Punish doctors who overcharge, says medical chief

Chief medical officer wants to punish doctors who charge unnecessarily high fees.

bill shock

As Australia’s chief medical officer vows to investigate the possibility of punishing doctors who charge unnecessarily high fees, the Actuaries Institute says high out-of-pocket costs and a lack of transparency around specialists' fees are undermining the health system.

The Australian reports that Professor Brendan Murphy will determine whether there is a point at which billing becomes unethical and should be considered malpractice. Colleagues have noted the growing number of GoFundMe campaigns seeking donations to pay for life-saving surgeries and cancer treatments.

Pensioners taking out reverse mortgages, people raiding their superannuation and GoFundMe campaigns to cover out-of-pocket expenses indicated a serious problem, he said.

“We feel that is not consistent with ethical medical practice,” he told The Australian.

“One of the questions now is defining at what point it becomes egregious. You could argue that the causing of severe financial pain, material financial pain, is egregious.”

Prof. Murphy will discuss the issue with the Medical Board of Australia, specialist medical colleges and associated groups in a bid to develop a means to better protect patients.

The Royal Australasian College of Surgeons says overcharging patients breaches its code of conduct, but has not been able to determine a threshold for action.

A government website to be launched next year aims to at least partially address the problem. It will offer de-identified data on the range of fees being charged for procedures and professional groups, particularly in gynaecology, obstetrics and cancer services, will be encouraged to add their own information. The aim is to allow patients and GPs to compare specialists by name and price.

Prof. Murphy deplored a common view that the more expensive a specialist’s costs, the better the standard of treatment, adding, “the best guide is the referring GP who gets to know the surgeons or proceduralists they refer to.”

He is also seeking better-quality reporting and information on surgical outcomes, a view echoed by the Actuaries Institute, which says a lack of transparency around patient outcomes is undermining the system.

The institute also wants to see independent healthcare coordinators appointed to help patients navigate treatment options and manage out-of-pocket expenses.

It advocates that all costs associated with a treatment be combined into a single total cost. “While inherently challenging in the private healthcare industry, [this] would be a game changer,” it said in a Green Paper, How to Make Private Health Insurance Healthier, at a summit in Sydney this week.

“This should help patients understand the total cost of their treatment and budget accordingly, target inefficiencies in the supply side of healthcare services and lower the total cost for the chosen healthcare pathway.”

The Green Paper presented a case study of a 57-year old prostate cancer patient whose specialist recommended robotic-assisted surgery. The patient, who had top-level private health insurance, had $20,000 in out-of-pocket costs. If he had undergone traditional surgery, with similar results, his out-of-pocket costs would have been closer to $3000.

It also stated that more than a quarter of patients with breast cancer had out-of-pocket costs for treatment of $10,000.

Private Healthcare Australia chief executive Rachel David said that almost half (44 per cent) of privately insured patients were left with a gap in private hospital bills and that 2 per cent had out-of-pocket expenses of more than $10,000.

Would more transparent fees make your life easier? Would you welcome an independent healthcare coordinator to help you navigate the system?

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    COMMENTS

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    mogo51
    5th Jun 2019
    9:58am
    Medical fees, especially 'specialist's' and hospital charges are just unsustainable. These people have no concern for patients it's about the almighty dollar. Where they are caught rotting the system, then disqualification and hefty fines ,even jail time if necessary is what is required.
    TREBOR
    5th Jun 2019
    11:08am
    If they had one iota of concern for people, those 'specialists' who constantly put public patients at the end of the queue - while queuing up for the mighty dollar themselves - would refuse to do so and would abide by their Hippocratic Oath (as opposed to their hypocritical oath).

    Who can fairly say that leaving a patient in constant pain time and again, by shuffling that patient further down the line to let in the higher paying fool on private, is NOT 'causing harm'? Ask the patient.....

    Jesus - they even do a course on 'medical ethics' - about the same as a journalist's ethics - a book as thick as one page of paper...
    jackie
    5th Jun 2019
    11:25am
    mogo51, I agree. When I first went to my medical centre, they bulk billed for everyone. Later they changed bulk billing to health care card holders only.

    My doctor advised me the other week the centre will charge health care card holders $20.00 except aged care pensioners.

    That $20.00 can be going without a meal or medication to some on NSA and DSP.

    This is outrageous and sheer greed. The excuse for the $20.00 charge was toward medical equipment costs. I am sure that would be a tax write off.
    jackie
    5th Jun 2019
    11:42am
    TREBOR, have you noticed those overcharging doctors are not good at their job. That's because they are only in it for money.

