Morning all,
I went to my doc last week as I have had some abdominal pains and wanted it checked, the practice no longer bulk bills so I paid the $30 Gap fee.
He recommended a CT scan (Bulk Billed) which I did.
Now to get my results I have a Telehealth appointment with the Dr this afternoon, on the confirmation text I received yesterday it mentioned that there is another $30 Gap Fee for the appointment.
Does this seem fair?
Genuinely interested in others thoughts here.
Indeed. People seem to think GPs are a charity when they're most often private businesses wanting to make profit.
And here comes the neggers who think I'm wrong.
damn, I'm out of negs today, so I gave you a + instead!
Bummer, Coles had men's skin tanning solution on special and I did not buy it!
@payless69: Now you'll have to tan the old fashioned way and get skin cancer. You'll have fun paying the GP then ;)
Some of these appointments are < 5 minutes, why should I pay full fees for a full-time appointment when there's nothing to discuss? I understand if there's an abnormality a fee must be charged, but what if everything is in the clear?
No GP should charge if your results are fine. It shouldn't even be an appointment. Just a phone call from the GP or practice.
Because of the time taken to review them. They look through them before they speak to you, they do years of training in order to be able to do that. Results can fall within normal ranges but be abnormal for an individual, they can be out of normal range but be normal for another. You're paying not just for that time, but for the staff booking the appointment, the consumables etc. It's really stupid that the Medicare rebate pays for all of that now because it wasn't originally set up for that, but costs have risen and the rebate barely has.
@MessyG: GP doesn't look through your ct scan or apply their own analysis to anything..they just pass on the results that radiologists/whoever else isn't supposed to (not their job to deliver tragic news).
@MessyG: Very rare for a GP to actually look at the scans. They'll likely read the report and summarise it in layman's terms for you. This also takes work and knowledge but not as much as you make out.
@cooni: Even if they don't look at the images, they still need to read the report, and correlate that with the patient's clinical signs and symptoms, past medical history, and formulate a diagnosis (or lack thereof) and plan. This takes time and expertise.
@MessyG: Like others have mentioned, they just read out the conclusion or summary from which ever specialist that did the scan/test. Even my kids could do that.
@mrvaluepack: I would argue that the value of the GP in this setting is not about knowing how to read (although most do read quite well), but about know what the words on the screen actually mean, and how it applies to the patient in front of them.
@Save Medicare: Just googling the words i dont know is much better than the doctor just reading it out and sending you on your way. Maybe its just me, but i actually do my own research on those words and draw my own conclusion on whats required.
@mrvaluepack: You could ask the pathology for a copy of the report and they will give it to you after asking you to sign a paper. You could then give the report to your kids for an opinion instead of going to the GP.
Nope, i wish i could but they force you to see the GP for the results.
That is incorrect. You could ask the pathology and they'll give you your reports. They are required to wait for 7 days by law before issuing the reports to you (to allow for time for a GP visit), but nobody is forcing you to see a GP to get your own results. I've received my reports from Dorevitch heaps of times. Another alternative is to have it uploaded to your myhealthrecord, which you should be able to access online from within my.gov.au
@CocaKoala: Ok, not sure if you are bullshitting or not but I'll give it a go next time i get a blood test.
How would you get the results from Dorevitch? Because they usually grab the entire slip from you and you are left with no other details. Do they email it to you, mail it or do you need to go collect it from the same place they took your sample?
According to this:
https://www.healthdirect.gov.au/blood-testing
Getting your results
If you want to know the results of your blood test, make an appointment to see your doctor.
Some pathology services will send you a copy of your results if asked by your doctor.
Seems that all points back to seeing/contacting a doctor.
Ok, not sure if you are bullshitting or not but I'll give it a go next time i get a blood test.
Either I'm bullshitting or you're being completely ignorant. I suppose it's easy enough to find out.
How would you get the results from Dorevitch?
If you are able to speak, you'd ask them right at the pathology that you want a copy of the results.
From this gov.au URL:
Can I have a copy of my pathology test results?
Yes. Patients are legally entitled to a copy of their pathology test results although the treating practitioner is in the best position to understand and interpret the test results and its potential impact for their patient. If patients would like a copy of their test results, they should be requested from the treating practitioner at the time of consultation, or directly from the relevant pathology laboratory.
Each pathology laboratory will have their own protocol on how to release pathology test results to patients, and they may inform the treating practitioner of this request. This is because reading their own pathology test results may be distressing or potentially confusing for some people. Pathology test results are also reported using technical medical language and may be difficult for most patients to interpret or understand.
