Latest / 360 with Katie Woolf / Palmerston GP Superclinic Chief Executive Robyn Cahill says Medicare subsidies have not adequately increased for decades which could force more GPs to slug patients fees

Transcript

Palmerston GP Superclinic Chief Executive Robyn Cahill says Medicare subsidies have not adequately increased for decades which could force more GPs to slug patients fees · 360 with Katie Woolf

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  Speaker 1: Now we know that a fifth COVID vaccine's now being
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  Speaker 1: offered to certain age groups, and we were contacted by
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  Speaker 1: listeners yesterday and the day before wanting to know where
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  Speaker 1: they can go, and well we can get that jab now.
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  Speaker 1: Robin Carl joins me on the line right now to
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  Speaker 1: give us a bit of an update. She is indeed
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  Speaker 1: from the Palmeston GP Superclinic. She is the CEO. Good
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  Speaker 1: morning to you.
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  Speaker 2: Robin, Good morning Katie.
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  Speaker 1: Great to have you on the show. Robin. Who's eligible
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  Speaker 1: for the fifth dose of the vaccine?
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  Speaker 2: So anyone over the age of eighteen who has not
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  Speaker 2: had an active case confirmed case of COVID in the
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  Speaker 2: previous six months, or who hasn't had a COVID vaccination
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  Speaker 2: in the previous six months are able to access this
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  Speaker 2: fifth dose after the twentieth of February.
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  Speaker 1: So after the twentieth of February, and Robin, have you
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  Speaker 1: had many people getting in contact with you sort of
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  Speaker 1: wondering more about it.
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  Speaker 2: We have had quite a few calls because, as you know,
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  Speaker 2: when the government has rolled out previous doses, there's been
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  Speaker 2: so many conditions attached to them. You know, you had
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  Speaker 2: to be over a certain age you had to be
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  Speaker 2: suffering from a particular condition or a whole range of
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  Speaker 2: other things, and there was this very staggered approach to
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  Speaker 2: providing access for the vaccines to people. This time, they've
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  Speaker 2: just gone over eighteen haven't had COVID in the last
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  Speaker 2: six months, haven't had a COVID vaccine in the last
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  Speaker 2: six months. And it doesn't matter where you're up to
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  Speaker 2: in your COVID vaccination cycle. They're saying you should have
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  Speaker 2: this dose.
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  Speaker 1: Yeah right, and so can people get it anywhere? What's
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  Speaker 1: the process?
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  Speaker 2: So there are a significant number of general practices now
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  Speaker 2: in the Darwin and Alice Springs area who are doing
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  Speaker 2: COVID vaccines. It's changed a little bit for us because
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  Speaker 2: up until the end of last year we were an
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  Speaker 2: Australian Government vaccination center, but they ceased that to the
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  Speaker 2: end of last year, so we're now just providing the
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  Speaker 2: service as per usual general practice services. So anyone can
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  Speaker 2: ring up and book in or go online and book in,
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  Speaker 2: and most practices, I think their usual GPS, if people inquire,
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  Speaker 2: will actually be able to provide that service for them.
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  Speaker 2: If they can't, they're more than welcome to come out.
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  Speaker 1: Yeah right. Robin speaking of you know of GPS, and
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  Speaker 1: we've been getting quite a few or we've sort of
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  Speaker 1: been getting quite a constant number of calls and hearing
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  Speaker 1: quite a few stories about concerns from seniors claiming that
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  Speaker 1: they're no longer being bulk billed. I know that there
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  Speaker 1: has been a process change. You and I have spoken
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  Speaker 1: about it before, but what is the situation right across
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  Speaker 1: the territory and right around Australia at the moment when
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  Speaker 1: it comes to that bulk billing.
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  Speaker 2: I think the challenge has been that for a very
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  Speaker 2: long time, the rebate that people get, so people get
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  Speaker 2: confused that Medicare is the funding system for general practice care,
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  Speaker 2: but it's not. It's actually the amount of money that
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  Speaker 2: the federal government are saying to us, we are happy
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  Speaker 2: to subsidize your healthcare to the amount of and it
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  Speaker 2: varies depending on what you have done. The problem with
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  Speaker 2: it is that it's been out of step with the
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  Speaker 2: cost of living and cost of delivering services for probably
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  Speaker 2: two decades. There was the review done in the late
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  Speaker 2: nineteen eighties where they looked at what was happening in
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  Speaker 2: general practice and what the rebates were, and at the
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  Speaker 2: time they said it was significantly out of step, and
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  Speaker 2: to be honest, it hasn't increased a lot since then,
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  Speaker 2: so it's been out of step with the cost of
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  Speaker 2: providing services and the cost that people are dealing with
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  Speaker 2: on a day to day basis, just in terms of
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  Speaker 2: daily living for a very long time.
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  Speaker 1: So in the national news, I know that this morning
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  Speaker 1: there were some reports that a lot of gps are
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  Speaker 1: going to soon stop that bolt billing all together, citing
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  Speaker 1: that Medicare has not sort of increased in line with inflation.
