‘Medicare trip-wires and quicksand’: GP stops seeing patients in aged care

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Dr Nick Tellis says he has stopped treating patients in residential aged care after almost 25 years, blaming the new GP Aged Care Incentive’s “soul-destroying” bureaucracy.

The incentive, launched last July, pays $300 to the GP and $130 to the practice per patient for completing eight visits and two care-planning services in a 12-month period.

It is intended to revitalise access to care for some of the most vulnerable patients in the health system.

However, Dr Tellis told AusDoc he had regularly treated around 50 patients in aged care but that his work was now “close to zero”.

“If you do aged care at scale then, on paper, it is more financially advantageous for everyone to have the GP Aged Care Incentive,” said the Adelaide GP and self-declared “Medicare wrangler”.

“But in reality, multiple bureaucratic trip-wires, quicksand and complexity make the system soul-destroying. It is incredibly painful to navigate.”

One issue with the payment — made three months in arrears — was when a patient died.

“You do not get paid for the work you have already done,” Dr Tellis explained.

“You might have done visit one and two but no further visits because the patient passed away, so you get the base Medicare rebate only.” 

This was one among many issues.

For the past decade, Dr Tellis, his registrars and other doctors at the practice had shared aged care work.

In theory, this was still an option, based on the Federal Government guidelines stating that a ‘responsible provider’ could delegate the second of the two quarterly visits.

However, Dr Tellis said doing this “broke the system”. 

“If two registrars, a supervisor and all sorts of people provide services to the patient, MyMedicare cannot compute it.

“Services Australia will tell you it is cool if one doctor at the practice provides this and another provides that, but in reality, that is not the case.”

This became apparent when the quarterly payment came through.

“Previously, all Medicare billings would go into a practice account, but that is no longer done because of payroll tax.

“Doctors now have to receive the money themselves, and then we need to invoice them. But it is hard to do because you do not know when it has arrived.

“At three months in arrears … payment is released, but the details of the payment go to the practice rather than the practitioner.

“It then becomes hard to marry up what money is for what.”

After “fossicking” through Provider Digital Access (PRODA), he made progress, yet he surrendered before reconciling every dollar.

“I am not going to spend two hours of my time reconciling a couple of hundred bucks. It is ridiculous.”

He said that when the process broke down, Medicare staff would only speak with the specific GP, not practice staff.

“You are pulling doctors away from clinical work to speak to bureaucrats who, frankly, do not understand their own system.”

After his years navigating aged care red tape, the new incentive was the “straw that broke the camel’s back”.

“Some people have said, ‘You should be doing this for the love of aged care.’ I have done it for the love of aged care for the better part of a quarter-century.

“At some point, somebody else is going to have to do this after me.”

If registrars were not being paid sufficiently, this would not happen, he warned.

The alternative was episodic locum-type care, which he said would lead to more patients going to ED.

“All this could be avoided with regular, great GP care, but it is just a bureaucratic morass.”

Dr Tellis called for future funding changes to undergo six months of road-testing in GP practices before becoming permanent.

“If the bureaucrats involved in creating this got paid three months in arrears for their daily work, after jumping through all these hoops, I suspect we would never see a program like this again.”