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Double billing or appropriate billing?

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It’s a daily occurrence at most surgeries, including mine – the patient with a chronic illness who comes to see you and legitimately needs care on an unrelated condition.

Or it could be the patient who comes in with gastro but mentions problems with their diabetes. You realise that their care plan needs to be updated. You weigh them and check their blood pressure. Then there are the tests that need to be organised.

Some GPs will absorb the cost of the extra care and charge for one service – a common practice in disadvantaged areas. Others will ask the patient to return for a new appointment.

Alternatively, some GPs will claim a standard consultation and a chronic disease management item for the patient on the same day.

Well, not for much longer. The Government will block this practice from 1 November 2014.

The Government sees it as double billing. I call it appropriate billing.

There are times when it is legitimate to co-claim for two services provided at the same consultation.

The change is happening because the previous Government wanted to save almost $120 million in coming years by cracking down on what it believed was inappropriate billing by doctors treating patients with chronic ailments.

The AMA understands that the Department of Health has identified opportunistic billing by a small minority of doctors, but it had not brought the problem to our attention before the measure was announced in this year’s Federal Budget.

This issue generated quite a lot of discussion at the recent meeting of the AMA Council of General Practice.

Providing a consultation with a chronic disease management (CDM) item is not a common or routine practice for the majority of GPs.

I don’t co-claim often. But there are occasions when it becomes apparent during a consultation that my patient needs a care plan. For some of these patients, I think it would be an unfair impost to ask them to come back for another appointment. They may be elderly or have limited transport.

My colleagues who work in underprivileged areas with a high incidence of co-morbidities tell me that they tend to co-claim more often. Others say that they are booked out for weeks in advance, and their patients use the opportunity to discuss multiple issues during their consultation. Some will require care plans. The crackdown will have a disproportionate effect on these patients.

Perhaps the bureaucrats making these decisions should visit busy practices in disadvantaged suburbs or towns to see what doctors are facing in reality.

The crackdown on co-claiming is the latest in a long line of cuts to general practice items.

As with the decision in 2009 to remove MBS items for joint injections, this blanket measure has been foisted on the profession with little consultation. And with no consideration of the consequences.

GPs will be unable to claim legitimately for MBS items for two distinct, clinically necessary services at the one consultation.

This will create a situation where patient out-of-pocket expenses rise, increasing the risk that they will reduce or stop their treatment. GPs will be obliged to do more for less.

This is a budgetary measure and the die is cast, but I am hoping that the AMA will have the opportunity to moderate the measure and lessen the impact on patients and GPs.

While the Department says that it has evidence of inappropriate billing, it seems reluctant to try and tackle this or undertake further education. Unfortunately it finds it easier to undertake a blanket cost-cutting exercise.

We believe that the best approach is to modify the existing CDM items using the same provision that applies to health assessments − consultation items may not be billed with CDM items unless it is clinically necessary.  

This would be a simple and sensible solution to the problem identified by the Department. One that would not disadvantage GPs or our patients.