Is ‘consent’ the o-ring of Medicare audit?

Is ‘consent’ the o-ring of Medicare audit?

There’s a tiny technical glitch underpinning the legal integrity of Medicare auditing that could one day blow the whole system up. 

Medicare audit anxiety is a real thing that affects most doctors who provide (bulk-billed) “free care” to their patients.

Medicare rules keep changing with little notice or clarity.

Should the Medicare cops come knocking on their door, we know now that there is virtually nothing a GP can do about it but humbly pay it all back and wear any humiliation that accompanies the government default notice on their use of MBS items.

The way the current system works has been described as like getting a speeding ticket from a hidden camera when nobody will tell you the speed limit until you get caught.

Once you do get “caught” you have to pay back two years’ worth of speeding fines based on your gross income. It does not matter if you were actually in the car speeding.

According to two surveys, it looks like a large proportion of doctors are withholding services either regularly or from time to time for fear of a Medicare audit.

In The Medical Republic’s recent landmark national GP survey of more than 1,400 doctors conducted just a few weeks ago, it was found that over 84% of GPs, regularly, or from time to time, don’t perform certain services because of anxiety over the PSR.

But  “Medicare audit anxiety ” is not a recent phenomena. The fear effects of Medicare audits on doctors practising behaviour can be traced back as far as the mid-1990s.

Back then I helped establish a Women’s Health clinic for a client (at a time where male doctors dominated the workforce). Within 12 months of the clinic’s commencement, the only dedicated female doctor clinic received a Medicare audit letter for “performing too many Pap smears”.

Karmakar vs Minister for Health

The recent Karmakar case informs much about how hard it has been for individual GPs to try to fight the system, and how little has changed in 25 years as far as the power of the system over an individual doctor.

Most commentary has that this case puts beyond doubt that the PSR and Medicare can’t be fought in court and that instead someone has to work on changing the law.

In some ways the government bought itself cover on this whole problem via the  2011 Federal Senate PSR Inquiry. Nothing came of it as far as GPs are concerned despite quite a bit of protest from the sector.

A High Court finding and a finding of this inquiry, that this legislation exists to protect the taxpayer,  appears profoundly misguided in the context of  TMR survey results, which suggest the law may well be systemically harming patient care.

In the absence of a provable counterargument, the High Court has deemed that a focus on how well taxpayers funds are spent must take priority on how optimally doctors treat their patients.

Importantly, while Justice Logan’s judgement in Dr Karmakar’s case was clear in terms of law, he took the trouble to point out that there may be a public interest issue worth pursuing outside the domain of the PSR and the law as it stands.

A faulty o-ring in a complex system?

But there may be a small legal loophole that has still not been explored in the legal domain.

One question in the TMR survey departs a little from the core anxiety topic to explore how much a typical GP understands about their requirement to get consent from a patient for each billing item in Medicare to transfer their rights to the bulk billing rebate over to the GP.

The answer to the question is quite revealing (see below).

Essentially, most GPs either don’t even know the requirement exists, or they make an assumption  (one that has been has been pushed at them by the government)  that their practice receptionist pushing ‘yes’ on the billing terminal, constitutes implied consent.

It’s a convenience for everyone. But it’s a potentially big issue for the government one day.

The government understands that it must have the consent transferred formally from the patient for Medicare bulk billing to the doctor, for bulk billing to be a legal transaction. But they also understand that asking every patient to sign a DB020 form, which is the only real legal manner in which this consent could be given, is highly impractical. So the government has suggested that a GP can obtain ‘implied consent’ for this transaction via getting a verbal OK from a patient or by the act of pressing ‘yes’ on a billing terminal.

No one wants the major form of consent tested legally. It wouldn’t stand up in court. And working out what to do after that could become very messy, for the government and GPs.

But the fact that 50% of GPs aren’t aware of the rule at all (and therefore we probably can assume don’t do anything regarding consent) and of the 50% that do understand the rule only 9% say they obtain proper consent via the signing of a DB020 form, suggests very strongly that the vast majority of all MBS claims made for bulk billing over the years have been done, technically, without proper legal consent.

Wouldn’t it be interesting to see this technicality tested by a GP one day in the Federal Court?

The problem is that it could end up backfiring on GPs, as it could force a change that would introduce a horrific new piece of red tape that the profession doesn’t need.  But the concept that the government is winning all its cases based on an assumption that all the bulk billing transactions that a doctor has done have legally been transferred to the doctor from the patient, when they clearly haven’t, is an interesting one.

Source: Audit anxiety damages patient care, landmark survey finds, August 2021

Driving without road rules

Assume you are a good ethical doctor.

After many hard-earned years of study and work, you have just set yourself up in a brand new state of the art practice yourself.

You deserve it! Your patients and friends are impressed with your commitment. Everybody is cheering you on including your suppliers and the Government!

To help pay for your high-quality practice, you decide you want to make your services (bulk-billed) free to the patient.

The Government loves your choice. The punters (voters) and politicians love it.

For the long hours you put in, while fighting a tsunami of problems while your income goes backwards, you should be in line for a citizens award for your free services to humanity.

Unfortunately for you (the good doctor), you have taken up driving and know one has provided you with any road rules.

When you work this out, all you want to know is one simple thing: is going over 130km going to get you into trouble with the police?

The problem is, that for three decades nobody has been prepared to write a book of rules, so nothing is really clear. You have to do some guessing and assuming of what you think people want.

The federal government admitted in federal parliament 10 years ago that there is no commonly peer reviewed, agreed detailed driver education or published (clinically relevant) standards by which you can guide your practice of billing.

No standards on how to drive safely or what the speed limit is!

Worse, there is no appetite or urgency to give answers when people’s lives are at risk. The Government, their professional drivers’ association and the law firmly state it is not their job to interpret or even set the speed limit. They collectively state it is up to you to interpret with your peers. 

For decades fellow drivers have been given the same Government run around on the phone.

They get a different answer every time they ring. In the end, you get an answer in writing. After the pleasant exchanges on an official Government letterhead, they say we cannot tell you the speed limit, ask your friends.

In the meantime, you naively ask your trusted makeshift peer review group on social media. After all, they appear to be your more knowledgeable and experienced driving buddies. You even attend an ‘expert’ seminar on the road rules put on by someone who has spent quite a bit of time interpreting what they think the rules are and how you can apply them.

With good intentions but questionable authority, they tell you of their war stories.

Nobody in the room informs you that ultimately, the road rules can be changed without anyone’s knowledge.

The most common reason a road rule might be changed, is cost, not practice of medicine.

The ‘secret’ road rules are about managing a budget, not about managing the quality of practice. And because they are secret, anyone who thinks they have it worked out, eventually can come unstuck, along with their friends who they’ve told about their formula.

As the secret rule set changes, eventually one of your fellow drivers gets booked in a high profile court case. You and all your colleagues take some notes and start driving a lot slower on particular item roads. You change how you might normally practice.

For those that get prosecuted, only the headlines and not the details are reported in the news. Your fellow drivers might presume you are reckless which isn’t good for your reputation. Saying you are a good and ethical driver is no defence. You can’t present a fair defence including you were not even in the driver’s seat when the final penalty is imposed.

There is notable conspicuous silence from the driver’s associations.

This serves to undermine the legitimacy of any credible defence. Is it because some of their well-intentioned civic-minded members are tapped on the shoulder by the Government to be peers in the process of prosecution? After all, the government needs some peers to help them determine that you have done the wrong thing (just three peers per case will do it apparently).

It is only when you are booked that you find out that for the last two years, you have been living 200m from a hidden speed camera. And you only got booked when you sped enough times in one month to get noticed. But you are going down for all the fines now in that past two years, not the one you finally got notice for.

The Government then retrospectively and legally (statistically) prosecutes you for the last two years based on your driving habits in the last two weeks.

From this one month of speeding small sample size (fewer than 25 medical records), they may extrapolate your violations by 10 fold whether you were driving (bulking billing or not) over two years. These significant hypothetical fines are based on a small snapshot in time.

Once you get picked up, expect your car to be tested for defects (i.e. clinical relevance, contemporary notes, what do your PSR peers think). This is where the heat is on. Saying it was an emergency and you had no time is not an excuse.

Facing such a daunting process, this will naturally slow down the way you drive and your destination.

It’s understandable that doctors may be withholding care.

What’s in a small technicality (if it’s not really that small)?

Sometimes in the eyes of the law, a little technicality can throw out an entire case.

Every time a question about having a patient-signed consent form is raised in the media, Medicare loses their marbles over this issue.

You need to prove you have received informed consent for bulk billing to work.

Lawyers would have a field day arguing what constitutes consent in terms of bulk billing. Pressing a button on a billing terminal or suggesting your receptionist obtained verbal consent very likely does not legally constitute consent. Even getting a patient to sign a D020 may not constitute consent if they don’t know what they are signing.

What would your patients say if they were in the witness box about consent being obtained from them? They would not have a clue what you are talking about.

I am yet to see a lawyer prepare a written answer to this question.

We sought the advice of Hamilton Bailey lawyers and it seems there may be a legitimate argument out there to be heard.

Hamilton Bailey said it would be interesting to note a judge’s views on the following questions:

  • Is there a requirement to pre confirm that the doctor was bulk billing each patient with appropriate consent?
  • If consent is deemed not to be appropriate, does this invalidate or curtail the PSR laws?
  •  This point was not clear in the Karmakar case. The judge did not express an explicit view.
  • Would evidence that bulk billing consent has been given (rather than it be assumed), first need to be established before any Medicare investigations or subsequent prosecutions and/or liability could proceed?
  • Would a private billing (non-bulk billing) doctor have more or fewer rights if they did not bulk bill? 
  • Could it be as simple as: if you stopped bulk billing, most of your Medicare audit issues would be solved, as for most things you would be outside the legal jurisdiction of Medicare.
  • What about if it were found that in nearly all conditions, patient consent has never been formally assigned? Would that have the same effect?

 

Time might tell whether these questions might constitute a sort of ‘0-ring’  problem for Medicare. Or an opportunity for some downtrodden defence lawyer of a GP.

For those that are into technical arguments, the starting point is to look at the S.20A Health Insurance Act 1973 that outlines proof of consent.

Doctors must receive a signed bulk billed patient consent form. Essentially what this means is that the doctor has agreed with the patient to assign the responsibility for the payment of their bill to the Government.

The doctor agrees the Government is legally allowed to pay you what they feel like.

Technically, you have agreed that it is a “Good Samaritan” gesture (you have agreed to provide your services for free) and no longer have a legally enforceable contractual agreement or debt with the patient or the government.

In other words, where a doctor agrees to bulk-bill, they have legally waived their rights to collect any income from anyone; the patient and/or the government. There is no legal obligation to pay. It is now at the Commonwealth’s discretion. You have just given up your fundamental Constitutional right to claim property i.e. your money as your own.

