Safety net clamp could cost patients dearly
Poll: Are you happy with this federal budget?
Total votes: 52307.
You will need Cookies enabled to use our Voting Feature.
Poll closed 9 May, 2012
These polls are not scientific and reflect the opinion only of visitors who have chosen to participate.
PATIENTS of high-billing specialists face a fresh crunch under measures to further tighten the Medicare safety net that could add thousands of dollars to out-of-pocket costs.
Fees for procedures including vasectomy reversals, eye operations and some cardiac tests, and cosmetic procedures including "designer vaginas" and removal of "man boobs" are among services attracting in some cases thousands of dollars above average charges.
Some of the services, such as cosmetic procedures including nose jobs, are normally ineligible for Medicare cover. Procedures where there is evidence of excessive fees that will be targeted include removal of non-cancerous skin lumps and diagnostic biopsies for skin lesions.
The new crackdown comes amid pruning of many areas of health spending, aimed at financing initiatives in dental care and e-health.
The safety net focus is also aimed at ending arrangements under which some eye specialists appear to have shifted charges to anaesthetists in order to circumvent the first round of safety net caps, which slashed reimbursements for high fees billed for cataract operations.
After the first caps were introduced in 2010, Medicare tracked an almost simultaneous rise in the fees, from $500 to as much as $4000, charged by some anaesthetists working alongside ophthalmologists performing cataract surgery. Issues including difficulties proving such medicos were in league to exploit the safety net have meant the government has not taken action against the minority thought to be abusing the system. Under the new measures, anaesthetist fees will be capped for safety net purposes.
Medicare has also recorded huge claims by some specialists performing vasectomy reversals in clinics outside hospitals, which will now be reined in. One clinic doctor charged $9500 for a procedure that might normally cost many times less.
Other examples of excessive fees include $800 for a cardiac test that carries a schedule fee of about $30.
The new provisions mean safety net reimbursements for about 39 procedures will be capped at 100 per cent of the scheduled fee. All consultation fee repayments will be capped at 300 per cent.
While the measures will generate budget savings of about $96 million over four years, they are also likely to mean patients will face higher bills not recoverable under the safety net. Individuals and families on middle incomes and above can claim back 80 per cent of out-of-pocket medical bills above $1200 a year, where the fees do not exceed safety net caps.
An analysis commissioned by the Health Department concluded last year that while the safety net caps had been effective in limiting payments for excessive bills, they did expose patients to higher direct costs when doctors failed to prune their fees to match the caps.
One of the few significant extra spending areas is in e-health. National development of the personally controlled electronic health records system will get a further $233.7 million over four years, and funding for the National Electronic Health Transition Authority will continue. This development has been largely funded through redirection of $184 million from tele-health services under which incentive payments have been provided to doctors and others providing consultations by video to remote patients.