RACGP rejects proposed cuts to surgical assistance fees

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