RACGP rejects proposed cuts to surgical assistance fees

Doug Hendrie

3/10/2018 2:51:30 PM

The RACGP has questioned suggested changes to surgical assistance MBS items that would effectively cut payments by a quarter.

GPs who work as surgical assistants might see a drop in pay under proposed changes to MBS items.
GPs who work as surgical assistants might see a drop in pay under proposed changes to MBS items.

The Medical Benefits Schedule (MBS) Review Taskforce is proposing to end the arrangement where surgical assistants – many of whom are GPs – can bill patients separately, and instead introduce a system where the surgeon pays the assistant directly, in order to improve informed financial consent.
At present, surgical assistants get around 20% of the fee for the surgery. Under the taskforce proposal, that would drop to 15% – a pay cut of 25%.
As far as the RACGP is aware, similar cuts are not being proposed for other specialists who assist with surgery.
In the RACGP’s submission to the taskforce, President Dr Bastian Seidel said the proposal risked deterring GPs from working as surgical assistants, particularly at a time when overall MBS rebates have not kept pace with the cost of delivering healthcare.
‘Further reduction of funding for the valuable service provided by GPs is not supported by the RACGP,’ he said in the submission.
‘This could have devastating effects for the ongoing viability of the role, and its ability to attract skilled and appropriately qualified medical professionals.’
Dr Seidel said many GPs play a vital role as surgical assistants, improving continuity of pre-operative and post-operative care.
He raised further concerns regarding a loss of billing independence and future earning capacity, decreased bargaining power for surgical assistants, and the implications of an assistant being considered an employee of the surgeon.  
‘The [MBS] proposal states that surgical assistants would have significant “bargaining power” when it comes to determining their fee, but it is unclear how this would occur in practice,’ Dr Seidel said. 
‘The RACGP sees that the recommendation will likely result in reduced independence for surgical assistants, as they will no longer be able to set their own fees, or independently bill the patient for their services.’
Dr Seidel said that if the proposal was approved by the Government, surgical assistants would become reliant on the surgeon to be paid adequately and on time.
‘The RACGP further notes that the significant out-of-pocket costs associated with surgery are rarely due to the surgical assistant. However, this proposal appears to focus efforts aimed at reducing out-of-pocket costs on surgical assistants, rather than focusing on areas which incur the greater costs,’ he said.
‘If GPs are dissuaded from assisting in surgery, surgeons will need to seek these services from other health professionals – such as nurse practitioners. This will ultimately result in increased out-of-pocket costs for the patient, given there is no supporting patient rebate for a nurse practitioner to assist with surgery.’
Dr Seidel said it is not clear that the proposal would boost informed financial consent for patients, as bundling fees together would make it more difficult for patients to understand to what the fees applied.

MBS items rebates surgical assistance

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Umberto Boffa   5/10/2018 12:47:35 PM

I support the proposal as good for patients with simplified billing and discouragement of unnecessary assisting services

Kareem Marwan   10/10/2018 12:33:12 PM

As a surgeon, I strongly disagree with the proposed changes which would disadvantage surgical assistants, who are a an indispensable and valuable part of the surgical team. This may easily discourage a significant proportion to abandon this role. I find it hard to believe that out of pocket costs from assistants (which is already an uncommon occurrence) would be a major issue. If so, a simple regulatory mechanism by medicare and/or health funds to cap it would be an easier and more acceptable alternative.

Dr Nigel Munday   13/10/2018 11:08:16 AM

The Medicare Review proposal will dis-empower assistants - period. And bundling of assistant fees is the first step towards US style "Managed Care". Anaesthetists will be next. And then we can all bow down to the almighty health fund. If that is the future you want, then good luck to you.
Rebate reductions will lead to greater out of pocket costs to patients, or a great incentive for GPs to do other work. The end result - deskilling, and disempowering of a valuable workforce. Operative safety will suffer because it will be harder for assistants to challenge surgeons as advocates for their patients. Australia is a world leader in surgical safety and our surgical assistants are a major part of that. We should be looking at ways to protect and enhance the role, not tear it apart.

Angela Allan   20/03/2019 4:23:36 PM

Prior to the introduction of GST most assistant surgeon item numbers were billed by the surgeon and the fee received for the assistant item number was passed on to the surgical assistant. The system then was disastrous for surgical assistants as they were not paid on a regular basis by surgeons, their fees were not promptly adjusted as new fee schedules were issued and when there were billing errors by the surgeons' administrative staff the assistant had no recourse as the accounts had been closed by the time the assistant was paid. Several surgeons I know adjusted the assistant fee downward and used the lower overall fee account as leverage to keep fees lower but did not adjust their own fees. This proposal, with lower rebates, will undoubtedly force doctors away from assisting and cause a shortage of skilled service providers in this arena.