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Speaker 1: My name is Lily Maddon and I'm a proud Arunda

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Speaker 1: Bunjelung Calcotin woman from Gadighal Country. The Daily oz acknowledges

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Speaker 1: that this podcast is recorded on the lands of the

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Speaker 1: Gadighl people and pays respect to all Aboriginal and Torres

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Speaker 1: Strait Island and nations. We pay our respects to the

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Speaker 1: first peoples of these countries, both past and present.

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Speaker 2: Good morning and welcome to the Daily os. It's Wednesday,

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Speaker 2: the fifth of April.

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Speaker 3: I'm Zara, I'm sam.

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Speaker 2: A new review commissioned by the federal government has found

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Speaker 2: three billion dollars could be lost from the Medicare system

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Speaker 2: every year through either mismanagement or fraud. So what's gone

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Speaker 2: wrong and how is it impacting an already overwhelmed healthcare system.

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Speaker 2: For the first time on the tdapod, we're going to

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Speaker 2: hear directly from a GP about their perspective on navigating

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Speaker 2: this space that's coming up on the Deep Dive. But

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Speaker 2: first Sam, the headlines.

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Speaker 3: TikTok will be banned on all federal government devices as

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Speaker 3: soon as possible under new orders issued by Attorney General

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Speaker 3: Mark Dreyfus on Tuesday, Australia will join governments in the US,

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Speaker 3: UK and Canada in banning TikTok from its devices amid

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Speaker 3: data sharing concerns between TikTok's Chinese owners, Byte Dance, and

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Speaker 3: the Chinese government. The ban won't stop members of the

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Speaker 3: Australian public from using TikTok on their personal devices.

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Speaker 2: A trigger warning for this next story it mentions sexual assault.

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Speaker 2: Former NURL player Jared Haines has been found guilty of

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Speaker 2: two counts of sexual assault. The twelve person jury delivered

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Speaker 2: the guilty verdict for a twenty eighteen incident involving hain

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Speaker 2: and a twenty six year old woman at her home

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Speaker 2: in Newcastle. It was the third trial and second conviction

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Speaker 2: relating to the incident, with Haines's guilty verdict and a

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Speaker 2: previous trial overturned on appeal.

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Speaker 3: Australian police have seized a whopping three hundred and thirty

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Speaker 3: six kilograms of heroin that arrived in a Brisbane porler

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Speaker 3: last month. It is the largest ever detection of heroin

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Speaker 3: in Queensland's history. The shipman was from Malaysia and has

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Speaker 3: an estimated street value of almost two hundred and sixty

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Speaker 3: nine million dollars. A Sydney man who allegedly transported the

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Speaker 3: shipment to New South Wales has been arrested and charged

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Speaker 3: with importing and attempting to possess the Shipman.

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Speaker 2: And the good news, Christina Kosh will be the first

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Speaker 2: woman and Victor Glover will be the first person of

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Speaker 2: color to go on a lunar mission. That's following an

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Speaker 2: announcement by NASA this week. Costion Glover will be aboard

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Speaker 2: the Artemis two mission, which is expected to begin its

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Speaker 2: voyage around the Moon next year. The last time we

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Speaker 2: spoke about healthcare on this pod, we asked you about

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Speaker 2: your recent experiences with GPS. We got a heap of

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Speaker 2: messages about how hard it is to find a bulk

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Speaker 2: billing doctor at the moment.

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Speaker 1: It cost me one hundred and sixty dollars up front

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Speaker 1: with a seventy dollars rebate.

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Speaker 3: Sorry, yeah, paid for a two and a half minute appointment.

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Speaker 2: I drove to Sydney to see my GP and get

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Speaker 2: a skin check.

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Speaker 1: It was one hundred and eighty dollars.

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Speaker 4: Honestly, it's just getting out of control.

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Speaker 2: We also got a message from a GP doctor, Pari

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Speaker 2: Sangutovian saying doctors were also struggling in the current system.

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Speaker 2: So when the news came out this week that a

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Speaker 2: government commissioned report called the Philip Review has found that

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Speaker 2: the medicare system could be losing three billion dollars a

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Speaker 2: year to system failures and fraud, we decided to get

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Speaker 2: Pari on the pod to chat all about it. Hurry,

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Speaker 2: thanks so much for joining us on the podcast today.

