, including one around about a 10 minute walk from where I live. They charge $76 for a consult (plus the $41.40 rebate) if you pre-book. No extra charges for walk ins. But for walk ins they can’t promise you will get seen immediately. Who has the time for that?

Assuming SIA have the same business model at every clinic, do you think they are being fair or greedy?

 

[frickenel]

As someone who knew people who knew people, the above was relayed to me in quite a different manner.

K3, belive me you had to live it.

Wherever you were talking to hasn't a clue. The State Bank went broke FFS

it's hard reading the political threads on here TBH. People try to turn black into white, or make statements like "Eat the Rich" when their political persuasion supports the Elitists who want to own everythnig and leave the rest of us with nothing.

I'd get a bit cutting and sarcastic with other posters, usually because they took a rip at me, but i'm sort of beyond that now. I read their posts in the footy threads, and they seem quite intelligent, but then i find myself totally miffed by their posts on these boards.

At the end of the day, i guess it's what media a person is exposed to. It can happen the other way too if you only follow right wind stuff, and then get dragged down the whole QAnon rabbit hole.

I meioned this on another thread and i will say it again.

People should get onto Ground News which will throw dozens of news articles up on every topic. The articles will be from the left, the right and the centre, but they will tell you their biases.

It's the best way to find your line to the truth.

But i can assure you of this. The main stream Wall St media is part of the apparatus and hardly even a news service anymore.

The problem is that the left is like a cult. Even when they know they are being lied to, they'd rather listen to more lies than hear truth. It's like a mind disease.