Pathology services

[Psyber]

I discovered today something I'd never known that may affect other people when they have pathology testing.

When a GP decides something you, or your kids, present with needs investigation he usually orders all the tests you are likely need the same day, rather than order only the basic ones and bring you back for a second visit to see if further testing is required, thinking that in that way you can be told the results by phone, saving the GP time, and you and Medicare money.

However, in 1995, the federal ALP government was convinced doctors were getting kick backs from pathology companies for ordering unnecessary tests.
(Just as they were convinced then that Australia had too many doctors, leading to our present shortage.)

So, they introduced "Coning" regulations.
What this means is that if a doctor orders more than three individual tests for one patient in one day, Medicare only pays for the most expensive three tests.
This doesn't matter if you are bulk billed as the pathology company absorbs the loss.
However, if you pay for the tests, then try to reclaim from Medicare, you make the loss.

Ironically, there is no limit on how many tests (and consultations) Medicare will pay for if the GP sees the patient on several successive days and orders three tests each day!!

[Sky Pilot]

It certainly pays not to get ill or fall down with some exotic malady. Although it is arguably more expensive to take your dog/cat to the vet than take yourself to a doctor.

[mick]

I discovered today something I'd never known that may affect other people when they have pathology testing.

When a GP decides something you, or your kids, present with needs investigation he usually orders all the tests you are likely need the same day, rather than order only the basic ones and bring you back for a second visit to see if further testing is required, thinking that in that way you can be told the results by phone, saving the GP time, and you and Medicare money.

However, in 1995, the federal ALP government was convinced doctors were getting kick backs from pathology companies for ordering unnecessary tests.
(Just as they were convinced then that Australia had too many doctors, leading to our present shortage.)

So, they introduced "Coning" regulations.
What this means is that if a doctor orders more than three individual tests for one patient in one day, Medicare only pays for the most expensive three tests.
This doesn't matter if you are bulk billed as the pathology company absorbs the loss.
However, if you pay for the tests, then try to reclaim from Medicare, you make the loss.

Ironically, there is no limit on how many tests (and consultations) Medicare will pay for if the GP sees the patient on several successive days and orders three tests each day!!

Some doctors were getting kickbacks, tiny rooms in their practices rented by pathology providers as "collection centres" being one example. I agree its a farce that a doctor can see a patient on 3 successive days and order 3 tests each time, with a greater cost to the tax payer than if he could order the tests he wanted in one consultation. I have also noticed that after a long absence private pathology providers seem to have a gap payment once again. It seems to be up to the referring doctor to tick the bulk bill box on the request form for this fee to be waived.

[Psyber]

It certainly pays not to get ill or fall down with some exotic malady. Although it is arguably more expensive to take your dog/cat to the vet than take yourself to a doctor.

Yes, I discovered it when I had some form of inflammatory reaction after I returned from my trip to India.
It turned out to be just a mild, first-ever, episode of Gout brought on by my poor diet and episodic dehydration while in rural areas there.
(And drinking Kingfisher Ale when I couldn't get bottled water.)
But it could have been something nasty.

Fortunately, the net cost was trivial for me, but may have been a problem to others - that's why I thought it was worth warning people.
I suspect most younger GPs are not aware of this regulation, so I'll post about it on a few medical fora too.

[Psyber]

Some doctors were getting kickbacks, tiny rooms in their practices rented by pathology providers as "collection centres" being one example. I agree its a farce that a doctor can see a patient on 3 successive days and order 3 tests each time, with a greater cost to the tax payer than if he could order the tests he wanted in one consultation. I have also noticed that after a long absence private pathology providers seem to have a gap payment once again. It seems to be up to the referring doctor to tick the bulk bill box on the request form for this fee to be waived.

Yes it was true.

Some companies were offering very generous rent for a small site in the GP rooms, certainly hoping to get all or most of the pathology requests from the practice.
That's why the AMA backed the government in determining that rental rates had to match normal commercial rates for the floor area.
It was also agreed that practice principals could not oblige other doctors in the practice to use that pathology service.
Obviously, an on-site one is convenient for those who have no preference and don't want to travel.

I don't think many doctors would actually order tests that they believed were unnecessary - but there are always a few rogues.


Yes, the pathology services do leave it to the doctor to tick the box to request bulk billing.
The usual expectation is that he would apply the same principle he does in deciding whom he bulk bills.

Gap fees are increasing as the Medicare rebate gradually falls behind inflation as it has done since the mid-1970's.
The MBS fee the government bases the Medicare rebates on is now about 60% of the CPU/AWE-linked AMA fee, whereas it was about 90% originally.

GP's still tend to bulk bill Pensioners and children because the government gives them extra to do so, which makes it just viable.
GPs get Practice Incentive Payments for complying with Medicare requirements in various ways, plus 100% of the MBS fee.
Specialists who bulk bill get no incentives and only get 85% of the MBS fee - that's now effectively 51% of the AMA fee.


It has all become very political and less about health, which is why I originally quit practice in 2008.
In 2009-10, after an approach was made to me by local GPs, I tried bulk billing all comers, working one day a week, in my field.
Overall, I made a net loss of about $1500 over 6 months, despite a concessional daily rent from the local hospital.
It could have been viable, and worth doing economically, if I'd wanted to work at least four days a week...