New move to lay bare Specialist fees

Originally appeared in Medical Republic, March, 2019.

A website publishing individual specialists’ fees will be part of a federal strategy to reduce excessive out-of-pocket costs and patient “bill shock”, if the Liberal-National government is re-elected.

Health Minister Greg Hunt has committed to implementing such a website following the release of a report from the Ministerial Advisory Committee on Out-of-Pocket Costs, which found a minority of specialists were charging exorbitant and unexpected fees.

The report recommends publishing fees for consultations and for the items that make up 80 per cent of the volume of MBS services each specialist offers. The data would be supplied voluntarily and regularly updated by the specialists, who would commit to charging no hidden or administrative fees and could be held accountable under consumer law if they exceeded the fees outlined.

Entries would link to those of team members such as anaesthetists or assistant surgeons.

The supplied data would be complemented by recent historical government data on the same procedures, aggregated by specialty.

Labor health spokeswoman Catherine King was still considering the report when The Medical Republic went to press, but said Labor would address the issue of transparency and out-of-pocket costs before the election.

Mr Hunt said the initial focus would be on gynaecological, obstetric and oncological services, key areas for high out-of-pocket costs.

The report says GPs would be encouraged “to discuss costs as one factor when referring patients to medical specialists and to encourage the offering to patients of a number of acceptable medical specialists, to enable the patient to make a choice”.
In fact, GPs who use MedicalDirector or Best Practice patient management software already have a directory of Australian specialists integrated into their referral workflow, which is also freely available to the public online.

CEO Rami Weiss said the HealthShare website received half a million unique visitors a month.

“Since 2016, we have worked with private health insurers to provide information on specialist gap scheme participation, and more recently on procedure-level out-of-pocket costs,” he said. “We also receive information directly from specialists who add their own fees data.”

Mr Weiss said HealthShare had been in communication with the committee and hoped the government would add data to its platform, which was already working successfully, rather than replicate all its functions from scratch.

“We have already built sophisticated searching and filtering algorithms, we already have a comprehensive dataset of private-practising specialists and we already provide some costs data that is provided to us by private health insurers and specialists directly,” he said.

“We already receive data from other third parties, such as hospitals, so we have a proven track record of normalising multiple datasets to produce a single directory.

“We have also done the integrations into the GP clinical software, which is a multi-year process.

“Finally, we have already built a self-serve platform which allows specialists to add their own information – specialties, sub-specialties, special interests, practice locations, costs, and so on.”

The AMA, which contributed to the committee’s research, said it encouraged transparency around fees “and unreservedly condemns egregious billing, which occurs in a very small percentage of cases”.

But to be useful, the website would have to include not just fees but MBS rebates and private insurance contributions.
“Each insurer sets the rebate amount that they are willing to pay,” AMA president Dr Tony Bartone said. “If the insurer’s rebate is low, the out-of-pocket cost to their customer will be high. Out-of-pocket costs can vary by thousands of dollars because of the variation in what the insurer chooses to pay as a rebate.
“A website that does not have the full information is not in anyone’s interests.”

RACGP president Dr Harry Nespolon said he would welcome any means of making information about specialist fees and gaps more available to GPs and patients.

“Whether a specialist is offering a no-gap fee is often completely opaque [until you] actually ring up and find out,” he 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 … The role of a GP [is] to recommend the best person they believe to fix that patient’s problem.”

The committee, chaired by Chief Medical Officer Brendan Murphy, only considered non-GP services but said there was “scope to expand the proposed solution to GPs in the future”.

Mr Hunt convened the committee in 2017 after surveys by the Health Department and the Consumers Health Forum that found concern among patients about substantial costs that were not explained to them before treatment. One-sixth of respondents in the second survey said the costs had a significant impact on their lives; more than a quarter of those treated for breast cancer reported having to pay $10,000 or more out of pocket.

There were also sporadic reports of patients having to take out a second mortgage or applying for early access to superannuation.
Mr Hunt has also pledged to fund an education campaign for consumers, GPs and specialists to improve understanding of out-of-pocket costs and aid in the referral process. It will “highlight that higher fees do not always mean a higher quality of care”, the minister said. The Australian Prudential Regulation Authority reported that in the December quarter 95% of hospital services were provided on a no- or known-gap basis, with little variation among the states.

The website was expected to take up to two years to implement and cost $8 million over four years if developed externally.