Remember the movie the Castle…:

“ acquisitions by the Commonwealth other than ‘on just terms. S. 51(xxxi) of the Constitution is not allowed.”’

If the Commonwealth did not observe this rule, it may be considered theft.

I am not sure if doctors were over this technical point they would agree to bulk bill in the first place. Most informed people would at the least be very wary of what was going on.

This principle was established in the 1994 High Court Health Insurance Commission v Peverill case.

The importance of this case could legally mean that if the PSR has found you guilty of inappropriate practice ( for example on only 25 medical records) the Department could claw back two years of your income without securing evidence that you did secure appropriate consent.

But is it sufficient to presume that informed bulk billing consent has been provided to each patient they seek to make money from?

Many lawyers would argue this should involve more than a simple tap and/or signature at the front desk.

Legally this means that if the patient needs to be informed for it to be valid, then doctors have agreed to bulk bill.

Where to from here?

You could consider reducing or stopping bulk billing as one option. It’s not as crazy as it may seem. It will depend on where you are now, how attached your patients are to your service and how you communicated the change.

Most patients, after paying your medical fee via EFTPOS or their credit card, remain out of pocket for long. Ironically, the technology now exists for them to be out of pocket literally for seconds, but the government won’t introduce these systems because it would likely induce a lot of GPs to try kicking the bulk billing habit.

An understanding patient cohort and straight through billing via new web based payment protocols would also allow you to charge over and above the Medicare rebate in much smaller increments over time, which could change your whole financial paradigm?

To achieve the above, on the day of the consult, you could charge medical benefits only but make sure the patient does not assign the debt to the Government. This means the debt remains the ultimate responsibility of the patient and not the Government.

Medicare will usually pay the patient back into their nominated bank account or other practical means, within 24 hours for any Medicare rebate owing. It could do it instantly these days using cloud based billing systems, but it won’t because this would make it much easier for all GPs to do the above.

A more sensible way forward.

There is a more certain win-win solution out there if GPs want it: establish an independent not for profit peer-reviewed international healthcare standards and ethics board.

A similar one exists in the accounting profession and the concept has been adapted. The next thing doctors and healthcare workers should be pushing from the ground up is their professional memberships to provide real protection for their patients and providers and a fair go.

The International Healthcare Standards and Ethics Board project is something that has been endorsed by a leading international expert Professor Bill Runciman and has the support of Professor Ian Olver. It’s worth a look at.

This article had its origins in an article first published at healthandlife.com.au 

David Dahm is a Registered Tax Agent, the CEO and founder of the national medical and healthcare chartered accounting firm Health and Life and global Founder and CEO of the not for profit project the International Healthcare Standards and Ethics Board (www.ihseb.org)

Disclaimer: Please seek appropriate legal and accounting advice. This information is for general information and discussion only.

Stay safe, stop bulk billing! A simple cure for Medicare Audit Anxiety?

Stay safe, stop bulk billing! A simple cure for Medicare Audit Anxiety?

This article was first published by Health and Life on 28th August 2021.

As accountants to many doctors, we have a saying at our firm “You save lives, we save livelihoods”. 

 

Medicare audit anxiety is a real thing. This is affecting doctors who want to provide (bulk billed) “free care” to their patients.

 

In these COVID times, doctors are wary of providing too many long consults to patients and overprescribing. 

 

The Medicare rules keep changing with little notice or clarity. Without warning should the Medicare cops come knocking on their door, there is nothing your GP can do about it but humbly pay it all back without any warning. 

 

I think there may be an Achilles Heel opportunity for doctors to address their concerns and stop withdrawing essential care.

 

I understand the current law is like getting a speeding ticket from a hidden camera. The problem is nobody will tell you the speed limit until you get caught. 

 

Once you do get “caught” you have to pay back 2 years worth of speeding fines based on your gross income. It does not matter if you were in the car speeding. 

 

All you want to do is give out free (Government paid bulk-billed consults) rides to your customers and not accept a cent more. That is what everybody wants! Right?!

 

This may not sound fair or true. But it is and it can be life-threatening to your patient. It can bring unnecessary harm to you and the practice.

 

The Government and the doctors have known about it for decades. This seismic problem is systemically harming both doctors and patients.

 

According to the most recent surveys, it seems that doctors are secretly withdrawing essential care. you, as a patient, may need. 

 

Can you imagine if a patient actually knew there was up to 84% chance of a doctor withholding care? 

 

Not because the patient did not need it, but because their doctor feared a Medicare audit! 

 

In a recent landmark national GP survey (1,400 doctors) it was found:

 

“Over 84% of GPs, regularly, or from time to time, don’t perform certain services because of anxiety over whether the PSR might deem they’re performing those services to be inappropriate.”

 Source: Audit anxiety damages patient care, landmark survey finds, August 2021

 

I would be deeply concerned if I was a female in need of medical care. 

 

A practical example: let’s say I had just mustered up the courage to have a pap smear, only to be knocked back by the doctor for a non-medical reason.

 

Surely that is interference in the private medical practice, namely the doctor-patient relationship, that was deemed to be not constitutional according to the 1980 RACGP v Commonwealth 

 

 

I had first stumbled upon this matter and subsequently raised this ‘Medicare audit anxiety problem’ in the mid-1990s. This was after I assisted in establishing a Women’s Health clinic for a client (at a time where male doctors dominated the workforce). Within 12 months of the clinic’s commencement, the only dedicated female doctor clinic received a Medicare audit letter for “performing too many pap-smears” 

 

I am certain that the logic behind a female patient preferring to consult on such a matter with a fellow woman, is not lost on the reader.

 

I examine the questions not addressed and the fallout from the recent  Dr Karmakar case. 

 

In addition to any lobbying efforts that are required, there may be a small but significant legal loophole that has not been explored.

 

For nearly 30 years and after testifying at the 2011 Federal Senate PSR Inquiry I am disappointed to say nothing has changed, except the Government’s appetite to not want to address this matter at any cost. For me, in relation to her ‘dream team’, Dr Karmakar’s case was meant to highlight this problem

 

For the academics, back in 2011, If I had coined the phrase “Audit Anxiety” you can read my actual testimony on page 5 in the Federal Hansard.

 

 

Source: Proof Committee Hansard SENATE, COMMUNITY AFFAIRS REFERENCES COMMITTEE, Professional Services Review Scheme, FRIDAY, 23 SEPTEMBER 2011

CANBERRA page 5 – Note Hansard typographical error replace order with Audit”

 

Historically there has been a vacuum of professional silence. The appetite for medico-political or legislative change appears to be deafening and conflicted. At times it feels that the representatives are afraid to offend and are keen to secure seats and sell tickets to a Titanic problem that they can only fix and not the Government. Hubris may be the real enemy; this remains uncertain.

 

The Dr Karmakar decision ratifies my ongoing fear about this unfair law that systemically harms patients and GP’s. 

 

The High Court’s earlier decision that this legislation exists to protect the taxpayer appears profoundly misguided when you read the latest landmark survey reports into Medicare Audit Anxiety. Doctors are withdrawing necessary care out of fear of a Medicare audit. 

 

There seems to be some truth (yet to be confirmed) that suggests the law is systemically harming patient care. 

 

In the absence of a provable counterargument, respectfully, the High Court has deemed a focus on how well taxpayers funds are spent must take priority. They have had to assume peer review is open and transparent and the standards have been endorsed by the medical profession.

 

However, I am encouraged by Justice Logan’s comments in her case on the issue, that there may be a public interest issue worth pursuing outside the PSR area. 

 

Since the decision of notable concern is the problem has worsened.

 

The recent landmark Health Ed (1,400) survey results come to the same conclusion but at an increasing level. We had initiated the first national Medicare Audit Anxiety Surveys in 2016

 

To be quite honest the results were not a surprise, except it may now provide palpable proof the laws are harming patient care and our doctors’ welfare.

 

Other key findings of the report are revealing.

 

 

 

Source: Audit anxiety damages patient care, landmark survey finds, August 2021

 

“One of the things that’s coming out from [these cases] is that practitioners will continue not to know what their requirements for item numbers are. If they get it wrong, they could be facing a half-a-million-dollar bill.”Jeremy Knibbs

 

Guess what Jeremy, knowing this, despite everyone’s good intentions, nothing has changed in over 20 years! 

 

In the 2011 Federal Senate PSR Review Inquiry on the 25th of October tabled in it’s report:

 

“The Senate Committee endorsed peer review as the underlying principle of the PSR Scheme”. 

 

My position was cited for the need for clear public MBS rulings to help with interpretation. 

 

Source: 2011 PSR Senate Inquiry statement final report: Review of the Professional Services Review (PSR) Scheme) Chapter 2 Audit Procedures page 17

 

On a different tangent, Jeremy Knibbs makes another important point in his article: Audit anxiety damages patient care, landmark survey finds, August 2021. This is worth exploring further.

 

 

This current position of the Government and the profession is that it is not their responsibility to interpret the Medicare item numbers!

 

 

Source: RACGP advice on MBS rejected by doctors, Medical Observer, 7th October 2011

 

From the same article, Jeremy Knibbs, a well-known editor and publisher for The Medical Republic further sparked my curiosity. He made an insightful comment about patients not signing or appropriately consenting to be bulk billed. Is there a possible loophole where you could avoid unwarranted attention from a Medicare audit?

 

“An interesting piece is that most GPs either don’t know that they are required to get proper consent from a patient for each billing item in Medicare or if they do know, they aren’t doing it in a way that legally the government could ever really enforce if push came to shove and some clever lawyer asked the government to prove that assignment of the rights to bill the Medicare item directly to the doctor was ever actually given.” Jeremy Knibbs

 

 

Source: Audit anxiety damages patient care, landmark survey finds, August 2021

 

Does stopping billing provide legitimate protection?

 

For the non-lawyers amongst us (including myself), I had coined, a few years ago, the following Medicare speeding ticket analogy. This may further explain the complex nature of the current Medicare laws.

 

The Medicare Speeding Ticket Analogy 

 

 

Assume you are a good ethical doctor. After many hard-earned years of study and work, you have just set yourself up in a brand new state of the art practice yourself. 

 

You deserve it! Your patients and friends are impressed with your commitment. Everybody is cheering you on including your suppliers and the Government! 

 

To help pay for your high-quality practice, you decide you want to make your services (bulk billed) free to the patient. 

 

The Government loves your choice. The punters (voters) and politicians love it! After all, it is all about being in (em)power(ed)!  You are applauded by politicians for being a great role model citizen!  

 

For the long hours you put in, while fighting a tsunami of problems while your income goes backwards, you should be in line for a citizens Award for your free services to humanity!

 

Unfortunately for you (the good doctor), this is like naively driving and not knowing or being told the road rules. 

 

When you work this out, all you want to  know is one simple thing: is going over 60km going to get you into trouble with the police and the law? 

 

The problem is, that for three decades nobody will give you or anyone else the answer. Like others before you they have tried everything, even going to the media!

