New strategy to tackle high specialist fees

Matt Woodley

4/03/2019 4:11:17 PM

While RACGP President Dr Harry Nespolon welcomes the opportunity to improve transparency surrounding out-of-pocket costs, he has stressed GPs should not be required to find patients the least expensive procedure available.

The Government hopes the initiative will increase the understanding of medical out-of-pocket costs among consumers, their families and healthcare professionals.
The Government hopes the initiative will increase the understanding of medical out-of-pocket costs among consumers, their families and healthcare professionals.

Announced late last week, the proposed Government-funded website is one of a number of recommendations outlined in a Ministerial Advisory Committee report into patients’ out-of-pocket expenses.
The website will include information supplied by individual medical specialists related to the fees they charge for common services. It will also allow users to search common services by specialty and geographic location based on data from existing Government sources.
The Government hopes the initiative will increase the understanding of medical out-of-pocket costs among consumers, their families and healthcare professionals.
‘A concerted education campaign is required to inform consumers that there is not necessarily any relationship between fees charged and the quality of medical care,’ the report states.
However, RACGP President Dr Harry Nespolon told newsGP that while the college is supportive of any effort to improve transparency surrounding out-of-pocket expenses, he stressed GPs should not be required to find patients the most inexpensive surgeon or procedure available.
‘Whether a specialist is offering a no gap fee is often completely opaque to the GP and to the patient until they actually ring up and find out. Any way that that information can be made more readily available, the better,’ Dr Nespolon said.
‘Most GPs want to make sure that patients do get the best possible outcome from a referral and fees are part of that, but I don’t think it is up to the GP to act as a broker or to find the cheapest surgeon.
‘We certainly don’t want to enter into US-style managed care where there’s an administrator making a decision about where the patient’s best-served or [their] cheapest option is.
‘The role of a GP [is] to recommend the best person they believe to fix that patient’s problem.’
Federal Health Minister Greg Hunt has said the website is necessary because of a small number of medical specialists who charge very large or unexpected out-of-pocket fees, causing distress and financial hardship for patients, as well as undermining the private health insurance system.
‘I am confident this website will improve transparency and choice for patients and families. It will reduce the burden of “bill shock” and allow patients to make informed choices,’ Minister Hunt said.
The Ministerial Advisory Committee into out-of-pocket expenses was formed in the wake of a Department of Health (DoH) survey that revealed widespread consumer concern about exorbitant or unknown specialist medical fees.
More recently, a Consumers Health Forum survey found more than a quarter of respondents treated for breast cancer had incurred an out-of-pocket cost of more than $10,000, while one in six respondents said that out-of-pocket costs had a significant impact on their lives.
Additionally, one third of respondents said out-of-pocket costs were not explained to them before treatment, while there was a common view that using private health insurance would expose people to more costs.
The committee also cited the DOH’s most recent Hospital Casemix Protocol Annual Report, which shows that shows that 35.6% of hospital separations result in out-of-pocket costs, which in some cases are upwards of tens of thousands of dollars.

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Helen Toyne   5/03/2019 7:52:34 AM

The first thing GPs need to know is that according to the Department of Human Services website, when writing a referral patients should be allowed to choose their provider. We can certainly recommend a quality clinician or service, but it is NOT a requirement that referrals be to named specialists. Public hospitals in particular seem unaware of this.

Dr Jan Sheringham   5/03/2019 8:14:38 AM

So now we are expected to become brokers for specialists and/or hospitals?? Our task is to help our patients to access the best possible investigation and treatment options based FIRST on clinical need. If timing and/or cost cut across that option, I am willing to advise other services BUT I will NOT routinely seek to prevail on anything which borders on patient/personal responsibilities. I will counsel ONLY based on my clinical judgment- that is what I have spent my entire practising life as s GP doing, to the best of my abilities. Where cost concerns are high, the more empathetic specialists and/or their staff are often more than willing to provide advice on other public/private options best known to them, and with high levels of patient satisfaction. These specialists therefore get much more purchase with me than those who refuse to assist in true cases of need! As a GP, both my time AND my capacity for extra work is now non-existent, so good luck with this sort of program!

A.Prof Christopher David Hogan   5/03/2019 2:09:50 PM

This is indeed Tiger Country . When we GPs are suffering severe economic pressures & yet still hanging on to Bulk Billing it seems churlish of us to criticise our colleagues who are not afraid to privately bill.
That being said, if they have the economic capacity to choose, people are more interested in the result than in the cost.
On the other hand there is a great need for specialists to be frank & open about their fees at the time of patients making an appointment either on their website ( if they have one) or via their receptionist
I am concerned about the dilution of the power of a referral . I spent a great deal of effort getting to know my consultants so that I could match patient to consultant. Their were many I would not use again based on level of skills, level of communication with the patient & with me.

David smith   12/03/2019 12:55:38 AM

Perhaps we should have extended skills trained GPs to service areas with the highest average gap fees? More competition would lower fees... but specialists would of course express concern for patient safety 😏

Tony agnello   12/03/2019 1:04:07 AM

The length of specialist training programs need to be reduced to ensure our public training networks aren't clogged up by trainees "doing their time". This would increase the number of specialists produced each year lowering specialist fees. It also wouldn't affect the standard of care as the newly minted specialists would be members of the specialist colleges that determine their standards.