title: Estimating non-billable time in Australian general practice.
abstract: OBJECTIVE
  To quantify the time that general practitioners spend on patient care that is not claimable from Medicare (non-billable) and the monetary value of this work were it claimable, and to identify variables independently associated with non-billable time.
  
  
  METHODS
  Prospective, cross-sectional survey, April 2012 - March 2014.
  
  
  METHODS
  Australian general practice; a substudy of the national Bettering the Evaluation and Care of Health (BEACH) program.
  
  
  METHODS
  1935 randomly sampled GPs (77.4% participation rate) from across Australia provided filled questionnaires on 66 458 patient encounters.
  
  
  METHODS
  Non-billable time spent on patient care since patient's previous consultation; duration of and reasons for non-billable time; estimate of its monetary value were it claimable from Medicare; variables associated with non-billable time.
  
  
  RESULTS
  69.5% of GPs reported non-billable care outside patient visits; 8019 patient encounters (12.1%) were associated with an occasion of non-billable time. Mean time spent per occasion was 10.1 min (range, 1-240 min). Reasons for non-billable time included arranging tests and referrals, consulting specialists or allied health professionals, medication renewals, and advice and education, and encompassed all International Classification of Primary Care Version 2 chapters. The notional average annual value per GP of this work was $10 525.95 (level A rebate) to $23 008.05 (level B). Non-billable time was independently associated with female GPs, younger GPs (under 55 years), female patients, patients aged 65 years or more, and one or more chronic problems being managed at the recorded encounter.
  
  
  CONCLUSIONS
  Most GPs spend a significant amount of unpaid time on patient care between consultations, an inherent problem of the fee-for-service system. This work should inform discussions of future funding models.
authors.affiliation: All the authors are from Family Medicine Research Centre, University of Sydney, Sydney, NSW joan.henderson@sydney.edu.au.
authors.forename: Joan
authors.initials: J
authors.lastname: Henderson
authors.affiliation: All the authors are from Family Medicine Research Centre, University of Sydney, Sydney, NSW.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Valenti
authors.affiliation: All the authors are from Family Medicine Research Centre, University of Sydney, Sydney, NSW.
authors.forename: Helena C
authors.initials: HC
authors.lastname: Britt
authors.affiliation: All the authors are from Family Medicine Research Centre, University of Sydney, Sydney, NSW.
authors.forename: Clare
authors.initials: C
authors.lastname: Bayram
authors.affiliation: All the authors are from Family Medicine Research Centre, University of Sydney, Sydney, NSW.
authors.forename: Carmen
authors.initials: C
authors.lastname: Wong
authors.affiliation: All the authors are from Family Medicine Research Centre, University of Sydney, Sydney, NSW.
authors.forename: Christopher
authors.initials: C
authors.lastname: Harrison
authors.affiliation: All the authors are from Family Medicine Research Centre, University of Sydney, Sydney, NSW.
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Pollack
authors.affiliation: All the authors are from Family Medicine Research Centre, University of Sydney, Sydney, NSW.
authors.forename: Julie
authors.initials: J
authors.lastname: Gordon
authors.affiliation: All the authors are from Family Medicine Research Centre, University of Sydney, Sydney, NSW.
authors.forename: Graeme C
authors.initials: GC
authors.lastname: Miller
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001315:Australia; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000191:economics; D005260:Female; D058006:General Practice / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics*; D011446:Prospective Studies; D012017:Referral and Consultation / Q000191:economics*; D012051:Reimbursement Mechanisms / Q000191:economics*; D012737:Sex Factors