 

All they found was a well-intended Government and their poorly trained decorated  peers admitting in Federal Parliament 10 years ago that there is no commonly peer reviewed, agreed detailed driver education or published (clinically relevant) standards. 

 

No standards on how to drive safely or what the speed limit is!

 

To add insult to injury, there is no appetite or urgency to give answers when people’s lives are at risk. They all acclaim this is in the “too hard basket”! The Government, their professional drivers’ association and the law firmly state it is not their job to interpret or even set the speed limit. They collectively state it is up to you to interpret with your peers. 

 

For decades fellow drivers have been given the same Government run around on the phone

 

They get a different answer every time they ring. The well-intended Government employee frustratingly continues to put them on hold while they are trying to make a life or death decision. In the end, after some time you get an answer in writing and guess what?! After the pleasant exchanges on an official Government letterhead, they say we cannot tell you the speed limit, ask your friends!! 

 

In the meantime, punters are getting frustrated at the doctor, because they are taking too long to make a decision. Ultimately, he succumbs to the madness, as the next person waiting at the traffic light is about to enter a road rage fit! 

 

In the meantime, you naively ask your trusted makeshift peer review group on social media. After all, they appear to be your more knowledgeable and experienced driving buddies and friends. This includes their mechanics (practice manager and other self-proclaimed billing experts with Phd’s). Giving you an insider’s view, by name dropping their high profiled well-heeled legal this provides you with some uneasy comfort.

 

With good intentions but questionable authority, they impressively tell you of their war stories. What they do and how they never have got into trouble. They have found the secret sauce.

 

Unfortunately, complexity breeds ignorance. Nobody in the room realises that ultimately, the cards are always stacked against them. Never try to be too clever or conscientious. Not entering the Medicare casino may be a better bet. 

 

For everyone else who wishes to play, the police keep warning you not to speed! Whatever that means!!

 

In the meantime, you love the freedom and instant importance (popularity) the drive gives you. The only problem is increasingly the unclear rules in recent weeks and months keep changing. Suddenly there are more speed cameras on the road. You get news one of your fellow drivers got slammed in a high profile court case. Reality starts to set in. 

 

For those that get prosecuted, only the headlines and not the details are reported in the news. Your fellow drivers presume you are a reckless idiot, and some do know they are speeding too. Saying you are a good and ethical driver is no defence. In fact, you cannot present a fair defence including you were not even in the driver’s seat when the final penalty is imposed.

 

For fellow drivers, this may not be a concern other than the salacious social media gossip that entails anyone who seeks to defend themselves. 

 

There is notable conspicuous silence from the driver’s associations, who they all assumed would represent any concerns. This can only undermine the legitimacy of any credible defence.

 

Enjoying the kudos, is it because some of their well-intentioned civic-minded members are tapped on the shoulder by the Government? After all, they are needed to enable this process, in a world of plausible deniability.

 

In the meantime back where you live you suddenly get pinged for a speeding fine. 

 

You did not see the camera in the bush, and the next minute the police are at your door. They just want a “friendly chat”. You are not clear whatever you may say will be held against you. You do not want to sound difficult. You are a good person. You are happy to answer any of their questions. After all, what could go wrong?

 

You find out that for the last two years, you have been living 200 metres down the road from a hidden speed camera. You cannot see the camera and even the camera does not know the exact speed limit it needs to consider it as “breaking the law”. Only when you speed enough times in a month do you get noticed or someone vexatiously dobs you in or out of concern.

 

What you soon realise, after a couple of years without warning, you get hit with a retrospective speeding ticket based on your driving habits in the last two weeks. The Government then retrospectively and legally (statistically) prosecutes you.  

 

From this small sample size (fewer than 25 medical records), they may extrapolate your violations by 10 fold whether you were driving (bulking billing or not)over two years. These significant hypothetical fines are based on a small snapshot in time. 

 

Once you get picked up, expect your car to be tested for defects (i.e. clinical relevance, contemporary notes, what do your PSR peers think). This is where the heat is on. Saying it was an emergency and you had no time is not an excuse.

 

Facing such a daunting process, this will naturally slow down the way you drive and your destination.

 

I hope you understand why your doctors may be withdrawing essential care.

 

Back to the Karmakar case!

 

 

Reflecting on the Karmakar case, it is worth asking if there are any notable omissions and admissions. 

 

Sometimes in the eyes of the law, a little technicality can throw out an entire case from the outset.

 

One that comes to mind is bulk billing. 

 

Every time a question about having a patient-signed consent form is raised in the media, Medicare loses their marbles over this issue and they keep stating you must have a signed and or consent from the patient. 

 

You need to prove you have received informed consent. Lawyers will have a field day arguing what constitutes consent. Signing and pressing something without the patient understanding may not legally constitute consent. What would your patients say if they were in the witness box?

 

I am yet to see a lawyer prepare a written answer to this question. I have left this as an open challenge to any budding, qualified and experienced lawyer. I am keen to hear other legal views. 

 

We have sought the advice of Hamilton Bailey lawyers. A big shout out to Lukasz for his assistance on this matter, and it seems there may be a legitimate argument out there to be heard.

 

It would be interesting to note the judge’s views on the following questions:

 

  1. Is there a requirement to pre confirm that the doctor was bulk billing each patient with appropriate consent? If consent is deemed not to be appropriate, does this invalidate or curtail the PSR laws? This point was not clear in the Karmakar case. The judge did not express an explicit view.

 

  1. Would evidence that bulk billing consent has been given (rather than it be assumed), first need to be established before any Medicare investigations or subsequent prosecutions and/or liability could proceed?

  1. Would a private billing (non-bulk billing) doctor have more or fewer rights if they did not bulk bill? 

 

Could it be as simple as: if you stopped bulk billing, would your problems instantly disappear? 

Time will tell whether these questions if asked, become an ‘Achilles heel’ opportunity for the next brave doctor who dares to take the system on. 

For those that are into technical arguments, the starting point is to look at the 

S.20A Health Insurance Act 1973 that outlines that proof of consent.

 

Doctors must receive a signed bulk billed patient consent form. Essentially what this means is that the doctor has agreed with the patient to assign the responsibility for the payment of their bill to the Government. 

 

The doctor agrees the Government is legally allowed to pay you what they feel like. Technically, you have agreed that it is a “Good Samaritan” gesture (you have agreed to provide your services for free) and no longer have a legally enforceable contractual agreement or debt with the patient or the government. 

 

In other words, where a doctor agrees to bulk-bill, they have legally waived THEIR rights to collect any income from anyone; the patient and/or the government. There is no legal obligation to pay. It is now at the Commonwealth’s discretion. You have just given up your fundamental Constitutional right to claim property i.e. your money as your own. 

 

Remember the movie the Castle…:

 

“ acquisitions by the Commonwealth other than ‘on just terms. S. 51(xxxi) of the Constitution is not allowed.”’

 

If the Commonwealth did not observe this rule, it may be considered theft. 

 

I am not sure if doctors knew this technical point they would agree to bulk billing in the first place. Any informed person would not. 

 

This was established in the 1994 High Court Health Insurance Commission v Peverill case

 

The importance of this case could legally mean that if the PSR has found you guilty of inappropriate practice within e.g. 25 medical records, the Department could claw back two years of your income without securing evidence that you did secure appropriate consent. I am not sure it is sufficient to presume that informed bulk billing consent has been provided to each patient they seek to make money from.

 

Many lawyers would argue this should involve more than a simple tap and/or signature at the front desk. 

 

Legally this means that if the patient needs to be informed for it to be valid, then doctors have agreed to bulk bill. 

 

On a final note, the bigger implication is: how do they claim back money based on an extrapolated statistical calculation of no fewer than six-figure sanctions based on fewer than 25 medical records (Health Insurance (Professional Services Review — Sampling Methodology) Determination 2017 section 8) over two years without having to miraculously presume each of those patients had consented to bulk billing?

 

I apologise for the technical detail but it is important to put it out there for you to share with your lawyers if you are considering mounting a defence. 

 

Where to from here? 

 

The simple solution, for now, is to reduce or stop bulk billing if you are confident that patients will value your services. If not, build a strategy so you no longer have to fear the bulk billing clinic down the road and a Medicare audit.

 

Remember patients, after paying your medical fee via EFTPOS or their credit card, they do not remain out of pocket for long.  

 

On the day of the consult, charge medical benefits only. MAKE SURE THE PATIENT DOES NOT ASSIGN THE DEBT to the Government. This means the debt remains the ULTIMATE responsibility of the patient and not the Government.

 

From personal experience, Medicare will usually electronically pay the patient back into their nominated bank account or other practical means, within 24 hours for any Medicare rebate owing

 

Technology today makes this a simple and easy process your receptionist can do for your patients. 

 

As a doctor, if you are ever forced to pay back any money to Medicare you may still have the ability to recover the money from your patient! Make sure your terms and conditions are clear and in writing.

 

This may be the smartest and quickest way to get paid and improve your cash flow and reduce your audit concerns.

 

Is there a better alternative!

 

There is a more certain win-win solution out there if GP’s want it… but you have to demand it. It is to establish an independent not for profit peer-reviewed international healthcare standards and ethics board. 

 

A similar one exists in the accounting profession and the concept has been adapted. The next thing doctors and healthcare workers should be pushing from the ground up is their professional memberships to provide real protection for their patients and providers and a fair go.

 

The International Healthcare Standards and Ethics Board project has been endorsed by a leading international expert Professor Bill Runciman and has the support of Professor Ian Olver. So this is more than just a fanciful idea. It can become a critical mechanism to solve our most critical problems during these COVID times. 

 

Contact me if you would like to help out. Simply sharing this article with your patients as to why you do not wish to bulk bill will make a significant difference.

About me: David Dahm BA (Acc.), CA., FCPA, CTA, FFin, CPM, FAAPM, FAIM, FGLF.

Registered Tax Agent, Former AGPAL Surveyor 10 years of service 

David Dahm is CEO and founder of the national medical and healthcare chartered accounting firm Health and Life and global Founder and CEO of the not for profit project the International Healthcare Standards and Ethics Board (www.ihseb.org)

 

After a serious work-related car accident in 1989, and nine operations later I continue to be a patient and provider advocate. I enter my third decade as a national Chartered Accountant for Medical and Healthcare practices in Australia. I am a former 10-year Australian General Practice Accreditation surveyor. I come from a medico family. I have served on the AAPM National Board and was the inaugural national Chair of the Certified Practice Manager CPM post-nominal. I continue to provide accounting tax and practice management advice to many practices all over Australia. 

You know who you are and I thank you for this real honour and privilege to serve you and your community through you. Note: I am not a lawyer please seek appropriate legal and accounting advice. This information is for general information and discussion only.

1st July 2021 new 2.5% Award and 10% Super pay rise or freeze?!

1st July 2021 new 2.5% Award and 10% Super pay rise or freeze?!