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Speaker 2: Really appreciate it.

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Speaker 4: No problem, Thanks for having me. I'm actually visiting my

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Speaker 4: sister at the moment up in Queensland, and so there's

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Speaker 4: the two nephews running around in the background and mums

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Speaker 4: sort of come up to visit as well, and she

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Speaker 4: was just like, have you started yet? Tried to give

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Speaker 4: me a muffin. That so important?

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Speaker 2: Oh look, mums being mums, they're the best ends. I

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Speaker 2: want to start just really basic with something. We speak

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Speaker 2: about it very often on the podcast, we write about

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Speaker 2: it really often on our Instagram, but yet it feels

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Speaker 2: like a very complex thing. So I just want you

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Speaker 2: to explain how does bulk billing actually work?

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Speaker 4: Yeah, so you're right, it is one of those things

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Speaker 4: that you know, we're constantly exposed to it. Every time

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Speaker 4: you see a GP, but it's a much more complex

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Speaker 4: and convoluted system than it needs to be. I think

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Speaker 4: in order to understand how it works, I think we

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Speaker 4: sort of need to go almost one step back again,

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Speaker 4: which is to sort of understand what medicare is. So basically,

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Speaker 4: the most useful way of thinking about Medicare is thinking

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Speaker 4: of it as an insurance scheme, which is exactly what

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Speaker 4: it was designed to be. I think it's really important

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Speaker 4: to understand that when we talk about bulk billing, we're

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Speaker 4: not talking about free healthcare. And I think if there's

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Speaker 4: a take home message from this that there is no

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Speaker 4: such thing as free healthcare, as much as we'd like

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Speaker 4: there to be. It is an essential service, but like

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Speaker 4: with any other essential service like food and clothing and shelter,

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Speaker 4: none of it is free. There is a cost. So

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Speaker 4: I think a good way to sort of think about

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Speaker 4: how it actually works is so I'm from Melbourne, and

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Speaker 4: I guess the TDA logo is a coffee cup. So

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Speaker 4: if we're sort of going on brand here and us

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Speaker 4: coffee as a temple, let's say let's say it's late

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Speaker 4: or the early eighties, and you go, you want to

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Speaker 4: buy a coffee from your from your local cafe and

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Speaker 4: it costs two dollars fifty. Because it's the early eighties,

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Speaker 4: I don't know how much a coffee cost then, but

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Speaker 4: let's say it's two dollars fifty, and you pay the money,

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Speaker 4: you get your latte, and you leave, and that's the

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Speaker 4: end of that transaction. Now, let's say the government has

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Speaker 4: introduced some kind of taxpayer funded scheme to help people

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Speaker 4: cover the cost of the coffees because it's considered an

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Speaker 4: essential service, and you know, some people might consider that

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Speaker 4: to be the case. So what happens is that same

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Speaker 4: transaction takes place. Basically, you go your audio coffee, you

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Speaker 4: pay the two dollars fifty, you get your coffee, and

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Speaker 4: then the government provide you with a rebate for that

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Speaker 4: full two dollars fifty. So the important thing there, just

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Speaker 4: in terms of that transaction is that you're not getting

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Speaker 4: a free coffee. You're still paying for it. You're still

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Speaker 4: paying that full amount for it, but you are receiving

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Speaker 4: a rebate from the government, which at that particular point

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Speaker 4: in time covers the full cost of your coffee. Now,

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Speaker 4: if we fast forward to let's say sometime in the

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Speaker 4: last ten years, the cost of that coffee has actually

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Speaker 4: gone up. Let's say it's closer to five dollars. Now,

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Speaker 4: Now what happens is a government it still gives you

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Speaker 4: two dollars fifty rebate. The cafe owner still charges you

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Speaker 4: that two dollars fifty that you're originally being charged for

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Speaker 4: your coffee because they feel bad. They don't want you

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Speaker 4: to pay an extra two dollars fifty out of pocket,

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Speaker 4: and you've on the whole got a free coffee, shall

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Speaker 4: we say, in inverted commas. But because it costs that

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Speaker 4: cafe owner an extra two dollars fifty to actually make

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Speaker 4: your coffee, they're just absorbing that cost every time they

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Speaker 4: make someone a coffee. And that's essentially what has happened

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Speaker 4: with Medicare and what's happened with GP clinics. The cost

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Speaker 4: of the this over time since Medicare was introduced has

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Speaker 4: actually gone up. The cost of the rebate from the

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Speaker 4: government has not, according to indexation, hasn't actually gone up.