    The same applies to other highly paid professions. It's hard to find a good dentist, veterinarian and etc. It's like striking the lotto when you come across one.

    The only good doctors are the passionate ones. The ones that went into it for the good of others, not their pockets.

    You will find most of the greedy ones have come from a wealthy background.
    KSS
    5th Jun 2019
    1:01pm
    jackie you have to be reasonable. Doctors and medical centres are effectively small to medium businesses with all the same overherads as any other business i.e. rent/mortgage, utility acounts, staffing costs (including wages, super, insurance etc), consumables (those dressings the practice nurse uses etc), vaccinations held on premises etc, not to mention insurance - building/contents, professional indemnity (which alone can cost thousands every year) not to mention all the additional education GPs have to do each year to keep their registration and obviously there are the registration and accreditation fees not onbly of the GP but also the premises/clinic.

    I am not denying that GPs make a reasonable salary but they also have to study for more than 10 years and deserve to be adequately compensated. You are lucky you ponly have to pay $20, there are many GPs near me where the fee is $70-90 and they get back the medicare fee of about $39.

    The issue is not the GP but the other specialists who charge like wounded bulls simply because they can. A minimum $250 + for an initial consultation after a referal from your GP and that does not include any extra tests they may order., is just outrageous especiall when you consider you are likely in and out in about 15 minutes!

    And by the way, being a GP is just as much a specialist as any other type and they must have knowledge and skill as well as currency across a far broader spectrum than say a heart or kidney specialist.
    jackie
    5th Jun 2019
    2:16pm
    KSS, I am not being charged the $20.00 but I think it's unfair that those on NSA and DSP are charged that.

    It's a proven fact the NSA is unlivable and $20.00 for them can be going without food, medications or a job interview.

    Those on the DSP are on it because they must be extremely ill and require frequent medical attention for whatever their condition is. $20.00 for each visit is terrible especially when Medicare covers the consultation visit.

    This medical centre has been there for decades. It used to bulk bill everyone until recently. The property is owned by a doctor.

    They obviously have enough wealthy patients and are trying to get rid of the poor ones. They didn't increase charges for them.

    Medical practices such as this one are to blame for our hospitals being clogged up too. Greed is a terrible disease.

    BTW Prevention is the best cure and sometimes Google can be a better doctor.
    Snowflake
    5th Jun 2019
    10:27am
    My daughter worked at a Canbera hospital in the breast cancer area. They used to bring a specialist down from Sydney to look at the scans. He was in Canberra 3-4 days. His bill was $30,000. She dealt with the invoicing.

    I had stitches out the other day and to my surprise I had to see a doctor before the nurse could take them out. I've had a lot of sutures in my life and never had to have a doctor check them if a nurse was available. If they hadn't been behind my ear I would have done them myself as I have had to do once or twice in my life. Another quick consultation fee to the surgery, a cost that was totally unecessary. By the way, the sutures were in for 12 days so well due to come out. Then there was the doctor in Canberra who charged for a consultation fee at two different hospitals at the same time. And he thought he hadn't done anything wrong. Then there was the young first year doctor that worked out how to use the overtime rules for visiting patients out of hours and managed to rack up an overtime bill of $200,000 for the year. He was spoken to and took exception to it and threatened to sue the hospital. I could go on but nothing ever happens. The whole medical system needs an overhaul and these money hungry doctors, and I believe they are a minority, should be weeded out.
    jackie
    5th Jun 2019
    2:21pm
    Snowflake, I have removed stitches myself. It has saved me time and money.
    JAID
    5th Jun 2019
    10:42am
    We like to think it is a free country. Indeed an awful lot comes free. Some doctors are a long way from it. Still, it is your choice. Where their services are part funded by the government there can be no reason why average prices actually charged can or should not be published but and that may be a kind of punishment but there is absolutely no reason why practitioners should not charge what they see fit.

    It is an informed purchaser's decision as to whether what the practitioner sees as fit is actually greed or overpricing or whatever.

    Few complain when people with limited expertise ad 50 or 60 percent (or more) to the wholesale price of a jumper, pair of slacks or dress and flog it off in a local store. The rare medical procedure by someone who can actually perform it is worth a whole lot more and you will probably find there is more total effort and far more expertise put into the exercise for the dollars earnt anyway.

