The Australian Medical Association (AMA) fears patients booked in for surgery in the new financial year could be hit with huge out-of-pocket expenses as the industry scrambles to keep up with more than 900 changes to the Medicare Benefits Schedule (MBS).
The leading doctors’ association says that the changes have been dumped in one large batch with no time to understand or inform patients and could lead to “chaos” across the system.
The AMA said the more than 900 changes to MBS rebates for private surgery were some of the biggest changes made to Medicare in decades.
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The latest changes will affect rebates for orthopaedic surgery, general surgery and heart surgery.
AMA president Dr Omar Khorshid accused the government of not providing the sector with enough time to implement the changes.
“The AMA is concerned that the private healthcare sector – including health funds, hospitals, doctors and patients – will not be ready for the 1 July changes due to poor implementation by the government,” Dr Khorshid said.
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“Less than one month out from the implementation of these changes, and we still do not have all the information we need to assess and change over our schedules and payment processes to reflect the changes.”
Dr Khorshid explained that similar problems were encountered the last time MBS changes were made in 2018, and that no lessons had been learned from that experience.
“We had enough problems in November 2018 when the first tranche of MBS review changes resulted in private health insurers, through no fault of their own, not having their schedules updated in time,” Dr Khorshid said. “That meant that no-gap arrangements were not possible or were significantly delayed, leading to uncertainty for doctor and patient alike.
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“Patients were left out of pocket, spinal surgeries were delayed, and doctors couldn’t provide patients with informed financial consent about potential gap fees.
“Those changes involved replacing 70 spinal surgery items with 60 new items.
“The 1 July changes involve expected changes to 594 orthopaedic surgery items, 150 general surgery items, and 188 cardiac surgery items.
“After the spinal surgery debacle, the AMA and the private health sector told the Department of Health that six months’ lead time is needed ahead of MBS changes.
“More than two years later, we are facing the same problems, but with more than tenfold the volume and complexity.
“This will put significant financial and operational risk on health insurers and private hospitals, and leaves doctors and patients scrambling and confused about what and how to bill against Medicare and private health insurance policies come 1 July. We simply don’t know what the rebates from funds will be, as they haven’t had the time to prepare and release them in advance – including for surgeries already booked for next month.”
Health minister Greg Hunt said the changes were based on medical advice from the Medicare Services Advisory Committee, a taskforce established to assess rebates as part of a thorough review of Medicare.
“We will work very constructively with the medical groups,” Mr Hunt said. “It (the taskforce) is focused on patient safety, patient services, and patient outcomes.
“These are medical changes based on medical advice,” he said.
“Many of them date back to last year’s Budget, so there’s been a long lead time. But for example, there are new procedures in bone grafting, new orthopaedic procedures which will open up more opportunities for patients.”
Dr Khorshid said that despite working with the government in good faith, the rushed nature of the changes could result in huge problems in the new financial year.
“We have repeatedly reached out to government and the Department of Health to communicate the needs of the sector to ensure a smooth transition of the MBS changes,” Dr Khorshid said. “However, giving the sector just weeks instead of months to change over its entire system to support almost 1000 changes leaves the health system and patients at risk.
“The government’s reminder to doctors to consider patients’ circumstances when charging fees misses the point. At the moment there’s no way for doctors to know if they are charging a gap due to the chaos caused by the department’s poor implementation,” he said.
“The AMA is calling on the government to urgently commit to changing the process going forward to avoid past problems, and ensure that this massive change to MBS rebates occurs without disruption to patient care.
“We are also calling on the government and private health insurers to safeguard patient private health insurance rebates, to ensure that they are not worse off financially, for undergoing orthopaedic, general or cardiac surgery after 1 July due to implementation issues with the MBS.”
In other health news, almost nine out of 10 visits to the GP in the nine months to March 2021 were provided with no out-of-pocket cost to the patient.
GP bulk billing rates reached an all-time high of 88.7 per cent for the period from July 2020 to March 2021. This is three percentage points higher than the same period last year (85.7 per cent) and 6.7 percentage points higher than the same period in 2012-13 (82.0 per cent).
Across all Medicare services, the bulk-billing rate reached 80.9 per cent, an increase of 4.4 percentage points since 2012-13.
Telehealth changes to Medicare introduced for the COVID-19 pandemic contributed to high bulk billing, while also reducing the risk of spreading the disease in the community.
Do you have surgery booked in after 1 July? Are you worried that you may have to cover extra out-of-pocket costs as a result of these changes? Why not share your thoughts in the comments section below?
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