Driving quality care
- On 05/10/2016
Dr Kean-Seng Lim transformed his practice by focusing on quality, patient-centred care.
“I think the questions doctors should ask themselves are, ‘is the patient coming to see me because I’m the cheapest place in town? The next thing to ask is, ‘do I have the choice to practise medicine the way I want to practise it?’”
Seven years ago, Dr Kean-Seng Lim faced a crossroad. To continue to bulk bill patients or introduce private billing.
“Our practice has always been a family practice and we have a very stable patient base. We have generally tried to provide what we considered a fairly comprehensive level of service to our patients and this was not going to be possible with the trajectory that the rebates were taking.”
If he continued bulk billing, he risked the financial stability of his practice – established in 1965 by his father, and one that Dr Lim has worked at for 20 years. He could have lessened the shortfall by increasing the number of patients he saw per day, but this is turn came at a higher cost – albeit not economic. For Dr Lim, reducing the quality of care to his patients by increasing throughput was not the kind of medicine he wanted to practice.
In the end, he decided on private billing.
Like many doctors, Dr Lim struggled with the idea of charging patients a fee. His Mt Druitt medical practice is located in one of the most socio-economically disadvantaged regions in Australia, also known as the location backdrop to SBS’s observational documentary Struggle Street.
“The future of general practice is a very interesting. We are doing more in terms of chronic disease management, the cases we see are more complicated, they are much more time consuming. The level of skill, the level of expertise that we need to employ is growing. So it’s not going to be business as usual. I think that we really need to change the way we do things.”
“Most of our patients are older or working class. We are now seeing families where you have both parents working and they have young children, but equally we still have large numbers of families where there is one predominant breadwinner and they might have several children that have to be cared for from the one income,” Dr Lim said.
The decision to charge a fee raised concerns that the practice would lose some patients, however Dr Lim said the biggest fear was the impact that this would have on his patients, as to whether it might delay their presentation, or whether it might impact on follow-ups and mean that patients were not coming for regular check-ups.
“At the end of the day, most of our patients were actually very supportive and we didn’t see any reduction in patient numbers at all,” he said. He still bulk bills more than 60% of his patients, but the other 40% has remained stable.
“I think that patients choose to come to see us because of the service that we provide, not because of what we charge.”
Dr Lim’s Tips for a smooth transition:
- Communication with patients and education of staff – preparing the staff and the patients
- Good billing software “making sure that the software is able to communicate with Medicare to allow us to process claims”
- Set up digital systems for patient booking and interaction
“We are looking at a world where general practice itself is going to have to change in a number of ways. One of them is that we will be making much greater use of teams in general practices – it’s not so much a case of a relationship purely between a patient and a general practitioner, it’s actually a relationship between a patient and the whole general practice team. I think that we will have to become much more systematic about what we do. And this means we will have to be smarter about the way we use technology. The other aspect of technology is communication and sharing of information across the general practice team, but also other health providers across the other sectors.
“So I think this is a time of great evolution for general practice. I do think there is a risk that if general practitioners do not take on this role and do not actively become engaged in this process of change that general practice could become sidelined or pushed by external forces – government, other health providers, policy makers or the funding. If we wish to decide what it is we are going to do then we have to take control of these elements.”
Are you thinking of trying private billing?
The billing model that you choose will depend on a range of factors. Future Practice and the AMA NSW have developed a web tool to quickly and easily test the long-term financial sustainability of your practice. Check your practice now: