AUSTRALIAN patients will be hit by a new $20 fee for seeing their GP when changes to Medicare, introduced by the Abbott government to save billions of dollars, begin to take effect from next week.
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Under a little-known "10 minute" rule predicted to blow out GP waiting times from January 19, Medicare will pay $20.10 less for consultations lasting six to 10 minutes.
For years, Medicare has paid $37.05 towards these "Level B" visits made by millions of patients each year requiring a new prescription or blood pressure check, for example. It will now pay $16.95, a move doctors warn will "destroy" free universal healthcare.
The Australian Medical Association says the change, estimated to cut $500 million from Medicare in 2015, will prompt many doctors to stop bulk-billing shorter consultations because the payment does not meet their costs.
"This change alone will kill off a lot of bulk-billing," said Dr Michael Levick, a spokesman for the AMA's Victorian branch. "This is a very sly way of cutting the [health] budget."
The change means people who currently pay to see their GP will receive $20.10 less back from Medicare for consultations up to 10 minutes, meaning their "out of pocket" cost or "gap fee" (the difference between what their doctor charges and what they receive back from Medicare) will increase.
Chair of the AMA's council of general practice Brian Morton said although bulk-billing GPs (those who charge their patients nothing) could absorb the pay cut and receive $16.95 for such consultations, they were unlikely to do so because Medicare payments were already failing to keep up with the costs of running a practice.
Instead, he said that as of Monday, many GPs were likely to stop bulk-billing and charge a fee for short consultations, meaning some patients who currently receive free care will have to pay.
Dr Morton said it was also possible that doctors and their patients would stretch consultations out to meet the 10-minute threshold for a rebate of $37.05 - the payment for consultations between 10 and 20 minutes. This would mean GPs would see fewer patients on average a day, making them less accessible to patients trying to book an appointment.
"It may be that patients and doctors extend the consultation unnecessarily to get over that 10-minute threshold and that will impact on access. If you can do an efficient, good-quality consultation for eight minutes that is relevant to the patient's circumstances and needs, it doesn't take long before those two minutes add up to block another patient coming in," he said.
Last financial year, about 35 million GP consultations, or 26 per cent of 134 million billed to Medicare, were under 10 minutes.
In the same year, the Australian Bureau of Statistics said one in five Australians who saw a GP said they waited longer than they felt was acceptable to get an appointment. One in 20 who needed to see a GP said they delayed it or did not go because of cost.
The change comes alongside a $5 cut to all Medicare rebates for GP consultations that will apply to non-concessional patients from July 1. This means people without a concession who see a GP for less than 10 minutes from July, will receive a rebate of $11.95.
Indexation of the Medicare rebate has also been frozen until 2018, infuriating doctors who are planning rallies to protest in all major Australian cities on February 8. They are hoping to pressure the Senate into disallowing the changes, some of which have been introduced through regulation.
A spokesman for Health Minister Sussan Ley said the changes to consultations under 10 minutes were designed to better reflect the time a doctor spends with their patient and to encourage longer GP consultations with patients for better health outcomes.
"Under the current rules, a GP can access Medicare rebates for up to 20 minutes, even if their patient is in and out the door in six minutes," the spokesman said.
While about 83 per cent of all GP consultations were bulk-billed in 2013-14, Dr Levick, a Brunswick GP on the board of AMA Victoria, said the federal government's cuts to Medicare were making bulk-billing unviable.
He said the changes meant his clinic would introduce a new fee schedule in February, with bulk-billing reserved for exceptional cases. Under his new fees, people will pay $30 for zero to six minutes and $55 forsix to 10 minutes, meaning their out of pocket cost after a rebate of $16.95 will be $13.05 and $38.05 respectively.
Dr Levick said short consultations were often used to review people with a previously serious illness such as pneumonia or for those with chronic illnesses. He said charging these patients could mean they forego the visits and end up in a hospital emergency department instead.