This article was first published by the Medical Republic on 13th July 2021.

From 1st July 2021Medicare rebates on average went up by 0.9%, Fair Work wages up by 2.5%, COVID19 skyrocketing cost$ and more over time is now a criminal offence (Vic other States coming). Something will have to give.

It has been another tough year for medical and healthcare practices. Practices continue to find their weary COVID-19 feet.

We control what we can. The new challenge is how to deal with the new statutory employment remuneration increases deemed by the Fair Work Commission and Employer Superannuation Scheme that employers are obliged to observe.

For most medical and healthcare practices, wages represent over 60% of a practice’s overheads.

COVID-19 has placed acute pressure on practice workloads and incomes. The plethora of changes to Medicare rules, systems and patient expectations have severely impacted a general practice’s bottom line and staff overtime.

The last thing most practices want to do is reduce staff hours or not provide a pay increase. Such drastic changes may hurt staff morale unless they are handled carefully.

Snap lockdowns and the fear of a lockdown has taken a toll on the front line staff. Significant amounts of overtime, job description revisions and expectations means practice staff are naturally expecting an increase. The absence of a cash boost will be felt this time around.

It is clear: unless practices have been carefully monitoring both the financial and non-financial impact of COVID-19, they may find a significant decrease in profitability of up to 5% to 10%.

In the meantime, use this 2021 End of Year Payroll Checklist to perform a quick check that you have updated your payroll systems and contracts correctly.

Three major factors impacting the sustainability of your practice:

1. Fair Work CPI 2.5% wage increase

Did you know that from the 1st July 2021, your staff may be legally entitled up to a 2.5 % pay rise? It is important to refer to the specific Awards such as the Medical, Nursing and Health Support Staff Awards.

A common error is that a practice may still have to pay an increase even if their staff are being paid above the Award. The only exception is if you have a valid and up to date signed individual flexibility employment contract in place with each staff member.

2. Employer super to increase from 9.5% to 10% per annum

The other big news is the 9.5% employer super will increase to 10% commencing 1st July 2021. There are legal options to salary sacrifice and absorb increases if your practice is feeling the pinch.

3. Mandatory electronic ATO report of underpayment of wages starting from 1st July 2021

Mandatory report of overtime and degrossing income means by 1st January 2022 your practice may be facing a Fair Work audit for under payment of your staff wages regardless of whether you believe you are paying them the right salary or above the Award.

We have produced a Medical and Healthcare Employment Compliance Self Assessment Checklist to help you check that you have ticked all the right boxes. The devil is in the details. Having a poor system that does not map the correct and up to date signed employment contracts to your payroll system is the most common error.

Avoiding fines of up to $660,000 per incident means now is a good time to double check you are recording your pays the right way. Many nationally high profiled law firms, practices and businesses have been caught. They had assumed but did not check whether the systems and procedures were up to date and working.

Our article “Overtime is no longer a badge of honour” covers the most common errors and ways you can find out if you have a similar problem.

These challenges represent an important opportunity to positively engage your staff to enhance recruitment and retention, which will aid in improving the sustainability of your practice.

If you are unsure about where to start, our newly revised employment kit provides practices with a better employment package template for key staff in the short and long term. These templates are developed to provide a solid career structure, which includes employer-paid training.

Three key strategies to overcome the impact of a staff pay increase

1. Reduce your reliance on medicare by improving the quality and type of services you offer

Performance and industry benchmark

The first step is to know your numbers then decide what to do next. Think about providing higher Medicare dollar value services, promote annual patient care cycles, alternative incomes e.g. consumables, vending machines in the waiting room and reducing bulk billing on services patients value e.g. procedures.

Make sure you have the most efficient and effective practice systems in place before finalising any employment arrangements. Many of our clients start with an evidenced-based industry benchmarking review before making any big decisions. This reduces any unnecessary staff unrest as an objective external measure has been used to decide future roles and responsibilities.

Improve workflows and or outsource

The other key areas are either improving systems/workflows (see our slide deck on How to increase my income). Our “Overtime is no longer a badge of honour” article will provide you with some practice ideas on how you can make your practice more efficient without having to reduce your staff wages or hours. Also, check our blog.

Consider fixed fee outsourcing important areas but non-core areas such as financial benchmarking, bookkeeping or doctor’s pays with our Doctors Pay Calculator Software or outsourcing service.

Finance and accounting requires a high level of training, experience and skills in an ever-demanding high compliance function. It becomes next to impossible for a practice to keep up with the changing technology, laws and regulatory requirements.

Due to new technology, practices can now cost-effectively outsource many of these key functions. This will enable timely and accurate financial reports. With financial reports, you no longer have to wait until the end of the year for your accountant’s annual financial statements. For many, this will be 12 months too late.

For example, smart practices use our live monthly financial benchmarking tool as a global position satellite to know what their next move is by knowing how similar practices to their own are trending.

Restructure your business and legal structure

Restructuring your practice now may be an effective way to increase the profitability of your practice. Most practices report operating a profit margin of 2% to 7% p.a with accounting firms who specialise in medical and healthcare practices. Our clients enjoy operating profit margins between 20% to 30%. This is significantly higher due to experience in implementing better governance structures, business models and practice controls. Our uniquely live practice benchmarks prove our clients do achieve these results on a consistent basis.

2. Review your employment contracts and pay arrangements

The key here is to make sure that after considering all the above factors.

As the famous Stanford business Professor Jim Collins book Good to Great “you have to make sure you have the right staff on your bus, sitting in the right seats”.

Only then can you check you are paying your staff correctly. Our Medical and Healthcare Employment Compliance Self Assessment Checklist will ensure you have identified the most important issues for the practice to consider.

3. Freeze staff wages or reduce staff hours and or increase productivity

If restructuring your practice or increasing efficiency is not an option (other than cashing out unpaid leave), unfortunately freezing staff wages or reducing hours may be an option as long as you are paying staff above the Award rates. Clearly, compromising your standards is not in the patient’s or practices’ interest.

The 2.5 % increase can be absorbed in over-award payments if you have documented your employment arrangements correctly. Clients who have correctly implemented our latest “Employment Kit” update (see below) released last year should have this option available.

5 Steps: Implement sustainable and legally binding employment arrangements

Step 1: Ensure the correct Awards apply to your staff

These are the latest Awards commencing 1st July 2021

1. Medical Practitioners Award 2020

2. Nurses Award 2010

3. Health Professionals and Support Services Award 2020

4. Pay Guides:

       Health Professionals and Support Services Pay Guide 2021

       Nurses Pay Guide 2021

Step 2: Acknowledge there has been a remuneration increase in the relevant Award (if applicable) and new 10% employer superannuation rate commencing 1st July 2021

A 2.5% increase in new Award rate increases for the Medical, Nursing and Health Support Staff Awards is effective from 1st July 2021. If you pay staff above the Award, unless there is a current and signed employment contract (this may not be correctly worded so you may still have a problem), the practice may remain liable for underpayment of wages.

Check that all work classifications, overtime and allowances payments have been agreed in writing and any above Award payments exceed any of these minimal Award entitlements. Seek professional advice in relation to Award free staff.

Prepare to update and reconfirm your employment contracts in writing and ensure they are signed off by your staff member. First, check you can afford the pay increases as detailed in points 1, 2 and 3 above;

Step 3: In principle reconfirm your employment arrangements with existing staff

Decide in principle whether your staff will be receiving a pay increase. Ask yourself: Are any staff in part or are all statutory and/or performance increases will require the staff member to sacrifice salary or agree to some other alternative arrangement? Will there hours be reduced or increased, leave cashing out etc.

Before formalising an employment contract, an exchange in writing via an email of any key terms of your arrangements subject to a signed formal contract should be agreed to first. This will save a lot of time and money especially when external advisers are being involved.

Step 4: Simplify your employment agreements: Individual Flexibility Agreements(IFA’s)

Consider simplifying your contracts. By using our Employment Template Kit, you can roll up all Award overtime, allowances and penalty rates into a single hourly rate. The example below illustrates this point. This type of contract is called an individual flexibility agreement. Each of the above Awards permits such an arrangement to occur.

An example is the Health Professionals and Support Services Award 2021:

“Clause 7.3 The agreement between the employer and the individual employee must:

(a) be confined to a variation in the application of one or more of the terms listed in clause 7.1 Notwithstanding any other provision of this award, an employer and an individual employee may agree to vary the application of certain terms of this award to meet the genuine individual needs of the employer and the individual employee. The terms the employer and the individual employee may agree to vary the application of are those concerning:

(1) arrangements for when work is performed;
(2) overtime rates;
(3) penalty rates;
(4) allowances; and
(5) leave loading.; and

(b) result in the employee being better off overall than the employee would have been if no individual flexibility agreement had been agreed to.

Clause 7.4 The agreement between the employer and the individual employee must also:

(a) be in writing, name the parties to the agreement and be signed by the employer and the individual employee and, if the employee is under 18 years of age, the employee’s parent or guardian;

(b) state each term of this award that the employer and the individual employee have agreed to vary;

(c) detail how the application of each term has been varied by agreement between the employer and the individual employee;

(d) detail how the agreement results in the individual employee being better off overall in relation to the individual employee’s terms and conditions of employment; and

(e) state the date the agreement commences to operate.

Clause 7.5 The employer must give the individual employee a copy of the agreement and keep the agreement as a time and wages record.

Clause 7.6 Except as provided in clause 7.4(a) the agreement must not require the approval or consent of a person other than the employer and the individual employee.

Clause 7.7 An employer seeking to enter into an agreement must provide a written proposal to the employee. Where the employee’s understanding of written English is limited the employer must take measures, including translation into an appropriate language, to ensure the employee understands the proposal.

Clause 7.8 The agreement may be terminated:

(a) by the employer or the individual employee giving four weeks’ notice of termination, in writing, to the other party and the agreement ceasing to operate at the end of the notice period;…”

Use this Medical and Healthcare Employment Compliance Checklist as a starting point.

Step 5: Confirm you have sustainable and legally binding employment arrangements?

It is important to consult an accountant first to ensure you can afford to pay your staff correctly. Do not forget your staff represents 60% of your total overheads. Furthermore, due to the new ATO gross pay degrossing and data matching rules, make sure they have checked your employment contract information can be correctly entered onto your payroll system.

Then seek legal advice from a lawyer to ensure legal compliance and finalise any agreements.

Order Employment Template Kit

To fast track the process you can order an Employment Template Kit.

The revised templates provided in our employment kit will help identify, train and reward your key staff plus offer flexible working arrangements without significant risk to the practice. It is a win-win for everyone. The content of the employment kit includes useful legally prepared individual flexibility employment templates, job descriptions, standing orders and an employment salary bonus scheme for your staff.

The employment template kit has been prepared by lawyers and kept up to date by Hamilton Bailey lawyers.