@CocaKoala: I guess my parents could also give their pathology and imaging reports to their kid to interpret… @mrvaluepack
@MessyG: My father is a local GP where I live. It is a pretty simple review for uncomplicated cases . He receives results via email 8/10 times. If everything checks out and there are no abnormalities, it takes him all of 5minutes to read through and determine whether all is ok (in majority of cases NOT all). So to schedule another appointment to tell the patient everything is fine and then charge accordingly, is somewhat of a dodgy tactic. I guess at the end of the day, it is up to the GP.
He receives results via email 8/10 times.
When it's accreditation time don't let them know patient information is coming via email. You won't pass. Normally it comes through secure messaging…. or funny enough fax and mail which is perfectly acceptable somehow.
In practice the way it works is they charge the same fee for a short consult as a long one - the Medicare rebates are so low that this is the only way the business can continue. The doc makes a profit on the 5 minute ones and a loss on the one hour ones, with it hopefully al evening out in the end.
No, its not an ideal system. But most alternative approaches are worse.
Becomes sometimes you win and sometimes you lose.
Stop penny pinching over a lousy $30, be happy.
It basically is a charity with the artificial scarcity in the profession.
Also, often you'll pay the gap just to be told "all fine".
You might notice this is far less common with allied health professionals, who can spend a lot more time pre & post consult, consults themselves are sometimes much longer (depending on profession), and they earn far less while trying to "make a profit". The reason? Less artificial scarcity.
Every Business Wants to make a profit
GAP = Excess Profit
There are not working free. Medicare is paying the GP
Medicare is paying the GP
Medicare is paying for some of their outgoings, so if they rely on that, they will be losing money.
Thats bogus, most GPs drive nice german cars and good luck to them, but please stop telling fibs.
but please stop telling fibs.
They need to pay office rent
lease of equipment
salary for nurse
salary for reception
cost of IT equipment
etc
etc
all this comes from the Medicare payment
@jv: Not sure why you are detailing me some of their expenses. Did i deny they dont have any ?
A high portion of doctors drive a nice german car, which of course means they are managing to pay all their other bills.
Thats all i said, if they can buy a nice car and good on them then dont try and bulldust me and pretend they cant earn any money.
@jv: Many surgery carparks have reserved spaces, those are the ones with a sign or painted "Reserved".
I highly doubt they are reserved for the uber drive who brings a glass of OJ.
They won't just hand you the results. They will discuss them, and determine a way forward.
If you are all better and just want results, call them and cancel the appointment while asking for them to send you the results or make them available for pickup.
Yeah I get that too. Maybe I've just used Drs in the past that include the results as the whole package.
More than happy to pay for it just wasn't sure if it had become the norm
Many specialists have free follow up consultations. Well technically they aren't free, they are factored into the expensive initial consultation fee.
A GP will mostly charge for all appointments. If they bulk billed in the past then this has just been happening in the background and transparent to you.
It has because of the Medicare rebate freeze that went for nearly a decade. This government doesn't seem interested in doing anything about it either.
To be fair, I doubt there's 10 years worth of Medicare rebate freezes laying around in the coffers.
Clearly that money that would have gone towards Medicare indexation was either spent or was never raised (e.g. due to tax cuts).
@Tommyaka: Surely this is something that needs to be handled though. They've already taken the savings, they won't need to back pay just adjust budget a bit better for the future.
Yes unfortunately I think this is the beginning of the end of the universal free healthcare here in Australia as our Medicare system gets crippled from decades-long lack of funding and we gravitate towards the more expensive American healthcare model.
The Albanese government needs to find an additional $1 or 2 billion more to properly fund Medicare to recruit more ED nurses and extend bulk-billing GPs visits for all Australians, but instead they chose to spend HUNDREDS of Billions to buy new American nuclear submarines and bombers. There is taxpayers money available, just whether the government wants to spend it in the right areas!
@xdigger: The Australian government needs to look at the cause why so many people goto the doctors…
Part of the problem is city life is very unhealthy. Sitting in cars/trains/traffic for hours upon hours a day and week is bad for peoples health. It also means people dont have time for walking about or preparing proper food etc.
People dont need more doctors, a large number need to get off their big arses and walk, talk to their kids, etc that would do wonders for mental and phsyical health ad it would also save money and polution on dumb projects like the new sydney airport and more train lines and tunnels.
They never send you test results without an appointment. At least my practice has never. Sometimes it's a 2 minute phone call just to confirm my email address with the gp but never just freely provided without an appointment.
They never send you results. Must see doctor for results.
most of the time i went to GP itslike less than 15 mins consultation and the outcome is to sleep on it take some panadols
True, he's probably going to tell me that I'm full of Sh*t (literally lol)
If you are that confident of the outcome, don't have the appointment.
