After a Ministerial Advisory Committee on Out-Of-Pocket Costs found a minority of specialists had been charging patients very large fees or ‘hidden’ administrative or booking fees, the National Minister for Health announced a national strategy to address the findings.
A new website will disclose the costs of medical specialist services under an opt-in system proposing to tackle concerns surrounding out of pocket costs
At the centre of the campaign announced earlier this month, would be the creation of a website which discloses the costs of specialist services. This would comply with the committee’s recommendation of a website which would display some of the Medicare Benefits Schedule (MBS) services provided by each medical specialist.
The Committee proposed that the website would:
- Only display the costs of MBS items related to outpatient consultations and the top 80% by volume of the other MBS items provided by each medical specialist;
- Demonstrate the aggregated out of pocket cost for each MBS item for the previous 12 month period based on data taken from existing databases;
- Have the data populated, updated and managed by the medical specialists themselves;
- Require medical specialists to commit to charges consistent with their declared fee schedule for both in-hospital and out-of-hospital treatment; and
- Also require medical specialists to make a commitment on the website that they will not charge hidden booking or administrative fees and that all their fees would be associated with a clinical service.
In addition, the Committee recommended that the website would require specialists to provide their contact details, outline whether they employ a ‘no’ or ‘known’ gap system, and collate a list of the other medical specialists or providers they most commonly work with in procedures.
The Committee recommended that General Practitioners be excluded from the initial roll out of the website due to the large number of registered GPs. Similarly the report recommended the exclusion of medical specialists working under a corporatised model offering services such as radiation oncology, assisted reproductive services and diagnostic pathology or radiology. As services delivered in these models usually employ headline billing by multiple specialists there would be limited benefit to patients by outlining fees by individual specialists. It was suggested that relevant corporate entities instead display their own fee scales on their websites.
The introduction of the Government website presents several challenges for affected medical specialists. While participation in the website is proposed to initially function on a voluntary basis, the Committee acknowledged that near full participation from specialists was required to ensure the website’s success. While no recommendations were made to enforce participation, the report discusses the introduction of regulatory systems to ensure participation if an initial opt-in approach is not successful.
The Committee also proposed that the website would display a statement such as “All doctors were asked to share their fee information. This doctor has declined” if a medical specialist did not decide to opt in. The negative perception this statement could induce among patients may adversely impact non-participating specialists.
The proposed website and its reliance on medical specialist disclosure and maintenance of up to date information could also present potential risks to specialists who do not update their data in a timely manner. Specialists should exercise caution in this area and be aware of their obligations under each relevant state and territories’ consumer laws.
While the Minister has not indicated when the website is scheduled to be rolled out, medical specialists should begin considering the benefits of participating in the website, the obligations that arise if they do and the potential impact if they decide not to opt-in.
This article was written by Scott Chapman, Partner and Luke Depares, Graduate-at-Law.
P: +61 2 9334 8609
E: schapman@hwle.com.au