This cost-effective peace of mind solution will enable you to continue to reward your staff on merit and provide high-quality services thereby minimizing patient fee increases. If you have any queries, before making any changes, please contact us at no obligation, by email at pa@healthandlife.com.au on 1800 077 222.

To order click here Employment Template Kit or Upgrade.

Good staff employment contracts are good for staff morale. Generally, staff prefer to work with practices that are open and transparent. This can only build trust and prevent any further feelings that they have been taken advantage of in these unprecedented and changing times.

Disclaimer

We strongly recommend you consider reconfirming your employment agreements in order to implement these changes at your next semi-annual staff performance appraisal. We continue to provide this unique and exclusive template in Australia. Please note we are not lawyers. It is important you seek independent legal advice before implementing any ideas from this article or related links referred to. The purpose of this article is so you can ask better questions from your advisers.

This will enable you or your practice to save thousands of dollars on expert advice and time. Most importantly, this process will only add to your staff morale and recruitment and retention strategies. This may be a perfect solution for your practice if your staff are concerned about their future wages or working conditions.

About me: David Dahm BA (Acc.), CA., FCPA, CTA, FFin, CPM, FAAPM, FAIM, FGLF.

Registered Tax Agent, Former AGPAL Surveyor 10 years of service

David Dahm is CEO and founder of the national medical and healthcare chartered accounting firm Health and Life and global Founder and CEO of the not for profit project the International Healthcare Standards and Ethics Board (www.ihseb.org).

After a serious work-related car accident in 1989, and nine operations later I continue to be a patient and provider advocate. I enter my third decade as a national Chartered Accountant for Medical and Healthcare practices in Australia. I am a former 10-year Australian General Practice Accreditation surveyor. I come from a medico family. I have served on the AAPM National Board and was the inaugural national Chair of the Certified Practice Manager CPM post-nominal. I continue to provide accounting tax and practice management advice to many practices all over Australia.

You know who you are and I thank you for this real honour and privilege to serve you and your community through you. Note: I am not a lawyer please seek appropriate legal and accounting advice. This information is for general use and discussion only.

If you subscribe to our newsalert, you should receive automatic notification of any material updates we become aware of.

Coronavirus leaves medical practices on the verge of collapse

We have a free sustainable COVID-19 plan for your practice

ABC 7:30 Report national TV interview

ABC 7:30 Report article interview

Coronavirus leaves medical practices on the verge of collapse.
As reported by the Royal Australian College of General Practice in June 2020, 12% of practices do not feel they are viable, and 37% are not sure!

Are patients afraid to attend your practice?


Are practices closing down?

As featured in The Medical Republic, click here for more information
Six vital steps to take if your practice is in COVID-19 distress

If you have a good plan, it is not all bad news.

It is not all bad news many practices are doing better than last year. This is how.How are you and the team doing?

We understand that practices are busy responding to COVID-19. We hope this guide may help you work more efficiently and effectively.

This step by step 101 survival guide playbook will help the team stay focused. 

This will take another six months and has permanently changed how general practice will operate in the future.

Since February, we have been extremely busy helping GP practices in the East Coast starting in Epping with a COVID-19 Response.

At the time, this has stretched our resources. The upside is we have now produced a free peer-reviewed self-assessment checklist and a practical troubleshooting guide for your practice.

The key is to calm any concern with a plan on how the practice can deal with immediate PPE issues, to short and long term viability and part transitioning to telehealth to ensure patient continuity.

Based on our 28 years of national experience and your input over the years, we have addressed the problem. This practical guide is for owners, staff and patients to reduce any immediate concerns.

The checklist is being updated daily due to rule changes. You can access and bookmark a live link to your browser.

Check your finances now.

The end of the financial year has arrived. Now is the time to check how did you go? We are pleased to report the majority of our clients have faired well; many are even performing better than the previous financial year. So the message is –  it is not all doom and gloom. 

Many have used the survival guide to help respond to the pandemic. The key to success has been having the right attitude and setting the right priorities without re-inventing the wheel when time is your enemy. 

There is no need to be overwhelmed. Lead by starting to working on your practice and not just in it. September 2020, when Job Keeper and Seeker end, will be the next challenge point for everyone.

Need free assistance? 

You can DIY, or we can provide Practice Assistance at your request. To deal with any important or urgent issues, we will provide a high priority complimentary orientation session if you have any questions for the first ten practices that contact us.

This will be the new normal for general practice, the next big move is to the cloud starting with Telehealth services.

Where to start?

Please click on the invitation registration link below to get the practice started. See our national webinars on demand article to access past and future webinars based on the playbook.

Click here to register for access our quick practice checklist and the guide. Feel free to share. We welcome your feedback on our Facebook feedback page. Thank you for any ideas. 

We are receiving a lot of national media interest, so keep an eye out for updates and follow our social media feeds.

Stay safe.

Important coronavirus updates: JobKeeper scheme and unpaid pandemic leave

There have recently been some changes to workplace laws to support employees and employers during the coronavirus pandemic.

JobKeeper scheme

The Fair Work Act has been amended to support the implementation and operation of the JobKeeper wage subsidy scheme (JobKeeper scheme) in Australian workplaces. These changes are temporary and will end on 28 September 2020.

The JobKeeper scheme helps employers significantly affected by coronavirus to keep paying their employees by providing a subsidy administered by the Australian Tax Office. The changes also give eligible employers the ability to give certain directions to and make agreements with their eligible employees to help manage their business.

Find out details about the JobKeeper wage subsidy scheme, including how it affects and interacts with Pay and Leave entitlements.

Unpaid pandemic leave & annual leave changes to awards

The Fair Work Commission has added a temporary new schedule into 99 awards to provide greater flexibility during the coronavirus pandemic. The temporary schedule gives employees:

  • two weeks of unpaid pandemic leave
  • the ability to take twice as much annual leave at half their normal pay if their employer agrees.

The schedule applies from an employee’s first full pay period on or after 8 April 2020 until 30 June 2020. Find out more at Unpaid pandemic leave & annual leave changes to awards.

The Fair Work Commission has also made other temporary changes to some awards to provide more flexibility during the coronavirus outbreak – see Temporary changes to workplace laws during coronavirus.

Annual Wage Review

The Fair Work Commission is in the process of carrying out its annual review of minimum wages. A decision is expected sometime in June. You can follow the process on the Fair Work Commission’s website, and we’ll send you more information when it’s available.

1st July 2020 1.75% Award pay rise or freeze?

Think carefully

Did you know that on the 1st July 2020 your staff may be legally entitled up to a 1.75 % pay rise? Just ensure you have carefully considered the future of the practice. Then make sure you have a current agreement with your amazing staff in writing. You cannot afford to make an irreversible strategic mistake and go broke losing the entire practice. 

Many practices are feeling the pressure of offering pay increases to hard-working staff responding to the COVID-19 pandemic. We thank them all for their great effort and sacrifice.

However, in a time of falling revenue and uncertainty, any decision not carefully considered may make or break a practice. Until a vaccine is being found, there will be significant workflows, and job descriptions changes as new business models and services such as Telehealth are being considered.

These will have an impact on compensation arrangements and employment agreements with your valuable staff. Clear communication and clarity on the way forward will maintain staff morale.

If your practice is paying above the Award rates, there is an option to absorb any wage increase if you have correctly job classified your staff. This is a critical step. The devil is in the detail. We recommend that wage freezing is the last resort option. Correct documentation is critical.

Now is a good time to spend your Cash Boost from the Government and/or any other State Government grants on improving your practice systems and arrangements or reconsidering the real future of the practice. There is no point in throwing good money after a bad idea. We all live in difficult times. 

Commencing 1st July 2020 up to 1.75% pay increase

The industry general minimum pay increase was set at 1.75%. However, it is important to refer to the specific Awards below.

COVID-19 has led to a number of important changes that could seriously impact your practice. Here we cover the four most important ways to address these changes. Regardless of whether you pay your staff above the Award, without current and correctly documented contracts, on the 1st July 2020 wage rates should be increased by up to 1.75% p.a. Please refer to the relevant Awards below for specific details.

In general, staff wages represent up to 60% of the total overheads of a practice. These changes are accompanied by two more other challenges for employers in medical practices.

COVID-19 is putting a lot of pressure on practice revenue and this is forcing a change in workloads and types of work on offer. Practices do not have a choice but to respond in accordance with the law. Job Keeper has complicated this. Some practice have found that this has, in fact, disrupted the positive culture the practice once had.

Now is a good time to review your arrangements, especially before JobKeeper runs out whether your staff are receiving this or not. Important strategic decisions need to be made. To be candid there is no point if the patient survives and the practice dies. 

We have provided some new ideas without freezing wages our webinar on-demand Innovate, Adapt or Merge and our Kicking Covid-19 101 Survival Guide playbook.

These challenges represent an important opportunity to engage positively with your staff to enhance recruitment and retention, which will in turn aid in improving the sustainability of your practice. 

If you are unsure about where to start, our newly revised employment kit provides practices with a better employment package template for key staff in the short and long-term. 

These are legally prepared templates by the national Award-winning legal firm Peripheral Blue Legal. They have been developed with Health and Life to provide staff with a solid career structure, which includes employer-paid training.

Now the detail! 

New national wage increases up to 1.75% p.a. from 1st July 2020

The new Award rate increased for the Medical, Nursing and Health Support Staff Awards is effective from 1st July 2020, even if you pay staff above the Award unless you have a valid employment contract.

From 1st July 2020, the Medicare rebate increased by 1.4% for general and medical practices will continue to not exceed the annual increase in the Fair Work minimum wage which increased by 1.75%.

Some ideas to consider.

Practices and staff, therefore, have four options. Click on the links for smart ways to; 

1) Organised pay structures from cashing out excessive leave and converting permanent casual staff to permanent staff due to the new Fair Work rules; 

2) Look at new ways to boost your income and efficiency in complicated and risky non-core areas;

3) Legally restructure your practice and become more efficient and tax-effective; and 

4) ethically and sustainably improve staff productivity.

Some examples

1. Organised pay structures from cashing out excessive leave and converting permanent casual staff to permanent staff due to the new Fair Work rules

Take it or leave it – leave arrangements and COVID-19 new pandemic leave 

There is a new option for people to be paid out two out of their four weeks’ annual leave – see Fair Works Cashing Out Annual Leave. Also, look at your local State Act’s to cash out long service leave especially in relation to permanent casuals. Seek legal advice first. Just make sure it is in writing. Two weeks in lieu of actually taking leave can only occur if the employee is entitled to a minimum of four weeks leave.

For the practice, this can be a win-win opportunity. Accumulating excessive leave creates a significant liability for a practice. Note that any leave owning for annual, sick or long service leave is based on the employee’s current hourly rate.

For example, a person who started five years ago and has had five annual pay increases and has had no annual leave (which admittedly would be rare) is entitled to be paid at the employee’s current annual employment rate and not at the rate when it should have been taken at the end of each year.

