Articles / Report: The Impact of Medicare ‘Rorting’ Media Coverage on General Practice

Report: The Impact of Medicare ‘Rorting’ Media Coverage on General Practice

writer

Yasmin Clarke

Data analyst; Journalist

The questions in this survey were inspired by the recent media coverage on Medicare ‘fraud’, reported extensively by the ABC, The Sydney Morning Herald and The Age.

The demographics of these respondents are described in the chart below. By and large our respondents appear reasonably representative of the general population, except in age where our respondents skew towards the older end (69% of respondents were aged 55+).

In this survey, we asked GPs questions about the media coverage and potential impact on their professional life. We also asked GPs questions about underbilling (undercharging or not claiming Medicare items even when appropriate) to develop a picture of ‘reverse leakage’ from the Medicare system in general practice.

This survey data shows that around two-thirds of GPs reported daily occurrences of underbilling, and more than half of GPs are demoralised from the mainstream media reporting on claims of Medicare fraud.

More than one-third of GPs reported intentions to disengage from Medicare, reduce their clinical hours, or leave clinical practice as a result.

In total, 412 GPs or GP registrars responded to the survey, although not all GPs responded to every question – precise respondent numbers are noted in the results that follow.

What GPs thought of the media reports

We asked GPs: “How would you describe the media reporting on this topic so far?”. This was a free text response, so responses ranged from a word or a few words to paragraphs.

264 GPs responded to this question. There were very few responses that could be characterised as positive. Negative responses generally contained words that had strong emotional content.

We also asked GPs: “How did the story about Medicare fraud in general practice make you feel?” and GPs could select multiple options here.

We provided a short range of both positive and negative emotions that seemed relevant based on our discussions with GPs, and an ‘other’ category where GPs could write their own responses.

The majority of GPs who responded selected emotions that could be characterised as negative. More than half of GPs (55%) said they feel demoralised as a result of the media reporting on Medicare fraud, while almost one third said they feel furious (32%) and feel burnt out or exhausted (30%).

Less than 5% of GPs selected emotions that could be characterised as positive, such as hopeful. Around a quarter (23%) of GPs who responded identified other emotional responses (either instead or in addition to those listed) while 12% of GPs said they had no significant emotional response.

In the ‘other’ category, 83 GPs gave a response. The following emotions were reported (as well as a variety of longer comments with opinions on the reporting or their feelings):

Disgusted

Disappointed

Insulted

Frustrated

Annoyed

Upset

Angry

Disbelief

Despondent

Concerned

Fed-up

Hopeless

Saddened

Ashamed

Suspicious

Cynical

We then asked GPs: “As a result of this recent media coverage alleging Medicare misuse, how do you think this will impact on the following aspects of your medical practice?” with eight items listed underneath.

These were asked in a single question to improve the response rate and shorten the survey, however they relate to slightly different aspects of GP practice. They can be thematically grouped as below:

Impact on GP engagement with Medicare:

Adjusting clinic business model in order to increase the proportion of private/non-Medicare billing

Adjust clinic business model to decrease engagement with Medicare billing

Impact on GP engagement with profession:

Reduce your clinical working hours

Look for clinical work alternatives that do not involve you directly billing Medicare (e.g., hospital work)

Consider leaving clinical practice altogether

Likelihood of bringing forward plans for retirement

Impact on GP emotional state:

Experience of stress/burnout/demoralisation

Enthusiasm for general practice as a career choice

More than one third of GPs said they are more likely to reduce engagement with Medicare (37%) or increase the proportion of private billing (45%) as a result of the media coverage.

Around half of GPs said that the recent media coverage would not lead them to disengage with Medicare by adjusting their billing model.

Similarly, around one third of GPs said they were more likely to reduce engagement with the profession as a result of the media coverage, either through reducing their clinical hours (38% of responding GPs), or consider leaving clinical practice (34% of responding GPs), or look for alternative work that does not involve billing Medicare (30% of responding GPs).

In addition, 51% of GPs said they will bring forward retirement plans as a result of the media coverage, though as noted above, the majority of our respondents are aged 55+.

Many GPs also reported that the media coverage impacted their emotional state. 45% of GPs who responded to this question said they are less likely to have enthusiasm for GP as a career choice as a result of the media coverage, and 58% of GPs said they are more likely to experience stress, burn out or demoralisation as a result of this media coverage.

Underbilling in general practice

We asked GPs: “In a typical day of clinical work, how often would you perform a service that was potentially rebateable on Medicare, but chose not to charge Medicare?” and “In a typical day of clinical work, how often would you perform a service and undercharge Medicare due to fear of triggering a Medicare alert?”

The responses for each question are within 1-3% of each other in most cases, so there does not seem to be a practical difference between the two questions. Perhaps the questions were not clearly worded enough to distinguish.

Looking at both questions in combination, around two third of responding GPs (72% and 64%) underbill Medicare at least once in a typical clinical day. More than one quarter of responding GPs (26% and 30%) underbill Medicare five times or more in a typical clinical day.

We also asked GPs: “Which item numbers do you most frequently underbill, and which item numbers do you use instead?”. This was a free text response to which 259 GPs responded. Of those, 221 GPs reported a specific item number or category of item number that we could interpret as meaningful (the remainder of the responses were not possible to analyse).

Around half of these GPs (55%) said they underbill item 36 (Level C consult), 24% said they underbill item 44 (Level D consult), 13% said they underbill item 23 (Level B consult), and 6% simply said they underbill long consultations (which could be interpreted to include Level B, C, and/or D).

Some GPs also specified in their response which item they billed instead. The most common was billing a lower level for the type of consultation.

One third of responding GPs (33%) reported billing item 23 (Level B consult) instead of item 36 (Level C consult) and 10% of GPs reported billing Level C instead of Level D. Many GPs did not specify which item they billed instead, likely because this was a free text double-barrelled question.

We are considering running more detailed questions on underbilling in upcoming surveys to further quantify this aspect of Medicare ‘leakage’. If you have any ideas on this or any other survey topics, please get in touch at editorial@healthed.com.au.

For transparency of data, we intended to ask the following question but it was incorrectly set up in the survey, so the responses are unfortunately not meaningful.