That one time he doesn’t go tho…
Wasn't that confident. Needs some extra checking on a couple of things
Your GP still 15 minutes for standard consult? I thought they all changed to 10 minutes in 2021. I'm paying $39 gap for 10 minutes. I happily pay whatever because my GP is amazing, the 4-9 day wait for an appointment is the real problem.
If the rebate is $39.75 as I saw reported somewhere, I've been paying a gap of $45.25 for years.
You might be right, I'm not actually sure since it would not be something that would influence my decision on seeing my doctor whom I see monthly.
It's also worth mentioning that some some things are still bulk billed, like anything part of a care plan for chronic conditions.
Had a good GP in a long established practice with 15 minute bookings. Practice was sold to a corporate who changed to 10 minute bookings and most of the original docs either retired or left and were replaced with O/S trained young doctors whose main concern seemed to be to get you out the door ASAP.
Fortunately got in with one of the original docs in a new practice before he was fully booked out. No time pressure and surprisingly usually seen within 5 minutes of scheduled time,
I've also followed my GP between practices, it's really difficult to find a good one.
Much of the job is knowing which things will likely get better and which things won't.
It will take me less than a minute to reassure a patient that there mole isn't melanoma and the outcome is "do nothing". Your paying for the doctor's experience to know that its fine.
A lot of the time it is reassurance that it'll settle or its nothing, but then you'll get a random "hey this is serious, we need to do something". Knowing when you need to worry/do something is what you see us for.
it mentioned that there is another $30 Gap Fee for the appointment.
Correct, for each consultation with the doctor, there is a $30 gap fee……..
Yes, it's considered fair as this is what Australia wanted when they voted for Labor/LNP who are both killing off GP rebates.
Some places enjoy a relationship with GP and try to force you back to GP but you can still get the results yourself if you wanted to. Call the scan place up saying you're under financial hardship and want it directly from them.
But if you need assistance with understanding the CT results or suggestions, pay the $30 again.
Not against paying it as I 100% want to know what the Dr thinks, just wanted to know if it's become the norm now. I feel in the past I haven't needed to pay twice.
Yes, it's becoming the norm. GP can only get paid for seeing patients, whether they're fine or not.
The point is that the GP needs to be paid twice.
I feel like it should be part of your initial consultation so I don't think you should be charged imp. But all you can do here is decide to go elsewhere next time or call around and check out other practices.
Medicare rules are that a GP charges for the time spent with the patient, within time brackets, 10min, 20min etc (not sure the exact brackets). If the GP would like to charge a fee for a set of services (blood test + results in one package, Medicare doesn't pay). So unfortunately your GP can't have "results" as part of your initial consultation.
Surgeons etc are different. My limited understanding is that the procedure fee from MBS/Health Fund includes follow up, so that's why when your surgeon sees you on the ward on the following day there's no gap.
I don't believe it's the norm here. I attend a practice where they don't bulk bill however if I need to have a second or third appointment (phone or in person) for results or in relation to the same issue I am only ever charged once for the first consultation.
when they voted for Labor/LNP who are both killing off GP rebates
How are they equally to blame , based on the past decade or so of political power federal split?
Each successive government has extended the medicare freeze. It's been ongoing since 2013. It was introduced by the ALP before the 2013 election and each LNP government since has continued it and the Albanese government haven't lifted it yet (I don't think they've even made a mention to either).
The freeze is over
http://www.mbsonline.gov.au/internet/mbsonline/publishing.ns…
The problem is that the Medicare payment is now permanently too low, the indexation is starting from a low level.
The other problem is that MBS is not indexed using a factor that represent medical costs, or even CPI, it's indexed to the same factor which is used for the federal Health department's budget (which is below CPI, the entire public sector is underfunded) so even with indexation costs are rising faster than payments.
@greatlamp: I stand corrected. Didn't notice that the freeze was over.
Although that index rate isn't much better, that's a joke of a way to be able to say "we lifted the freeze".
The ALP MBS freeze was never meant to be permanent
LNP kept it that way
@Save Medicare: They probably should've put through a legislated sunset clause or something in there. Guessing it was extended if it was just a budget choice
My GP tried to do the same to me for blood results which take 10 secs to deliver. When I challenged the receptionist, she finally said it would be up to the Dr.
Thankfully, my Dr realises saying 'everything looks fine' doesn't constitute either a charge to me or Medicare.
This is why Medicare is broken.
Yeah my GP started doing the same thing.. "up to the doctor if you will be charged"
The doctor probably still billed Medicare… just didn't charge you a gap.