There are many reasons why no annual leave may have been taken, ranging from a lack of back up support staff to annual leave plans falling through.

However, the liability adds up, in either staff burnout or unnecessary financial liability. We have seen significant disputes arise when owners retire or staff are experiencing burnout and seek compensation for this reason alone.



Cashing out of leave as a policy may be a way to ‘meet everyone halfway’ and maybe a good idea to prevent employee burnout. However, taking four weeks of leave annually rather than cashing out is good for staff morale and is also more family-friendly. Clearly smaller practices may have less flexibility in this area due to staffing constraints.

See our article Important coronavirus updates: JobKeeper scheme and unpaid pandemic leave.

2. Look at new ways to boost your income and efficiency in complicated and risky non-core areas

Reduce your reliance on Medicare income. Like Netflix, consider packaged monthly subscription services and outsource high audit risk non-core activities

From 1st July 2020, there are new Medicare Benefits Schedule and Telehealth items numbers for general practice. The new telehealth numbers can generate up to an additional $40,000 to $60,000 per full-time equivalent GP. GP’s can increase their income by 40% per annum if the practice is set up correctly. This is a more sustainable area of practice. GP’s can charge existing patients to follow up with chronic diseases. However, practices need to carefully revise their workflows and systems. 

There are a number of ways to do this. Download our latest free Kicking COVID-19 GP checklist. Register for the General Practice 101 Survival Guide and Checklist and Playbook Guide and see our website or this newsletter for our national webinars on demand that go into more detail. Armchair Medical also has many great ideas for your practice click here.

Outsource increasingly complicated and high audit activity areas. For example, it is critically important to know your numbers before the end of the financial year. Key areas such as bookkeeping and or part of your monthly financial reporting. From 1st July 2019, the tax offices new data-matching of State and Federal information exposes practice to more instant tax audit and significant fines and prosecutions. These include underpayment of permanent casual workers for annual and sick leaveunderpayment of payroll tax for medical and health contractors and underpayment of wages.

It is now impossible to undo or unsay mistakes without avoiding expensive scrutiny by hungry Federal and State tax authorities who need the money to cover a declining tax revenue base due to the pending recession. Get your housekeeping right now before it is too late.

Feel safe your practice is using more accurate, reliable and timely information when making a big a decision.

3. Legally restructure your practice to become more efficient and tax-effective

Carefully review your business model and practice structure for sustainability

Doctors Contracts video shows how to set up your practice so it is medico-legally, taxation, investment and succession planning friendly. Contact us for a free and no-obligation assessment.

4. Ethically and sustainably improve staff productivity

Carefully implement the new Award changes

Peripheral Blue Legal and Health and Life have jointly produced legally prepared employment templates will help you immediately comply.

These are the latest Awards, commencing 1st July 2020;

1. Medical Practitioners Award

2. Nurses Award

3. Health Professionals and Support Services Award

The main points include:

  1.  A 1.75% increase in new Award rate increases for the Medical, Nursing and Health Support Staff Awards, effective from 1st July 2020 (even if you pay staff above the Award), unless you have a valid employment contract.
  2. A requirement to confirm employment terms to ensure your employment agreements are legally binding (we recommend you seek legal advice from a lawyer), regardless of whether you have a signed employment contract. The key points are detailed below. This is important if you wish to avoid an underpayment of wages claim and any related fines. These fines can be up to $54,000 per breach.

If you are thinking of absorbing future wage increases or ensuring your practice will not be hit with a claim for underpayment even if you are paying your staff above the Award, make sure you have properly implemented the employment laws. We recommend you seek independent legal advice.

Do you have legally binding and sustainable employment arrangements?

As stated above, if you do not have signed and up-to-date employment contracts, your staff may be entitled, from 1st July 2020, to up to a 1.75% p.a. pay increase even if you pay them above the Award.

Practices should have updated their payroll software programs to reflect and pay these changes by now. Currently, wages represent 60% of a practice’s total overheads so it is a significant investment. Freezing staff wages can significantly hurt morale. However, any significant cost increases will have to be met by possibly reducing practice standards or increasing patient fees. 

Great staff employment contracts are good for staff morale

Generally, staff prefer to work with practices that are open and transparent. This builds trust and prevents any misguided feelings that they may have been taken advantage of.

The new and revised 2020/21 Health and Life Employment Template Kit

As described in this news alert, there are quite a number of significant and sensitive changes.

The new terms provided in our employment kit will help identify, train and reward your key staff plus offer flexible working arrangements without significant risk to the practice. 

This is a win-win for everyone. 

This solution will enable you to continue to reward your staff on merit and provide high-quality services, thereby minimizing patient fee increases. In order to achieve this objective, we have updated our employment kit to include: see Employment Kit Offer for the full table of content and cost

If you have any queries, before making any changes, please contact us at no obligation, by email at pa@healthandlife.com.au on 1800 077 222. 

Do you want to order an Employment Template Kit or Upgrade? See our Employment Kit Offer. This will enable you or your practice to save thousands of dollars on expert advice and time.

Do you want to order an Employment Template Kit or Upgrade? See our Employment Kit Offer.

This will enable you or your practice to save thousands of dollars on expert advice and time. 

Most importantly, this process will only add to your staff morale and recruitment and retention strategies. This may be a perfect solution for your practice if your staff are concerned about their future wages or working conditions.

The content of the employment kit includes useful job descriptions and a quote for the kit. Email us at pa@healthandlife.com.au to order. 

DISCLAIMER

We strongly recommend you consider reconfirming your employment agreements in order to implement these changes at your next six-monthly staff performance appraisal.

We continue to provide this unique and exclusive template throughout Australia. Please note we are not lawyers. We have had these agreements reviewed by independent lawyers  Peripheral Blue Legal. 

It is important you seek independent legal advice before implementing any ideas from this article or related links referred to. The purpose of this article is so you can ask better questions from your advisers.

By contacting Health & Life we can assist you. Where necessary refer you to the highly skilled and experienced external lawyers we work with regularly.

Could your business do with a cash flow boost?

The two cash flow boosts provided by the federal government to help businesses deal with the COVID-19 emergency have largely been overshadowed by the JobKeeper program, but they could provide valuable financial support to organisations that qualify. 

Some businesses may have already noticed refund payments or tax credits appear in their tax account. 

With the Australian Taxation Office (ATO) warning it will be watching for businesses trying to take advantage of the support measures, it’s worth understanding how the scheme works and what you may be entitled to. 

Enhancing your cash flow

The Boosting Cash Flow for Employers scheme is a temporary measure for small and medium-sized employers and not-for-profit (NFP) organisations. 

Financial support is being delivered in the form of tax and GST-free credits totalling between $20,000 and $100,000 to eligible businesses. 

For most businesses, the cash flow boosts don’t come in the form of tax refunds, but credits against your tax liabilities instead. The tax credits are automatically applied to your business account when you lodge your business activity statement (BAS). 

Eligibility for the tax credits

Your business may qualify for the cash flow boost regardless of whether it’s a small or medium entity, NFP, sole trader, partnership, company or trust. 

To be eligible, your business must have held an Australian Business Number on 12 March 2020. Small and medium entities and NFPs must have an aggregated annual turnover under $50 million. 

In addition, your business must have withheld tax from salary and wages; director fees; and eligible retirement, termination, and compensation payments; or undertaken voluntary withholding for contractors. 

Also, the entity must have earned business income in 2018-19 and lodged its 2019 tax return on or before 12 March 2020. Alternatively, you must have made GST taxable, GST-free or input-taxed sales in a tax period since 1 July 2018 and lodged the relevant BAS on or before 12 March 2020. 

Receiving your cash flow boosts

If you qualify, your business will receive its first tax credit through the BAS system from 28 April 2020. 

Eligible businesses with a deferred BAS lodgment date due to the recent natural disasters won’t miss out. The ATO will apply your tax credit when you eventually lodge your activity statement. 

Businesses qualifying for the initial cash flow boost will generally receive a second tax credit for the period July to September 2020. 

How much you will receive

Your cash flow boost is generally the amount you withhold from salary and wages each monthly or quarterly period. In 2019-20, eligible businesses will receive a credit equal to 100 per cent of the tax withheld, up to a maximum of $50,000. 

The minimum credit for a business is $10,000, even if the tax required to be withheld is zero. In this situation, you will be ineligible for subsequent boosts until your withholding exceeds $10,000 for a relevant period. 

If your business lodges activity statements in 2020-21, your second payment will be based on the value of your initial cash flow boost (up to a maximum of $50,000). 

Boost amounts are automatically applied to your business’s tax account and are used to reduce your BAS tax liabilities. You will only receive a refund from the ATO if the credit amounts exceed your business’s other tax liabilities or you overpay your activity statement. 

The tax man is watching

Although the tax credits will provide valuable financial support for businesses under pressure due to COVID-19, the ATO warns it is paying close attention to the scheme. It says some businesses are trying to artificially create or inflate an entitlement to the support measures. 

Business restructures or changes to the way employees are paid will attract the ATO’s attention. As will splitting your business to get below the $50 million turnover threshold, or increasing wages paid in a particular month to maximise your cash flow boost. 

The ATO also intends to utilise employee data it now has available through the Single Touch Payroll system to identify employers doing the wrong thing. 

If you would like help managing your cash flow during this challenging period, contact our office today.

2020 Doctors Pay Calculator now on the cloud protects practices from Employee v Contractor problems!

We are proud to announce, after many decades, the desktop Doctors Pay (Service Fee) Calculator has moved to the cloud.

Unfortunately, the and the desktop solution for DPC will terminate on the 31st July 2020. You will not be able to open the program unless you have a valid subscription program with us. You may lose access to all pay and tax information. Please urgently contact us for a Cloud conversion to avoid any avoidable provider payment delays.

2020 DPC

The new features detailed below will save the practice more time and money including problems with the Tax Office, Payroll Tax, Fair Work and fraud.

Save time, money and tax for the practice and providers.

There is a Xero integration feature. For more information watch this video.

What is new with cloud DPC 2020? 

Below are the key benefits from moving to the new cloud version: 

  • If you require up to date template service agreements prepared by a lawyer you can order this instantly online.
  • No more data transfers and annual desktop updates.
  • Your data can be accessed from anywhere as long as you have a browser. 
  • Bulk and individual emailing of tax invoice, income tax and BAS extract summary to providers and their advisers. These can also be directly sent to practice management systems. This can save 3 to 8 hours each pay run and accurately and instantly file and store data. 
  • Maintains a service agreement compliance register and disclaimers for non-compliance. 
  • Integrates with Xero (if you request this to be set up – note additional once-off fees apply).
  • Service fee viability calculator and negotiation tool.
  • Practice valuation tool. 

For more information, see the following link to our website: Doctors Pay (Service Fee) Calculator

Six vital steps to take if your practice is in COVID-19 distress

Practice management expert and accountant David Dahm has released a comprehensive and practical 101 survival guide for practice owners HERE

Since the start of the COVID-19 crisis, many practices have been buried in a rolling series of problems which are starting to culminate in a fight for financial survival.

