- On 14/06/2016
A Mixed Model
DMC Medical Centre in Sydney is located on busy Victoria Rd, Drummoyne and services a mixed demographic of an aging ethnic (Italian and Greek) population, self-funded waterfront retirees and, over the last few years, has seen an influx of the young families. The practice has three directors and 15 general practitioners with a FTE of 12.
Three years ago this practice was 95% bulk billing and almost entirely dependent on Medicare rebates. Despite a huge patient base, it was obvious to both the practice owners and the practice manager that the future viability of this practice was uncertain. It was evident that the increasing cost of delivering a quality service, including adequate access to care, adequate time required for each patient, dressing costs and so on, was not being covered by the Medicare rebates that they were accepting as full payment for services. Furthermore, they were beginning to risk doctor burnout and staff dissatisfaction and despite being busy and at capacity, it was also becoming evident that the patients were not happy.
With careful consideration over several months with input from each team member, the decision was made to transition from 100% bulk billing to a mixture of fee paying and bulk billing. They knew this strategy would test their database, but they hoped that they would not only retain their loyal patients, but attract new patients with the offer of “better” service. Happily, this is exactly what has happened.
They decided some of the doctors would transition to fee paying whilst others would remain bulk billing – according to each doctor’s preference. They hoped this billing structure would offset loss of database to the bulk billing practices nearby.
After 12 months, patient numbers were down by 12%, however financials held steady as the fees offset the loss in patients. At the two-year mark, patient numbers had risen to within 9% of original numbers, and at the three-year mark patient numbers had increased by 6% on the original figure and growth continues. At the one-year mark and then again at the two-year mark there was financial growth with significant growth at the three-year mark.
In the words of DMC’s Practice Manager, Fiona “communication is key”. They employed a well-managed, co-ordinated, whole of team approach.
According to Fiona, part of their success was due to their delivery of communication to patients.
Over approximately a six-month period, each patient was advised individually of the proposed changes. As they arrived at the practice they were handed a flyer which they were asked to read prior to their appointment with the doctor. The patients were reassured that the visit would be bulk billed and that the doctor would have a discussion with them during their consult. Staff and doctors alike were well trained on content and delivery of these discussions, patient files were then flagged, and each consecutive visit was billed accordingly. As a means of ensuring billing accuracy, each patient was given a colour coded card to hand in at reception following their consult to advise of billing status for that visit.
All new patients were given a choice and the staff members were well trained to match the skills of the doctor to the new patient, rather than whether they were bulk billing or private billing.
The staff members were well supported and extra staffing was allocated in first few days.
In fact, they were so well prepared that it was almost anti-climactic!
Patients reacted positively – mainly attributed to the fact that they were all advised individually by their doctors and the time was taken to explain to them the reasons behind the changes. Patients felt respected and had “buy-in” to the proposed changes. Their choice to see one of the bulk billing doctors was respected.
According to DMC, managing the model whereby they kept some full bulk billing doctors so as not to lose database and ensuring consistency of information delivery were the main obstacles during the transition.
The surgery reports that its doctors are happier. They are possibly working just as hard but better renumerated. Whole culture of practice has changed and has opened up opportunities for introducing new services.
Patients have been re-educated and now have greater respect for the quality of service that they receive at DMC. Interestingly patient complaints have decreased. The support and nursing staff have greater job satisfaction and staff turnover has decreased.
DMC had to adopt new technology to manage the complex model – in particular the use of Tyro. But they also improved their service offering by introducing travel health and a dressing charge. As a result of their transition, they’ve seen significant growth – four new consulting rooms and a Chronic Disease Management Centre.
Future of General Practice
Whilst DMC has managed to maintain a dual model they worry about Medicare being pulled altogether. Its doctors remain concerned by the constant changes inflicted upon general practice by government, which is counteractive to creating stability for practioners and patients. The practice is also concerned about ongoing access to healthcare for low socio-economic demographics and the practitioners who care for them and feel that these General Practioners will need subsidy via PIP or similar if they continue to bulk bill patients.
Advice for Other GPs
- Go gently with change and respect the patient’s choice
- Doctors must be willing to talk to their patients
- Give your Doctors and staff the words or scripts to use when talking to patients.
- Don’t tell patients months before – they will talk with their feet.
- Lots of communication, training and support
- Be collaborative, be a team.
Thanks to the Directors of DMC, Dr’s Joe Cordaro, Quentin Cameron and Don Munro and Practice Manager Fiona Kolokas for their time and willingness to share their story.