GP needs to seek informed financial consent before charging medicare for any services rendered
If they charged medicare, they would've told the patient
I've never had a GP or receptionist seek that from me.
@Specialist Diaz: This is what is legally required.
Maybe you've signed a slip assigning your Medicare benefits to them during your consultations in the past?
Or they tell you when you pay that you will get $X back from Medicare and you've not had a problem with that?
@Save Medicare: This is something where the health record could do a lot to regulate Medicare fraud. Like I know it isn't a big issue but at least if you know when your name is being charged against if something weird goes on you can see it.
What they really need to do is stop putting appointments with a gap through as bulk billed as it stuffs around with the statistics. The government should definitely fix it so the gap appointment fees are taken off before paying though so that incentive is removed. Don't see why someone should have to pay upfront then get reimbursed
Who pays for the rent, electricity, consumables, admin wages, nursing staff etc and costs have all risen.
Yes GPs can earn a lot depending on how much they work but the actual medical centre is tough business. Most are just breaking even now.
With all the consulting fees, Doctors pay the clinic around 30%. That 30% has to cover all the operational costs.
Yes the rebate for a standard 10min to 20min consult is $39.75 but that's now not enough to run the business so there's a gap.
If you think a doctor with 10yrs + education and so difficult to even get into medicine is not worth paying for then don't see them. Yet I see so many nail salons full every day with women paying $50 to $70 for fake nails.
Medicare rebate will go up in July I think by like 20cents for standard consult.
We charge a flat gap of $20.25 and bulk bill concession, pensioners, everyone over 75yo inc self funded retirees, under 16yo and all students inc uni students.
Does this seem fair?
Nope, especially if it's a "normal" result.
Historically, GPs would call you back to receive any type of result because they could only charge for an in-person consult. By calling you back they would create another occasion of service and billing opportunity.
They should be called out for this non-sense. "Normal" results should be delivered via email/phone/post at no cost.
On the other hand, if your result is abnormal and requires follow up care, then another fee seems reasonable.
If it wasn't for those Doctors that are rorting the system there would be plenty of money to go around. The system as it stands currently has insufficient checks and balances.
https://www.afr.com/companies/healthcare-and-fitness/the-gre…
Not the "doctor" side to be exact, but the "businessesman" side of thing. If all doctors are salaried public servants then none of this will happen.
Hey mate I really like this idea. The one thing I kinda want to understand is how would we ensure enough patients are being seen still by a gov salaried dr?
Like a private company that pushes for 10min appointments, no-one questions too hard (although everyone still says it's a bit shit). But if a public dr did that, I think you'd end up with media reports of the one or two times they didn't give patients enough time to go over the details e.c.t
A lot of people will say but that's fine if they take their time, and I agree in some situations and depending on the line of work. But any increase in time will mean less productivity and more importantly increase the shortage of doctors we have now.
So yeah I think if they did employ them they'd still have to be related to the Medicare system. In my opinion a great spot for public GPs would be near emergency clinics in a hospital, so they could save money in the emergency department by sending people to the GP next door and as well as it being a central location to find them.
@lancesta: I've always said since I went through GP training every hospital should have a GP clinic (or employ GPs) next door to pass all the ones they deem "not emergencies", as it saves them so much money.
The main issue us GP's see with being salaried is the warnings we get from all the UK GPs that come here. They get terrible pay, mountains of paperwork, have to hit KPIs and have to follow guidelines meticulously. Waiting times for patients can also be weeks for some areas in the UK, patients can't choose their clinic (and can't go elsewhere if they dont like their current clinic), so it would also remove the choice for the patient.
@dmcneice: Okay well I guess we wouldn't have to copy the UKs system exactly.
But 100% agree with the GPs in hospitals. We've got GP Access in Newy and it's amazing for that. Not public but I'm pretty sure it's not for profit. It's within the hospital and saves a lot of emergency time. Not everyone needs a bed. If I need stitches at 1am, I might not actually need an emergency dr but possibly a nurse with stitch skills or something. Unfortunately the only place to go for a lot of people is the hospital.
I reckon it'd be good to look at how the UK do it and and try and address the issues coming out of that.
I don't think we'd need to force patients anywhere but we could start by just providing gp services within the hospital
@lancesta: O definitely. I think i read a few years ago a non-admitted patient visit to the ED cost the taxpayer about $386.
A GP visit is rebated at just under $40. Even the most expensive private charging GPs usually arent over $120. It makes financial sense to just send patients there, cover the difference in fee's and the ED still save money. I have no idea why it isnt a thing already.
@dmcneice: Thanks for putting numbers to it. It seems like a no brainer when you say it like that.
