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End the loss on consumables

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Readers will need to pardon the pun, but the ban on charging for consumables like dressings when bulk billing a patient is an open wound that GPs and general practices have been struggling with for over a decade. It is estimated that more than 400,000 patients at any one time are suffering from hard-to-heal wounds. Venous leg ulcers, which are prevalent in the older population, for example, affect around 43,000 people. KPMG, as far back as 2003, estimated that $166 million a year could be saved by treating these patients with compression bandages and stockings.

The high incidence of chronic wounds produces a heavy burden on the Australian health care system. And a study on wound care costs in general practice conducted in 2011 showed that, in most cases, general practices are not recouping the costs of wound care. In providing this critical service for patients, GPs and practices typically incur a loss.

Before the introduction of the Practice Nurse Incentive Scheme, the practice nurse item for wound management helped offset the cost of wound care. Bandages and dressings generally cost anywhere from between $4 and $21 with the median just under $10. However some, such as a four-layer compression bandage, can be around $50.

As you know, many of the patients who need wound care are vulnerable. They are often aged and suffering from multiple conditions. GPs are faced with a difficult choice and tend to bulk bill them out of compassion. The GP/practice then is left with carrying the cost of the dressings, which in the context of an inadequate Medicare rebate is not a trivial sum.

Of course GPs could raise a charge for the bandage and just bill the patient the MBS fee for the attendance, which they can then claim on Medicare, but in doing this lose access to any bulk billing incentive. For GPs it is a lose-lose.

The Government’s freeze on Medicare rebates has made this situation even more intolerable.

As is so often the case when it comes to supporting best practice, the Department of Veterans’ Affairs is at the forefront, providing veterans with access to subsidised dressings for treating a range of wounds. While the Government may not want to pursue this model for non-DVA funded patients, it is time for a conversation about the potential for cost recovery on consumables like dressings, while still being able to bulk bill a patient. This is a conversation the AMA is now starting with the Government.

Ideally, the same arrangements that apply to vaccines should apply to consumables. Proper wound care is essential to managing patients in the community and keeping them out of hospital. It’s a classic situation where prevention is better than the cure and, from a patient’s perspective, a much better alternative than asking them to pop down to the pharmacy to purchase dressings (with a retail mark-up) and then having to return to the practice to have the dressing applied.