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Speaker 4: To meet up with you know what, the actual true

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Speaker 4: cost of that consultation is. So up until recently, gps

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Speaker 4: that were bulk billing were just wearing this cost, which

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Speaker 4: will sometimes double the amount of what the Medicare rebate was,

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Speaker 4: but sort of reached this breaking point for a lot

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Speaker 4: of GP clinics. And we've noticed this in the last

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Speaker 4: couple of years, especially during the pandemic, that a lot

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Speaker 4: of bulk billing GP clinics have had to actually close

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Speaker 4: down because they're unable to keep up with, you know,

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Speaker 4: the costs of just existing as a small business and

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Speaker 4: the cost of medical supplies and paying their staff, et cetera.

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Speaker 4: So now what we're seeing is that GP clinics have

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Speaker 4: started to charge this gap fee, which is what you'd

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Speaker 4: probably be seeing at a lot of GP clinics now,

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Speaker 4: which is a bridging sort of fee to actually cover

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Speaker 4: the cost of what it really, you know, the true

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Speaker 4: cost of a consultation is. And unfortunately, because the government

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Speaker 4: hasn't really helped with increasing the rebate amount, that extra

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Speaker 4: cost gets passed on to the patient. And that's why

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Speaker 4: we're sort of seeing the rise of private billing and

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Speaker 4: mixed billing GP clinics at the moment.

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Speaker 2: Yeah, and that's I mean, that's what we're hearing from

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Speaker 2: our audience. We hear time and time again how expensive

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Speaker 2: it's becoming to go see your GP and so I mean,

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Speaker 2: it's clear that there are issues both within the Medicare

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Speaker 2: system and generally within the industry at large. We have

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Speaker 2: seen a review that came out yesterday that was highlighting

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Speaker 2: a few of the issues in the Medicare system. It

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Speaker 2: was the Philip Review, and one thing that came out

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Speaker 2: was how complex the system is actually for gps to

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Speaker 2: work out how to build people. How does that work

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Speaker 2: and why.

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Speaker 4: Is that a problem? Absolutely? So, the way that these

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Speaker 4: rebates or these Medicare rebates are actually determined is through

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Speaker 4: the system called the MDS or the Medicare Benefits Schedule. Now,

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Speaker 4: this is a list of just thousands and thousands of

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Speaker 4: what we call item numbers that determine the dollar value

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Speaker 4: of various rebates for services. So that service could be

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Speaker 4: just a standard consultation that you spend. When you see

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Speaker 4: a GP is defined as something less than twenty minutes,

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Speaker 4: it could be a procedure. So if you have a

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Speaker 4: skin lesion ex size for example. Now, the tricky thing

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Speaker 4: here is that at the moment, gps generally charge what

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Speaker 4: are called time based item numbers. So I mentioned there

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Speaker 4: that a standard consultation is something less than twenty minutes.

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Speaker 4: In itself is a huge problem because if you come

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Speaker 4: in to see a GP and all you need is

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Speaker 4: a blood pressure check and a script, that could potentially

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Speaker 4: be done in five minutes. But if you had to

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Speaker 4: get a blood pressure check, your script sorted, you needed

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Speaker 4: to have a chat about a mental health issue or

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Speaker 4: some other medical issue that's come up, you could do

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Speaker 4: all of that in nineteen minutes, let's say, and you're

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Speaker 4: still within that twenty minute mark and you've covered a

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Speaker 4: whole lot of extra stuff, the rebate amount is still

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Speaker 4: the same for both of those consultations. So despite the

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Speaker 4: fact that it's this very complex system that has a

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Speaker 4: huge number of item numbers, it's also not very nuanced

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Speaker 4: for some of these consultations, and the provision of healthcare

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Speaker 4: isn't as black and white as just you know, we

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Speaker 4: spent twenty minutes doing this or we spent five minutes

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Speaker 4: doing this. So in the report that's come out recently,

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Speaker 4: one of the concerns that's that's sort of come out

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Speaker 4: is that because it's so condoluted, it is also open

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Speaker 4: to abuse essentially of that system. What we've also found

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Speaker 4: from that report is that despite sort of claims, I

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Speaker 4: think it was last year, that's you know, over eight

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Speaker 4: billion taxpayer funded, taxpayer dollars were being raughted by gps.

