Expert view: Chris Smeed, co-founder and CEO, Cubiko

The year 2022 will be remembered as the year that began with getting needles into arms and ended with many of those same arms reaching into pockets to pay for appointments. This is clear when looking at Cubiko’s Touchstone data set, an industry-first general practice benchmarking tool based on data from over 600 opted-in general practices.

Last year, our data confirmed a continued drop in bulk billing rates for both bulk billing and mixed billing practices across Australia. While shrinking margins and the rising cost of doing business are playing a role in this transition, we believe practitioner satisfaction will be an even greater driver in 2023.

The drivers and impact of billing changes

The Touchstone data set shows that in December 2022, bulk billing practices continue to only bill slightly less per consulting hour than their mixed and private billing counterparts. This gap isn’t larger because, on average, bulk billing clinics are seeing an extra 0.5 patients per hour. That means bulk billing practitioners are seeing more patients for slightly fewer billings, impacting their workloads and the practice’s financial sustainability.

The shift in bulk billing rates is part of safeguarding the well-being and satisfaction of practitioners. More practices are choosing mixed and private billing models to reduce stress and workload and combat record levels of burnout in our industry. At the end of the day, if a practice doesn’t have doctors, it can’t see patients.

For the practice, more patients per hour mean a larger waiting room, more reception and admin staff, more paperwork around claiming, more consumables, and even more car parks. This dramatically affects labour costs, consumables, and rent, further threatening the margins of bulk billing practice.

Having run a 20-doctor bulk billing practice in one of Brisbane’s lowest socio-economic suburbs, the impact of seeing more patients for fewer billings was always front of mind. It was imperative to balance financial sustainability with patient access to primary care. We know that every general practice is striving for that same balance on behalf of their patients and society, and for that, we are grateful.

The fall in bulk billing rates is more pronounced among metropolitan practices. The Touchstone data identified that MM1 (Metro) bulk billing as a percentage of total billings has dropped from 72% to 56% in 2022. Whereas this is only a decline of 86% to 83% for MM6-7 (Very remote and outer rural) bulk billing over the same period. This can possibly be attributed to this Report’s findings that 58% of metropolitan practices are targeting a revenue uplift compared to 45% of their regional peers. In turn, this may also be buoying higher average confidence in metro practices.

How GPs are using data to help performance

We’ve seen many practices and practitioners using Cubiko to review and analyse their historical bulk-billed invoices. They’re using this data to make informed decisions about which services to transition to mixed or private billing and how to positively impact revenue, practitioner satisfaction and accessibility of care for those who need it. In addition, practices are using systems like Cubiko to identify patient eligibility and grow their chronic disease management programs, health assessments and nurse-led item numbers.

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