Dahm says the most important starting point for any practice in distress and running from crisis to crisis, is to step back, take a deep breath and realise they are going to need a well-thought-out plan. “The bottom line do not make any big decisions without getting specific and written advice”, he told The Medical Republic.

“Now is the time to seek professional advice from your accountant. Remember you cannot unsay things to your staff e.g. we have to let go of our nurses or staff. There are many things you can do before this is a real or necessary option”.

Getting your initial messaging to staff right right is critical says Dahm. To do that managers and owners are going to need to ask the right questions and not just get the right answers, he said.

Dahm told The Medical Republic many doctors and practice owners have been not able to step back, given the speed and the nature of the crisis. But if a practice is going to survive, then formulating a plan is what needs to happen.

“Some may feel that their only option is to exit altogether. This is a last resort option. The first thing you must do is speak to your accountant and healthcare practice adviser who has experience with these matters”, he said.

“We do not recommend this as an initial response, no matter how you feel. Your practice is viable if you have the right attitude and approach.”

To help practices understand their context, Dahm has put together a 170-page survival 101 guide, which is available HERE. Due to the challenging environment, Dahm is updating the guide daily, and he expects some updates to be directed by feedback he gets on the guide.

The guide, called Kicking COVID-19: General Practice Continuity Checklist Guide, breaks down the key things a practice will need to do to assess its situation and plan for survival, or in some cases, exit. The guide is mostly in an infographic format for ease of communication.

The guide outlines the following six steps in detail and provides pointers to important resources so practices can either start implementing a plan themselves, or with professional help:

  1. Early leadership and team communication – get in control
  2. Establish a practice crisis plan – among other things, this will give your team reference points and purpose to keep them calm and thinking through the process in a better way
  3. Finance – don’t go broke! Call your accountant first and understand properly the financial settings you will be working within
  4. Process – automate and outsource
  5. Customer focus – what you should be telling your doctors and your patients
  6. Learning and growth – get daily feedback and use it

Dahm is also planning a free webinar focusing on the guide when he will discuss feedback on the guide, which he is encouraging all practice owners and managers who read it to provide.

A link to register for the guide is HERE.

Path labs are demanding 50% rent cuts

Major pathology companies are attempting to halve their rental payments to GP practices across the country, a move that threatens to financially cripple already struggling clinics at a time of critical need.

Many Australian GP clinics depend on rental payments from co-located pathology centres to remain viable, and the revenue source has become increasingly important during the COVID-19 crisis, which has cut their patient numbers and left many on the brink of collapse.

David Dahm was interviewed by the Guardian for this story Pathology giants seek 50% rent reduction from hard-pressed Australian GPs amid coronavirus crisis reported in April 2020

At Health and Life, our recommendation is not to automatically agree to a rent reduction as the current pathology downturn of income is temporary. 

This is a template response you may consider when responding to a request. So far none of our clients have reported that they have had to reduce their rent.

After September 2020 practice will be able to renegotiate leases now is a good time to assess what the practice requirements are. Seek appropriate accounting and legal advice now. 

They had reported that some of Australia’s biggest pathology companies began writing to GP clinics in the past week requesting they accept a 50% reduction in rent.

GPs say they feel pressured to accept or face an early termination of their leases, a problem compounded by the federal government’s decision to block new pathology services from replacing any that close down in the next six months of the COVID-19 crisis.

The situation has left GPs facing an invidious choice: accept the 50% rent reduction or risk losing their tenant and the entirety of their rent for the next six months.

The Australian General Practitioners Alliance, the peak body for GP-owned clinics, says GPs depend on pathology rents to survive, particularly at a time when COVID-19 has caused significant losses in revenue.

“In some cases, this may make the difference between general practices remaining open or closing,” AGPA executive officer Richard Hart said.

Pathology companies have suffered their own downturn due to COVID-19, as GP visits drop and demand for testing falls in parallel.

Both GP clinics and pathology services – which provide COVID-19 testing – form a crucial part of the response to the pandemic.

Letters from Laverty Pathology and Western Diagnostics Pathology, owned by pathology giant Healius, have been sent to clinics across the country.

“It is our strong preference to keep as many Approved Collection Centres open and trading as possible,” one letter said.

“To facilitate this, we are requesting that you agree to an arrangement that provides us temporary rent relief.

“Accordingly, we are requesting a reduction of 50% of the current monthly rent under our sublease.

“This proposed rent relief would be for an initial three-month period from 1 April 2020 to 30 June 2020, which will continue on an ongoing monthly basis until the parties further review the arrangement at the end of the period.”

Healius confirmed that its pathology providers had been reaching out to landlords, requesting their assistance with rental costs during a period when they are seeing a significant decrease in pathology testing volumes.

“Most of these requests have been met with a willingness to assist and discussions have been, and are continuing to, take place to agree a mutually acceptable outcome,” a spokesperson said.

David Dahm, an accounting and taxation adviser to GPs based in Adelaide, estimates that pathology labs bring in around $15,000 to $25,000 per annum per full-time GP.

With psychologists and other allied health now working from home due to COVID-19, GPs have already lost substantial rental payments.

At the same time, GPs are dealing with dwindling numbers of face-to-face patients, and technical problems with the rapid transition to telehealth.

GP clinics were gazing into a “funding black hole”, he said.

“GPs live off [the government’s Practice Incentives Program] and pathology rent,” he said.

Dahm said pathology labs closing or cutting rent would rob GPs of “what fundamentally keeps the doors open – that safety net”.

“What I’m saying to people is, firstly, you don’t have to accept what the pathology labs say to you. Get some professional advice. There are other ways around this particular problem and don’t just knee-jerk and react.”

This threat of breaking the lease was fully articulated in one letter to a GP, which said the proposed rent relief “is the most viable way for us to keep our Approved Collection Centres operating effectively without having to potentially close them pursuant to early termination rights in our sublease”.

A federal Department of Health spokesperson confirmed it was pausing new pathology leases – effectively stopping GPs from finding new tenants – as “part of Australia’s response to COVID-19”.

The department said it was “important that pathology providers remain viable and continue to prioritise and increase their capacity to test for COVID-19”.

Prime Minister Scott Morrison provided further support for this action on Wednesday when he announced that landlords would have to reduce rent for commercial businesses proportional to their loss in revenue.

Should you have any concerns contact us here to oragnise a time to for a confidential chat.

The Medical Republic has released a survey to its GP readership to find out more about rent reductions (take the survey here). So far, 81 GPs have responded. Here are the results:

Experiencing a patient exodus? Here’s how to coax them back

Patients are “voting with their feet” by avoiding waiting rooms during COVID-19, says business advisor David Dahm.

But GPs don’t have to wait for patient confidence to gradually return – they can take control of the situation and change the way they operate so that patients feel safe coming in for face-to-face appointments again, he said.

“GPs can’t just simply wait in the consulting room and think they’re going to always have the place fully booked,” said Mr Dahm.

“Our business is not just going to come to us just because we’ve been here for a long time. We now have to go and chase that business.”

The GP clinics that are adapting quickly are likely to be the financial ‘winners’ during COVID-19, he said.

Mr Dahm provided some suggestions for how doctors can COVID-19-proof their practice during a live webinar hosted by The Medical Republic on 28 May.

To watch the full webinar recording on demand, click here.

Practice Collapse: ABC 7:30 Report featuring David Dahm

Coronavirus pandemic leaves hundreds of medical practices on the verge of collapse

David Dahm was invited to speak on the ABC 7:30 Report about falling patient numbers and the impact this is having on General Practices and the healthcare industry.


Hundreds of medical practices are on the verge of collapse because of a fall in the number of visits due to the coronavirus pandemic, according to data collected by the Royal College of General Practitioners.

A third of the practices reported a drop in income of more than 30 per cent in May, when compared with the same month last year.

People are thought to have been reluctant to visit their GP during the pandemic for fear of getting sick or overburdening the system.

A survey of 1,000 GPs and practices shows that nearly half are not sure whether they will still be operating in six months’ time.

Key points:

  • COVID-19 has seen patient numbers fall at general practices
  • Hundred of GPs may not survive the next 6 months according to new data
  • Doctors say low Medicare rebate rates are also causing financial problems

Behind the scenes:





For the link to the full ABC article, click here.
For a link to a recording of the story, click here.

The Medical Republic webinar: Practices Pass Up JobKeeper by Mistake; Bullied on Rental Income

As many as 70% of GP practices may have so far passed up government support of anywhere between $30,000 and over $100,000 because practice owners and practice accountants are failing to comprehend how their practice structures actually qualify them for the new JobKeeper scheme. 

At the same time, major pathology labs are continuing to behave poorly by demanding rental relief of many practices of up to 50%, aligning their threats with government announcements, and implying their demands are legal, when they aren’t. 
Both trends combined with the existing issues around COVID-19 income drops – a result of the introduction of telehealth without any preparation, and government-induced patient reluctance to attend surgeries – are putting unnecessary and unprecedented pressure on the country’s GPs. 
Thank you The Medical Republic for seeking out our thoughts what is affecting the viability of your local general practice where it may harm community care. 
For more information click here.

5 tips to work productively remotely

In the current climate, many businesses are needing to make changes to accommodate staff working remotely. If you are able to work from home the ensuing changes to your work habits can be challenging to negotiate, however there are things you can do to ensure that you maintain productivity and motivation while you’re not in the office environment.

Here are five tips to help you effectively set up an office and work from home for what is looking like an extended period of time.

Create a clear working space

While it’s tempting to use your couch or bed as your ‘office’, set up your workstation at a table instead. Not only does this help you stay productive and focused on working rather than chilling, it also establishes clearer boundaries as to where work starts and ends. This can also signal to any family members also home that this space is where you go to work.

Whether you have the luxury of a spare room or just a small nook, ensure the space is clutter-free and well lit. Everything you need should be kept in this area so you don’t have to go searching for it.

Consider the ergonomics of your space

Just as working from your couch or bed isn’t great for productivity, it’s bad for your posture. This can lead to back pain, headaches and neck tension. You also want your wrists and hands to be supported.

Think about what your office space looks like and try to recreate this as much as possible. Use a pile of books or magazines to ensure that the top your laptop or monitor is at (or just below) your eye level. You can add a pillow as a backrest to your chair and a rolled up towel for lumbar support.

Create to-do lists and manage expectations

Studies have found remote workers tend to be more productive yet feel greater stress than those working from a traditional office.i, ii It can be tempting to up your output to prove to your manager or colleagues that you’re working hard while at home.

If you have a manager, check what the expectations are for the day or week, and be open about your ability to achieve these. As your manager can’t see if you’re struggling, it’s important to communicate. Team check-ins or group chats can help to stay across how everyone is progressing. If you manage a team, set up channels such as these to support your team.