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  Speaker 1: And you've just discussed the different reasons and some of
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  Speaker 1: the concerns historically, what is your understanding of what's going
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  Speaker 1: to happen. Do you think we'll wind up in a
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  Speaker 1: situation where there are a lot of clinics that do
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  Speaker 1: phase it out.
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  Speaker 2: I certainly hope not. The whole intention of the Medicare
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  Speaker 2: system when it was first rolled out several decades ago
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  Speaker 2: now was to assist those people who couldn't afford care
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  Speaker 2: to access care, and the expectation was that those of
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  Speaker 2: us who earned a reasonable living, who could afford to
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  Speaker 2: spend a few dollars on our own health, would actually
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  Speaker 2: pay a private fee. Unfortunately, the advent of fully bolt
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  Speaker 2: willing clinics really created some major issues in that area
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  Speaker 2: because people who were quite happy and willing and used
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  Speaker 2: to paying a little bit of an out of pocket
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  Speaker 2: became unused to paying it, and then there became this
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  Speaker 2: expectation that basically, you get that service and you don't
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  Speaker 2: have to pay for it, and then what we saw
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  Speaker 2: was people over using the service. For some people, it
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  Speaker 2: almost becomes the social outing to go regularly to see
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  Speaker 2: their GP. So I really hope that what most general
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  Speaker 2: practiceeople do will look at what they're doing and still
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  Speaker 2: look after those people who are under also pensioners, healthcare cardholders, people,
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  Speaker 2: young children, people, and if you've got three or four kids,
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  Speaker 2: going to the doctor and having to pay for that
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  Speaker 2: is very expensive.
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  Speaker 1: Yeah, you spot on.
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  Speaker 2: Yeah. So we've always been a mixed felling practice, and
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  Speaker 2: there are a number of mixed filling practices around And
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  Speaker 2: basically that means that we've got a core group of
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  Speaker 2: patients that we will automatically bulk build. So we bold
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  Speaker 2: build anyone up to the age of sixtent or actually
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  Speaker 2: until they leave high school. We also bill our pensioners,
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  Speaker 2: our healthcare cardholders and so on, and we charge a
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  Speaker 2: private fee for people who don't fall into those categories.
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  Speaker 2: More recently, we've introduced a new patient fee irrespective of
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  Speaker 2: whether the people fall into those characters. Categoristically, because we've
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  Speaker 2: been overwhelmed and because we offer services that are available
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  Speaker 2: when other services are often closed, we found we have
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  Speaker 2: this influx of people looking for assistance, so it became
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  Speaker 2: very unmanageable for us. I think most of the practices
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  Speaker 2: around at the moment are still looking to build, for example,
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  Speaker 2: pensmus so I hope they don't move away from that.
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  Speaker 2: It does take a little bit of balancing. It is
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  Speaker 2: a difficult environment to be in, but it's not impossible.
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  Speaker 1: Yeah, and Robert, where are things that I know that
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  Speaker 1: there was going to be that review into medicare? Where
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  Speaker 1: are things that with that from your understanding? And what
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  Speaker 1: do your hope comes out of that review?
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  Speaker 2: I have to be honest, I was a little bit
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  Speaker 2: amused when the main discussion point that came out was
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  Speaker 2: that they would provide Medicare billing for non GPS SO
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  Speaker 2: nursing and paramedics, et cetera, et cetera. Not amused because
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  Speaker 2: those people shouldn't be involved in the care, but because
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  Speaker 2: they've done that previously, and surprisingly people utilize those services
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  Speaker 2: and they went, oh, my goodness, we didn't expect it
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  Speaker 2: to be this popular, so I stopped funding it. So
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  Speaker 2: I think that what they really should be looking at
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  Speaker 2: is the bigger picture, which is one, why don't we
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  Speaker 2: have enough general practitioners? Why are people leaving general practice?
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  Speaker 2: And if we had more GPS in the mix and
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  Speaker 2: greater access to people, then you get a more equitable
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  Speaker 2: spread of who's prepared to bolt build the vulnerable groups
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  Speaker 2: and who's not. I think the very simple solution to
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  Speaker 2: all of this. The biggest impediment for general practitions is
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  Speaker 2: they probably don't want to charge the scene is, say,
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  Speaker 2: for example, sixty dollars instead of just bolt billing them.
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  Speaker 2: The outer pocket on that is only about twenty dollars.
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  Speaker 2: But to get that charge through, the doctor has to
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  Speaker 2: ask the patient to pay the entire amounts and then
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  Speaker 2: they get the rebate back. So to come up with
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  Speaker 2: the sixty dollars not just the twenty. If the federal
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  Speaker 2: government would actually stop and have a think about the
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  Speaker 2: fact that a copayment capacity would make it far more
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  Speaker 2: manageable for everybody, it would be a much easier solution
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  Speaker 2: so that would mean that, for example, you might charge
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  Speaker 2: sixty dollars the patient paste twenty and the balance of
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  Speaker 2: it is bill directly to Medicare. But at this point
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  Speaker 2: in time, doing that is illegal. If they really are
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  Speaker 2: genuinely serious about making healthcare affordable, making Medicare work better
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  Speaker 2: for everybody, that's where they should be looking.
