Funding environments
Medicare and private fees
Two funding sources at opposite ends of the same practice. One is priced in Canberra, the other is priced by you.
The stream most practices already have and do not think about
Almost every Allied Health practice carries some Medicare and some private work. For a practice weighted toward NDIS or Aged Care, it is frequently the only part of the revenue where the price is not set by somebody else, which makes it the natural hedge and the part most worth deliberate attention.
How much this matters depends on how many payers your discipline carries. Physiotherapy and podiatry sit across six each, which is what makes them resilient to any single decision, and it is payer spread rather than management quality that produces that. Disciplines carrying fewer payers feel every change harder, and for them the Medicare and private mix is doing more work than it looks.
What sits inside this stream is chronic disease items, Better Access and private fees. The gap fee is the lever, and most practices under-use it.
What gets brought to me
The gap fee has not moved in years
The Medicare rebate is a contribution toward your fee and you set the rest of it. Most practices set that number once and never revisit it, which is a real margin decision made by default.
Chronic disease work is losing money and nobody has checked
Bulk billed chronic disease sessions frequently sit below the fully loaded cost of the clinician delivering them. That is a legitimate choice and it should be a choice.
The service mix grew rather than got designed
Medicare, private, NDIS and private health extras all running through the same diary with different rates, different documentation and no view of which one is subsidising the others.
Diversification is the plan and nobody has costed it
Moving from a single funded stream into Medicare and private is the right instinct. It is also a different referral engine, a different marketing problem and a different cash flow shape.
What I am usually asked for
- Gap fee setting, and the margin case for moving it
- Service mix analysis across Medicare, private, NDIS and extras
- Whether a chronic disease caseload clears its own cost
- Diversification away from a single funded stream
- GP referral strategy, and why a GP would send to you rather than the incumbent
- Getting found by clients directly, where no third party holds the gate
Tools built for this
Allied Health Consultation Tracker
Open, upcoming and recently closed consultations on how Allied Health is funded, regulated, paid and employed, with the date each one closes.
Allied Health Margin Calculator
Model what a clinician costs you against any charge rate, so you can see immediately whether a rebate plus your gap clears it.
Private practice
Most practices carrying Medicare work are private practices, and the rest of the commercial picture sits there.
Advice from someone who has run the business
Clinicians at the provider I co-founded
Annual revenue at that business
Allied Health providers I have worked with
Independent advice, no clinical services
Wondering whether the mix is right?
The answer is usually in the numbers rather than in the clinical work, and it takes about an hour to find. A discovery call will tell you whether it is worth doing.