To-do lists (whether through Trello, a similar online system or simply written on a notebook) can help you stay on track and focused.

Keep to set working hours as much as possible

Working from home tends to be more flexible. Without a commute, you can start work earlier in the morning and wrap up sooner. Depending on your role and whether you work in a team, you may need to keep the same hours as your co-workers.

If you set your own hours, avoid the trap of working all hours of the day. In the State of Remote Work 2020 Report, 18% of respondents said they felt unable to ‘unplug’.iii Having a desk away from your relaxation spaces can better delineate your ‘office’ and ‘home’, while your to-do list can help you allocate tasks to the next day when you need to switch off.

Look after yourself and your mental health

While remote work can improve workers’ mental health in certain situations, feelings of isolation are also common, especially if you’re unused to working alone. Staying connected to your colleagues, friends and family is important.

Make sure you take time away from your screen and give yourself lunch and tea breaks. Weather permitting, sit outside for your break, or call a friend or family member. As you’re less likely to get incidental exercise, go for a walk or run after you clock off or before you start, and stretch throughout the day (set a timer on your phone to keep to this) to relieve any tension.

Moving from a work environment to working from home is one significant change many are needing to make, as we work together in minimising the impact of the Coronavirus. Be gentle with yourself as you make the necessary adjustments to your routine, social life and work habits.

https://academic.oup.com/qje/article-abstract/130/1/165/2337855

ii https://theconversation.com/its-not-just-the-isolation-working-from-home-has-surprising-downsides-107140

iii https://lp.buffer.com/state-of-remote-work-2020

The Medical Republic webinar: Turning the tide of the F2F patient exodus

Patients are “voting with their feet” by avoiding waiting rooms during COVID-19, but GPs don’t have to wait passively for patient confidence to gradually return, says business adviser David Dahm. 

Instead, GPs can take back control of the situation and change the way they operate so  patients feel safer making face-to-face appointments again, Mr Dahm told attendees at a live webinar hosted by The Medical Republic late last month.

“GPs can’t just simply wait in the consulting room and think they’re going to always have the place fully booked. Our business is not just going to come to us just because we’ve been here for a long time. We now have to go and chase that business,” he said.

The GP clinics that were adapting quickly were likely to be the financial winners during COVID-19, he said.

In his presentation, Mr Dahm used Brisbane City Doctors as a case study of a clinic that was rolling out several low-cost interventions to reassure patients the practice was a safe environment.

For starters, the clinic website has a pop-up box telling patients with symptoms of runny nose, sore throat, cough, fever, shortness of breath or diarrhoea that they: “MUST BOOK AN ONLINE TELEHEALTH APPOINTMENT”.

When a patient arrived at the clinic, they would see receptionists in masks, hand sanitiser on the counter and clear signage requesting patients wash their hands on arrival and before approaching reception.

The clinic had cling-wrap over the eftpos machine, presumably so the cover could be changed regularly to reduce the spread of infection.

Like many clinics, there was copious signage telling patients to ‘STOP’, go home and call the doctor if they had travelled overseas recently, had contact with a coronavirus case or had cold or flu symptoms.

“The fact that they are using really strong icons there – the ‘STOP’ signs – that is really, really effective,” said Jillian Bowen, a digital marketing strategist and educator who was also a panellist for the webinar.

“People tend to scan so anytime you can use some sort of a prominent, highly identifiable icon, that’s a great place to start.”

Another innovation was the use of restaurant buzzers so that patients didn’t have to linger in the waiting room.

“I don’t think everyone needs to rush out by a restaurant buzzer system,” Ms Bowen said.

“I think you can achieve pretty much the same thing with mobile phones and a quick SMS or something like that, but I love the way they’re thinking. The level of reassurance is fantastic.”

Another clinic used as a case study in the webinar was Maxim Street Family Medical Practice in West Ryde in NSW.

This clinic’s reception area had Perspex shields to protect receptionists and the patients from infection and the car pack had been converted into a drive-through clinic, with social distancing enforced.

Another clinic, NSW’s Dubbo Family Practice, had its waiting room chairs spaced 1.5m apart and a rope cordoning off the reception area.

To watch the full webinar recording on demand click here.

How to Globally Terminate COVID-19 and Preventable Healthcare Errors We are excited to globally launch our…..

How to Globally Terminate COVID-19 and Preventable Healthcare Errors (click here)

We look forward to your support by joining us on Facebook

To learn more why we need a not for profit International Healthcare Standards and Ethics Board (IHSEB) to avoid mixing politics, business with health visit our website ihseb.org.au

Do you really want to show your support and lead a global change? Why not join our community, become a patron and share the solution and be part of the solution with many like-minded people like you. 

In the meantime…

Everyone, please keep visiting your GP and stay safe!

#COVID19Safelyinnovateordie

AMA (WA) webinar: Money, medicine and protecting yourself

We are proud to be invited by the AMA (WA) to present to young doctors and Practice Owners. 

The Australian Medical Association (WA) is pleased to host a webinar that looks at money matters specific to doctors in training. While junior doctors focus on building their clinical skills and research repertoire, and walking the tightrope that is work-life balance, financial management and planning often takes a backseat. Yet all you need is some professional guidance and direction to get your finances on the right track.

Presented by Mr Dahm and Mr Tsoulakis

Money, medicine and protecting yourself for the article and webinar click here.

The future of your medical practice for the article and webinar click here.

National JobKeeper Webinar

Proudly hosted by The Medical Republic about JobKeeper

Medical and Healthcare Practices – your JobKeeper questions answered! For more information click here.

On Thursday the 14th of May, 7:30 pm AEST, we will be hosted by the Medical Republic to speak about how your Practice might qualify for JobKeeper and recent important changes to how the ATO views typical practice structures in the context of JobKeeper, and the basics on qualification for the payments. GP Practices and doctors could be missing out on more than $100,000 in government support through JobKeeper payments. You could be eligible even if you think you are not. 

Let us know in advance and register for our Live Webinar here. Get in quick, already 60 seats taken.

Register for the free General Practice 101 Survival Guide and Checklist and Playbook Guide  

as featured in the Medical Republic article 9 APRIL 2020 Six vital steps to take if your practice is in COVID-19 distress.

The Medical Republic webinar: Practice success is all about the attitude

The COVID-19 pandemic has placed practice business models under a magnifying glass, and many have been found wanting.

Fewer consults, increases in nurse and reception triage, medical stock wastage, lack of PPE, and issues with transitioning to telehealth have caused serious problems for many practices. Some may not recover.


The pressure to adapt in such a short time has resulted in increasingly fractured relationships between practice staff.


Practice adviser David Dahm argues the practices that will flourish in a post COVID-19 world are the ones with strong internal relationships and focused leadership – the ones that are willing to adapt to survive.

The Medical Republic publisher Jeremy Knibbs writes: “Mr Dahm predicts something like 5-10% of smaller GP practices will likely disappear as a result of COVID-19, but many of those that do survive will need to take stock and reassess their operating models to take into account of an ecosystem, especially around technology created competition, that will have changed forever post COVID-19”.


Join Mr Dahm for a live webinar addressing these issues. He will equip you with the skills you need to successfully lead your team into a healthy post pandemic era, and answer your questions live.
Topics covered in this webinar:

  • How to create a post-JobKeeper plan
  • How to build trust in your team and delegate tasks
  • Ways you can restructure your practice and try new business models
  • Techniques for communicating effectively with patients and staff
  • How to revise patient expectations and workflows
  • How to transition to digital and automated systems
  • Webinar through Zoom

Presentation and live Q&A with business adviser David Dahm.

For the article and webinar click here.

The Economic Stimulus Package: Instant asset write-off threshold increase explained

A key part of the government’s economic response to the coronavirus is to support business investment and cashflow by increasing the instant asset write off threshold and eligibility rules.

So what is the instant asset write-off (IAW) and how can it help your business?

Claiming an immediate deduction

Put simply, the IAW provisions allow your business to claim an immediate tax deduction for the full cost of a business asset you buy. Normal depreciation requires you to deduct the cost against your business profits over several tax years.

Under the new rules, you can claim a tax deduction in the same financial year you purchase new or second-hand plant and equipment costing under $150,000.

The IAW is not a cash refund. You don’t get the amount you spend back from the ATO, but instead get the advantage of bringing forward a tax deduction you would normally receive over several tax years.

A simple example is a plumber who buys a new $16,000 trailer for his company. Using the IAW he can claim an immediate tax deduction of $16,000, which in turn reduces his business profit so he pays less tax.

Rules for the IAW

To claim the IAW, the total cost of the asset must be under the relevant threshold. This includes the cost of having the asset installed and ready for use.

Each asset must be under the threshold, but there’s no limit to the total amount your business can claim.

If your business is registered for GST, the IAW threshold excludes GST. Otherwise, the threshold includes GST.

From 12 March 2020, businesses with an aggregate turnover of up to $500 million are eligible for the IAW, up from $50 million previously.

Eligible assets for the IAW

What you can purchase ranges from furniture through to computers and IT equipment, that may be required to enable staff to work remotely.

Industry specific kit such as new tools for tradies, or POS devices and security systems for a retail store also meet the rules.

Although the IAW is generous, assets such as horticultural plants and in house software are ineligible.

Watch out for the traps

To claim the deduction, your new asset must be fully installed and ready for use before the end of the financial year in which you lodge your claim.

If you are a sole trader, you also need to apportion any private use. For example, if you purchase a new car and use it for business purposes 70 per cent of the time, you can only claim 70 per cent of the cost.

You are not permitted to reduce the asset’s price with a trade-in or personal use apportionment to get under the current $150,000 threshold. For example, if your new equipment costs $210,000 and business use is 70 per cent (leaving a claimable amount of $147,000), you can’t claim the IAW as the original cost is still over the threshold.

If your business is structured as a partnership, it’s important to remember the partnership owns the asset – not the individual partners – so there’s no double-dipping. If a partner buys the asset in their own name and doesn’t qualify as a small business taxpayer personally, they can’t claim the write-off.

Using simple depreciation

If your business buys an asset valued over the IAW threshold, you can’t claim the immediate deduction. You can, however, allocate it to your general small business pool and use the simplified depreciation rules.

The general depreciation rules apply if you are ineligible or choose not to use the simplified rules, or if the ATO classes your business as medium-sized.

Using a general small business pool allows you to combine the business portion of higher cost assets and claim a 15 per cent deduction in the financial year you start using them, then 30 per cent each year after that.

Accelerated depreciation initiative

As part of the government’s coronavirus response, medium businesses with a turnover of less than $500 million can use accelerated depreciation rules to deduct 50 per cent of the cost of an eligible asset on installation. Normal depreciation rules apply to the balance of the asset’s cost.

In these unprecedented times, we are to assist you. Please don’t hesitate to give us a call if you have any questions about the instant asset write off or any aspect of the broader stimulus package.