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Speaker 4: If anything, gps are actually so scared of being audited

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Speaker 4: or billing in correctly that they actually end up billing

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Speaker 4: you know, less than what they should. So, if anything,

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Speaker 4: they've possibly saved taxpayer money. But that's also a problem

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Speaker 4: in itself.

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Speaker 2: Why is that? Why would they underbill?

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Speaker 4: Yeah, so there are and restrictions on particularly this time

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Speaker 4: based consultation. So if Medicare decides to order the GP

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Speaker 4: because they see that they've build a certain number of

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Speaker 4: long consultations, which are considered to be between twenty to

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Speaker 4: forty minutes, those gps are sort of placed under a

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Speaker 4: higher level of scrutiny, forced to explain why they've taken

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Speaker 4: so long and why they've built so many of these

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Speaker 4: higher valued consultations. And unfortunately this sort of penalizes doctors

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Speaker 4: who are spending more time with their patients, we are

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Speaker 4: dealing with more complex health concerns. It also disproportionately affects

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Speaker 4: female gps, who tend to take on more of these

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Speaker 4: patients with complex health care needs, more mental health concerns,

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Speaker 4: more women's health concerns which just take a longer time

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Speaker 4: to deal with. So it's really penalizing doctors for providing

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Speaker 4: good health care if they are charging those consultations. The

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Speaker 4: vast majority of gps are doing this appropriately because they

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Speaker 4: have spent twenty to forty minutes with a patient. Should

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Speaker 4: be remunerated appropriately for spending the time and for sorting

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Speaker 4: out these concerns, But instead they're being penalized for billing appropriately.

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Speaker 2: Essentially, you mentioned before there that there were claims last

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Speaker 2: year in the media that in estimated eight billion dollars

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Speaker 2: of tax payer money was lost from Medicare's budget each

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Speaker 2: year through fraud. The Philip Review this week has found

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Speaker 2: that number could be closer to three billion dollars a year,

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Speaker 2: and more likely as a result of non compliance than fraud. Well,

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Speaker 2: what do you say as a GP when you do

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Speaker 2: hear those accusations of fraud.

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Speaker 4: I think it's really sad because the vast majority of gps,

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Speaker 4: I can say with confidence, are just trying to do

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Speaker 4: what's right by their patients and what's right for themselves

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Speaker 4: as well in terms of billing the appropriate item numbers.

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Speaker 4: Gps have this important role of being the gatekeepers of

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Speaker 4: the system when it comes to Medicare, but it is

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Speaker 4: so confusing that I can say that I've inappropriately build

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Speaker 4: things before purely because I've not been sure what's the

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Speaker 4: right item number or it's not been very clear. So

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Speaker 4: there's all kinds of compliance issues that go on there.

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Speaker 4: Having said that, of course, it is a system that

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Speaker 4: is a trust based to a certain degree, and it

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Speaker 4: is open to GPS and other health professionals to take

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Speaker 4: advantage of and build in appropriately. So I would like

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Speaker 4: to think that it's not the majority of GPS or

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Speaker 4: doctors who are doing that, but you know, unfortunately, when

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Speaker 4: the system is broken and people will take advantage of

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Speaker 4: it in various ways as well.

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Speaker 2: I'm going to shift gears a bit because sounds like

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Speaker 2: there are lots of problems, but when there are lots

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Speaker 2: of problems, there can also be lots of solutions. The

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Speaker 2: Philip Review did make twenty three recommendations. It was things

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Speaker 2: like simplifying the process, actually improving the technology that drives

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Speaker 2: the whole system. For you, as a doctor, what's the

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Speaker 2: number one priority for you in terms of solutions here?