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  Speaker 1: Well, and you know it's going to make it like
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  Speaker 1: it makes it better for everybody. Then if you've got
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  Speaker 1: people that are actually going to their GP and they're
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  Speaker 1: able to see their GP rather than maybe even presenting
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  Speaker 1: to emergency because they can't afford to go to.
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  Speaker 2: The GP exactly, we're seeing a significant increase in presentations
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  Speaker 2: to emergency departments, which is really concerning. The Other part
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  Speaker 2: of that is that even if somebody goes to the
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  Speaker 2: ED and has an initial consultation there is there's something
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  Speaker 2: that they need longer term managed, they've then still got
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  Speaker 2: to connect with someone in a primary health care arena
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  Speaker 2: because you can't keep going back to ED for your
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  Speaker 2: long term chronic disease care. So it's really the main
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  Speaker 2: questions are why are new grad not wanting to b GPS.
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  Speaker 2: I think it's partly the bad publicity around the fee schedules,
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  Speaker 2: et cetera. But it's also there's a huge amount of
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  Speaker 2: red tape associated with being a general practitioner that is
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  Speaker 2: not required of any other specialty. So the justification processes
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  Speaker 2: for providing good care in the crime and health arena
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  Speaker 2: are really burdensome, and that's one of the things that
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  Speaker 2: makes it very difficult for doctors to consider stay in
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  Speaker 2: general practice. So as for example, our doctors might do
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  Speaker 2: a good eight hour day seeing their patients and then
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  Speaker 2: I'll spend another two or three hours into the evening
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  Speaker 2: just trying to keep on top of all the paperwork.
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  Speaker 2: As I've said, no other practice specialty requires that, and
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  Speaker 2: that needs to be looked at very specially as well.
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  Speaker 1: Yeah, hey Robin, before I let you go, we are
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  Speaker 1: we're getting fed fit here at mix one O four
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  Speaker 1: nine this month, and we're spending we're all spending a
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  Speaker 1: bit more time, I guess out in the sun. So
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  Speaker 1: it has got a lot of us thinking about whether
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  Speaker 1: and how often you need to go for a skin check.
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  Speaker 1: How often is it something you know? Is that something
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  Speaker 1: that we should be doing, and do you reckon that?
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  Speaker 1: It's something that people often forget to do.
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  Speaker 2: I think people forget to do it all the time
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  Speaker 2: because we get a little bit blase about it. You should,
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  Speaker 2: at a minimum be doing an annual skin check. If
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  Speaker 2: you're like me and blessed with Irish heritage, you probably
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  Speaker 2: should do it a little more often, especially here in
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  Speaker 2: the territory, because we have very very high v ratings
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  Speaker 2: and we forget that because we're so used to it.
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  Speaker 2: So I think that's very important. Your GP can do
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  Speaker 2: it for you. There's quite a few skin clinics around
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  Speaker 2: if your GP is not comfortable doing skin checks, but
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  Speaker 2: a simple skin check will help you keep an eye
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  Speaker 2: on anything that might be changing on your skin and
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  Speaker 2: your body and just yourself. If you see something on
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  Speaker 2: your skin and you're worried about it, don't be embarrassed
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  Speaker 2: about asking about it. If it turns out to be nothing,
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  Speaker 2: that's fantastic. But if it turns out to be something,
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  Speaker 2: it's so important to catch it early because too often
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  Speaker 2: people read it way too late, and the first they
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  Speaker 2: know that they've got an issue when they're diagnosed with
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  Speaker 2: a memoonom a WIT is very poor outlook. So get
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  Speaker 2: your skin checked at least annually, and keep it on
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  Speaker 2: your kids too. I think we in Australia have set
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  Speaker 2: the standard for growing your skin cancers when we're quite
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  Speaker 2: young as we're older, so really think about the time
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  Speaker 2: they spend in the sun. That Slip Slap Slop campaign
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  Speaker 2: was probably one of the best ones that we're ever
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  Speaker 2: done in terms of marketing and promotion. And just if
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  Speaker 2: you're concerned, see something that doesn't look quite right, just
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  Speaker 2: get your GP to have a look at it for
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  Speaker 2: you and get a chat.
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  Speaker 1: Very good advice, Robin Carl, it's always great to speak
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  Speaker 1: with you. Thank you so much for having a chat
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  Speaker 1: with us this morning.
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  Speaker 2: Most welcome. Kadi, it's always good to talk to you
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  Speaker 2: as well.
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  Speaker 1: Thank you. We'll talk again soon.