Why your GP may refuse to provide blood tests
9 min read
Dr Suresh Khirwadkar
What? Just what?
YES sorry the title is not a typo. It's real. It's genuine. And worse still, it's likely to happen.
GPs may soon have to start refusing to give you blood test requests, or you may just have to pay for them all without Medicare rebates.
This is a very real scenario that you and I as patients may face, nevermind the issues that doctors and in particular GPs will face.
Many will call this 'scare tactics from GPs', or 'they just want more money' well it's not and it's nothing to do with GP incomes or salaries.
Despite what many think, GPs do not have some pot of gold that the government give them for doing nothing, and we certainly do not get any money from your pathology tests. There's no kickbacks or referral fees or anything like that, so GPs stand to gain absolutely nothing from refusing to provide you with a referral for a blood test on Medicare. In fact, they stand to lose. A lot.
How do GPs lose?
Let's think about a scenario.
You need a blood test. You need at least 3, a common scenario, and indeed some of the ones linked in the articles that Medicare are ramping up compliance on.
You have iron deficiency, low vitamin D, and are feeling tired. Now I'd personally do a lot of tests, but even if your GP asked for your iron, vitamin D and just a full blood count, which would be an extremely basic panel, you are still looking at paying around $200 out of pocket for these tests without access to Medicare rebates.
So how does your GP lose out if you are paying?
Well if you are going to have to pay for those bloods, are you going to go that GP? Or will you go to another who will happily write you a Medicare form and you can get them for 'free' (bulk billed usually)?
And what about when that GP gets that letter? They will refuse. You will go to the next one. And so on. Until there's nobody left offering Medicare rebated blood tests.
The pathology company won't help you out, they will just charge you.
'It'll never happen, it's just scare tactics'
Sorry, wrong again. It already happened with MRI scans.
- Over 50? Sorry you can't have one for your knee
- Over 16? Sorry can't get one for your wrist
- Your headache isn't chronic or your GP doesn't think you have a brain tumour? Sorry you can't have one for your brain
- You have severe neck pain but no radiation down the arms? Sorry no dice. You can't get one of your neck
- You have an incredibly painful ankle and your GP thinks you have a nasty high grade sprain / tear - sorry you can't have one
It happens with medications too, though these are controlled by the PBS.
Take Xarelto (Rivaroxaban) - you can't get it even though the guidelines suggest you may need it to prevent serious risk of further clots, lung clots or worse. The government says you can only get it if you have a DVT even though this does NOT align with clinical guidelines on treating superficial clots above a certain size, the government just says you have to suffer and risk death, or pay well over $100 for it.
This is just one example, there's numerous others. Some GPs try to do the right thing by their patients and bypass these ridiculous rules, but technically they are breaking the law and risk serious fines or worse if they are caught.
There's examples of restrictions and rationing in almost every aspect of health care, and it's only getting worse. Always getting more restricted and patients are the ones that suffer as GPs cannot shoulder the burden any more, especially when risking hundreds of thousands of dollars of fines or worse.
Increasing compliance activity against hard working honest GPs just trying to do right by their patients is killing the profession, and it is likely to only get worse.
What is compliance activity?
You can read about the government's position [here](## What is compliance activity?)
The government loves to tout compliance as the saviour of Medicare, by protecting your hard earned dollars. The reality is very different. The compliance division, and the eventual 'star chamber' make up their own rules, then apply them liberally, without any remorse. They claim it's impartial. Yes it is, just like a blindfolded firing squad is impartial. It doesn't make it right.
You might say that 'well they just catch the criminals, so anyone caught must be guilty'. Oh how I would love to live in such a world where those found guilty are all 100% guilty, and there are never any incorrect judgements or miscarriages of justice. Justice, what a funny word, for a system that doesn't even allow doctors legal representation to defend themselves. Where the burden of proof from the PSR appears to amount to 'we think you are guilty so you are'.
Why should you care?
We are already seeing the death of bulk billing. There's been numerous stories about it in the mainstead press recently, and many many more in medical news outlets before this. It's just no longer viable for most practices and many are having to choose between stopping bulk billing or to simply close the doors). We already discussed how PBS medications have ridiculous restrictions that often don't align with clinical guidelines (for example, anticogulation for large superficial venous thrombosis that are significant risk, PBS still says no you can't have them). Imaging is another area where as we said, MRIs are restricted.
Even imaging requests like CT scans, just like many blood tests, do not have any 'requirements' attached to them. Take this example - for a CT of your sinuses. There's no requirements attached to that request. No criteria to fullfill, yet recently a PSR (Professional Services Review) committee found a GP 'guilty' of over requested CT sinus scans, and ordered them to repay many thousands of dollars, and banned them from requesting any more for 12 months.
This is going to be the same with blood tests - guilty after the fact, with no chance of recourse, no right to defend yourself, and no way to judge what is acceptable when there is absolutely no criteria to assess yourself against.
Do you think your GP is going to keep accepting these risks?
If you don't believe me, look at this PSR report from April 2022. Look at those eye watering amounts that were 'voluntarily' (read - forced) repaid by doctors for 'over claiming'. Many of the issues the PSR find don't even have any assessable criteria, so how do you know you shouldn't request them in the first place when there's nothing saying you can't?
How do GPs know they are breaking the rules, when there's no rules to break? Yet you are still found guilty of breaking them? And then forced to repay hundreds of thousands of dollars. And quite possibly lose their licence to practice, their livelihood, and their lives.
Yes I mean lives - suicide in the medical profession is very real.
What does all this mean?
Well it means your GP may just start refusing you those blood tests, or at least make you pay for them, or they risk their own livelihoods. Those requests your 'specialist' wants - nope. The requests your naturopath wants - sorry no can do. The annual tests - not going to happen. That iron monitoring? sorry not worth the risk any more.
All of this will result in terrible medical care, unless the GP forces you to pay for them, without rebates (even with GPs not receiving the rebates, they are still liable to be fined or 'prosecuted by the PSR').
So ask yourself, are you willing to pay for those bloods? Or do you just go without?
What can you do as patients?
Kick up a bloody big fuss about it that's what. Not to your GP. We are all as upset as you, believe me. We all complain bitterly but the government ignores us, and our representative bodies like RACGP and AMA do very little to help us (or you by extension). There's a few groups like ASGP who champion patient rights and campaign for better rebates, fairer care, more time for appointments, etc. Whilst they are growing rapidly, they are still unfortunately minnows in a very large ocean which the government mostly just ignores anyway.
You need to complain to YOUR representatives. Your members of parliament. Your elected officials.
- Complain that your care is being held back.
- Complain that your rebates are pathetic.
- Complain that your health is seemingly not important to politicians.
- Complain that your tests are unfairly restricted.
- Complain that your local area cannot employ doctors because of unfair restrictions.
- Complain that your GP is restricted from prescribing simple medications and you need to pay thousands a year just for a prescription from another doctor.
- Complain that your medications are unfairly restricted and to get the appropraite treatment you may need to spend hundreds if not thousands of dollars.
- Complain that your vaccines are held from you unfairly as the government will not pay for them.
- Complain that your GP risks career ending penalties if they even wobble and prescribe or request something they shouldn't, even though they didn't know they shouldn't.
- Complain that your health suffers because there's no GPs left.
The time is coming where GPs are going to have to start saying 'no sorry, I simply can't do what you need'.
What will you do then?