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Speaker 4: Yeah, it's an interesting one because, on one hand, the

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Speaker 4: one thing that would create the most change for both

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Speaker 4: GPS and patients at the moment in terms of particularly

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Speaker 4: that affordability side of things when it comes to accessing healthcare,

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Speaker 4: is increasing the Medicare rebate. Having said that, we've just

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Speaker 4: talked about how the MBS is quite complex and in

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Speaker 4: an ideal world, I think that would be completely rehold

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Speaker 4: and there will be a much simpler way of billing,

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Speaker 4: and hopefully we will sort of get towards that. So

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Speaker 4: in the short term, I think increasing the rebates seems

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Speaker 4: to be the most impactful solution currently, but it certainly

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Speaker 4: doesn't fix everything. There's a huge Like you mentioned, those

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Speaker 4: recommendations I think are all valid.

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Speaker 2: I just want to end, I guess on a note

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Speaker 2: from you your perspective, because I think that a lot

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Speaker 2: of people listening to this are seeing the prices go up,

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Speaker 2: they're struggling to get into a GP whatever it is,

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Speaker 2: but they're not, as I said before, hearing about the

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Speaker 2: struggles of actually being a GP. So what do you

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Speaker 2: want our audience to know about your profession? What's happening like?

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Speaker 2: What is your kind of five note that you want

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Speaker 2: young listeners to.

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Speaker 4: Know the issues that we're facing at the moment. I

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Speaker 4: think from listening to your podcast from perhaps last month

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Speaker 4: and hearing back from what a lot of your listeners

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Speaker 4: have to say, I think GPS are aware of those things.

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Speaker 4: So a lot of issues that came up surrounded cost

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Speaker 4: and accessibility. You know, GPS are fully aware that it's

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Speaker 4: really difficult to get an appointment to actually see us

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Speaker 4: and actually have this investment in your health care. But

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Speaker 4: the one thing that I think possibly isn't seen by

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Speaker 4: the wider public is what GPS are experiencing at the

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Speaker 4: moment and have been experiencing over the last few years. Now,

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Speaker 4: is this real decrease in morale and feeling devalued. Now

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Speaker 4: that's been happening for some time now, and for a

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Speaker 4: number of different reasons. We talked about the rebate amounts

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Speaker 4: not being enough. There's also a lot of increased bureaucracy

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Speaker 4: and red tape surrounding a lot of what we have

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Speaker 4: to do as GPS. Now. The medicine that we're practicing

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Speaker 4: is a lot more complex than it was back when

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Speaker 4: Medica was sort of created. People are living longer, they

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Speaker 4: have more complex health conditions, there's more chronic health stuff

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Speaker 4: going on, and that's very taxing both cognitively, emotionally, physically,

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Speaker 4: and because of the rising fees, there's a lot of

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Speaker 4: misdirected anger, I think, because you know, it's your GP

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Speaker 4: clinic that's charging you and extra gap fee. Patients have

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Speaker 4: been quite upset with you know, reception staff with GPS

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Speaker 4: for charging for things that they haven't had to pay

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Speaker 4: for before. And I think hopefully by you know, understanding

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Speaker 4: how this system actually works, we can sort of redirect

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Speaker 4: some of that displeasure about having to pay towards you know,

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Speaker 4: bodies that can actually do something about it, so towards

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Speaker 4: the government in terms of you know, rising or increasing

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Speaker 4: your rebate and understanding that you know, a lot of

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Speaker 4: the time, this is not about doctors being greedy, which

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Speaker 4: is unfortunately the narrative that sort of played out over

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Speaker 4: the last few years. And the reason they've been absorbing

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Speaker 4: these costs for such a long time is because we

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Speaker 4: are advocating for our patients, don't we understand that not

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Speaker 4: everyone can afford to pay these gap fees of twenty

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Speaker 4: forty to fifty dollars in order to just have this

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Speaker 4: basic essential service provided to them. So I think they're

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Speaker 4: going to be the main things that that GPS will want,

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Speaker 4: particularly your your listeners to know about.

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Speaker 2: All right, Thanks so much for your time today. We

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Speaker 2: really appreciate it.

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Speaker 4: No plum at all. Thanks for having the.

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Speaker 3: Zara, Thanks for joining us on the Daily Ours. There's

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Speaker 3: a link in the show notes to the episode that

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Speaker 3: we did last month with those first hand experiences seeing GPS.

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Speaker 3: It's called The Plan to Fix the Healthcare System. Will

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Speaker 3: be back again tomorrow. Until then, have a good day.