Estimating non‐billable time in Australian general practice

• Published in: Medical journal of Australia 2016-07, Vol.205 (2), p.79-83
• Main Authors: Henderson, Joan, Valenti, Lisa A, Britt, Helena C, Bayram, Clare, Wong, Carmen, Harrison, Christopher, Pollack, Allan J, Gordon, Julie, Miller, Graeme C
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Aged; Australia; Cross-Sectional Studies; Delivery of Health Care - economics; Female; General medicine; General Practice - economics; Humans; Male; Middle Aged; National Health Programs - economics; Prospective Studies; Referral and Consultation - economics; Reimbursement Mechanisms - economics; Sex Factors
• ISSN: 0025-729X; 1326-5377
• DOI: 10.5694/mja16.00287

Objectives: To quantify the time that general practitioners spend on patient care that is not claimable from Medicare (non‐billable) and the monetary value of this work were it claimable, and to identify variables independently associated with non‐billable time. Design: Prospective, cross‐sectional survey, April 2012 – March 2014. Setting: Australian general practice; a substudy of the national Bettering the Evaluation and Care of Health (BEACH) program. Participants: 1935 randomly sampled GPs (77.4% participation rate) from across Australia provided filled questionnaires on 66 458 patient encounters. Main outcome measures: Non‐billable time spent on patient care since patient's previous consultation; duration of and reasons for non‐billable time; estimate of its monetary value were it claimable from Medicare; variables associated with non‐billable time. Results: 69.5% of GPs reported non‐billable care outside patient visits; 8019 patient encounters (12.1%) were associated with an occasion of non‐billable time. Mean time spent per occasion was 10.1 min (range, 1–240 min). Reasons for non‐billable time included arranging tests and referrals, consulting specialists or allied health professionals, medication renewals, and advice and education, and encompassed all International Classification of Primary Care Version 2 chapters. The notional average annual value per GP of this work was $10 525.95 (level A rebate) to $23 008.05 (level B). Non‐billable time was independently associated with female GPs, younger GPs (under 55 years), female patients, patients aged 65 years or more, and one or more chronic problems being managed at the recorded encounter. Conclusion: Most GPs spend a significant amount of unpaid time on patient care between consultations, an inherent problem of the fee‐for‐service system. This work should inform discussions of future funding models.