Federal gov should definitely step in to get it sorted.
Doctors aren't rorting the system. The businesses that run the practices are. Since the Howard government deregulated who could own medical practices (it used to only be doctors), essentially opening them up to big businesses, costs skyrocketed. And then successive governments froze the Medicare rebates so costs couldn't be covered anyway. It's expedient for governments to blame doctors because people love to hate them, and it means they get to do f*** all about it.
Will Howard's legacy be the destruction of Medicare?
The Prime Minister's comment this week that Medicare was only ever intended as a safety net for the disadvantaged is an audacious attempt to rewrite history. Medicare had the same policy origins as Medibank; it was designed to be a universal scheme providing access to health care for all Australians.
This is kind of a fringe opinion, but I think it would've been better if things had gone the opposite way, and LHDs/area health service started opening up their own GP practices, hiring the GPs as staff specialists.
It wouldn't have to be attached to the hospital, but all linked into the same eMR. As a hospital doctor I find that so much gets missed and so much time is wasted trying to chase results and correspondence either by the inpatient/ED resident or the GP.
Give residents the choice of a GP term as well, to see if they like it before committing.
It would require a rejigging of how state health services are funded, but I think it could be great.
@Save Medicare: You are forgetting that in the private efficiency is generally superior. If all GPs are Staffies then they only need to see 2x patients a day to get the same salary compared with the GP who sees 10. If you think current GP wait times are bad imagine if GPs are public salaried medical officers.
@Deridas: I like to imagine that my colleagues would still like to do the best job possible, even if their compensation isn't based on pure volume of production.
A lot of us got into medicine because the ideal of a single-payer healthcare system that would take care of all its citizens regardless of their ability to pay that was inspiring.
Now GP ideologues who don't want to charge a gap are having to choose between churning out 11-minute, single consults in rapid succession and maximising GPMPs/TCAs, or providing actual high quality care to complex patients and taking a huge pay for their trouble.
Why do they have to choose in a country as prosperous as this?
They could honestly even run it as a mixed staffie/VMO model, with GPs taking a smal percentage of billings above their staffie award, just within an integrated system.
@Save Medicare: Unfortunately, that would be difficult. General Practice isn't recognised as a speciality under the SS award in NSW, so the few times where a GP has been an SS an exception is made. Not as such for the VMO award, but on sessional terms GPs are paid less than others as VMOs.
So as you say, other options include universal bulk billing with churn and burn medicine or charging a gap to make high quality care viable. However, unfortunately charging a gap is often perceived as greed. Especially since there has always been the expectation that healthcare are the primary care level is free.
So a good GP can either charge a gap which in some instances goes against social expectation, or take a pay cut to provide high quality complex care as you say.
This is the exact reason there are a lot of disillusioned GPs who move from primary care into alternative and more diverse roles. Which is a shame really, because good primary care prevents hospitalisation in many cases and can facilitate more patients transitioning into community or residential aged care after inpatient stays.
I like to imagine that my colleagues would still like to do the best job possible, even if their compensation isn't based on pure volume of production.
A lot of us got into medicine because the ideal of a single-payer healthcare system that would take care of all its citizens regardless of their ability to pay that was inspiring.
So much on the same page here. I definitely think there'd have to be a way to keep doctors churning through patients (as shit as it is), whether it's KPIs or bonuses awarded. But still it'd be shit for the doctor to have the choice between cuts short a critical consultation to get a bonus or missing out on the bonus.
Also GPs being in hospitals would lower reliance on emergency? Hopefully saving a bit of money and time there. GP Access in the Hunter does this (but it's privately owned).
Maybe if it was done as part of rotations in the hospital too it'd help as then everyone would get a better idea how other departments work and could physically talk to each other hopefully improving efficiency without impacting the quality of care (i.e. getting paperwork in correctly).
If there is profit to be made, then there will be private businesses popping up. Any state/government owned entities must stay away because they are all incompetent to run such business.
If there is no profit, no sane business will ever touch it. Hence the state/government can handle those unprofitable stuff.
Sounds great?
Realistically, I think people love it as they keep voting for their usual councillors and MPs.
it used to only be doctors
This is super interesting. I had no idea.
We've got a very small public hospital down the road from us that a lot of people use for rehab/recovery from surgery. Many of the nurses and doctors on site say it was far better when the doctors owned it. It started with a group of doctors and as they'd retire they'd sell their spot to another one who'd actually work in the place. Kinda passing it on as they went. Eventually a private company came in and offered them a lot of money to buy everyone out and the service quality has decreased dramatically.
Yes, they don't work for free.