    It is reasonable for people through their government to limit payout amounts to a generally fair level. The Hippocratic oath, seeks to provide an ethical framework for partitioners placing the quality of practice and integrity in dealings with patients as vital it does not suggest that the wealth of practitioners be brought to the table in those dealings. True, many practitioners may see the health of their patients as something which can be aided by limiting their own wealth and I have great respect for those but we live in an environment where knowledge and impact is propelled by variety; the price of services is the practitioner's prerogative.
    TREBOR
    5th Jun 2019
    11:10am
    **yawns**
    Hardworker
    5th Jun 2019
    11:15am
    Don't agree with you at all JAID. There needs to be a cap on everything so that the ones with overinflated egos don't get carried away with themselves. But the caps needs to be realistic for the level of expertise, difficulty, rarity, etc. Comparing life or death health care to the price of a jumper etc. is a ridiculous comparison. So the person dies do they if they can't afford the operating costs and no doctor in the public system has the expertise to do it??? We're not talking about high fees here, we're talking about exorbitant fees. I have worked in the industry and it is just disgusting how much some very average doctors think they are worth. Private health insurance is a rort that we are forced to be in if we want control over our health care. I think a body created and run by the medical profession itself that decides on caps for fees is the only way to go because these people will not be controlled by anyone else and the whole situation is already out of hand. Good luck with the suggestion of an independent healthcare co-ordinator. None of these things are truly independent. They all have vested interests. By all means earn a good living for the skills that you have but this is supposed to be a compassionate profession not a money grabbing exercise. We don't need to be rich we just need enough to have a good life. Lots of money does not equate to happiness.
    TREBOR
    5th Jun 2019
    11:04am
    It's called regulation of the medical industry....

    I've known doctors - personally likable people, too - who deem themselves to be worth double the going amount (not the rebate amount) since they are - for example - a woman and they deal with women (!!). I see an argument for a country GP to some extent due to distances of travel - my doc used to fly to a remote village once a week for practice there, since their doctor retired. Fair's fair in some cases... but not all.

    The issue really is - should the pricing of the medical profession be regulated? Or - as in REAL 'social medicine' - should doctors be employees of the state on salary and cost refunds for vehicle etc for home/institution attendance?
    Polly Esther
    5th Jun 2019
    11:20am
    ** yawns **
    Anonymous
    5th Jun 2019
    11:24am
    Here's a conundrum Bob, we recently had a Member of Parliament who was also a medical professional and she charges $400.00 for the first visit. She is not a specialist, just a GP. How would she have voted if legislation to cap medical costs was presented? Thankfully, the constituents in that electorate thought that having three jobs meant that she couldn't carry out all of her duties successfully.
    jackie
    5th Jun 2019
    11:28am
    Old Man, I have a good idea who she was. Her actions showed she was another self-serving politician lining her own pockets.
    JAID
    7th Jun 2019
    10:10am
    The issue is much more than those two alternatives. Salary or "social" medicine. It is a matter of people, with all the potential benefits, having the liberty to find their own various paths or not having that.

    Your choice of a police state is, at best, for underconfident, weak societies.

    5th Jun 2019
    11:15am
    Thankfully, overcharging medical people are not in the majority. Just to add to Snowflake's post, I had a spell in hospital a while back and while home recuperating I had time to go through the paperwork before taking it to our health insurer. I pointed out to the health insurer that the treating doctor had claimed for a daily visit when he had never turned up to see me. She laughed and said it was common practice for that particular doctor who had once been challenged about a set of claims that showed he was in his surgery, doing a hospital round and seeing a patient at home all on the same day at the same time. His response was to tell the representative of the health fund; "Pay it or I'll see you in court!" She also told me that doctors like him were few and far between.
    Bellbird
    7th Jun 2019
    10:31am
    It would not be the health fund that last doctor would see in court: it would be the public prosecution service for Medicare fraud. His practices should be reported to Medicare and to the AHPRA.
    Paddington
    5th Jun 2019
    11:20am
    Doctors and patients are being punished by freezing the GP rebate for years. People can choose their doctors so you just don’t go to the excessive chargers.
    I believe by freezing the GP rebate causes some of this overcharging. Some people may have little choice but when you can do your homework by looking at reviews and asking by phone of any costs involved.
    Your GP has responsibility when referring the patient to the specialist and they need to be aware of costs and quality of specialist.
    Again, pay the GP properly to allow them to do their job. Unfreeze the GP rebate now!
    KSS
    5th Jun 2019
    3:05pm
    But the NLP are currently unfreezing the rebate. Slowly I grant you, but unfreezing nevertheless.
    Buggsie
    5th Jun 2019
    11:21am
    I recently had a heart procedure with the aim of controlling or eliminating my atrial fibrillation. I had it done at a private hospital in Newcastle by a specialist cardiologist. The hospital has a state of the art catheter lab and a high care unit. The specialist recommended by my GP offers a no gap service for those who are privately insured and the procedure plus 2 days in hospital cost me nothing above the health fund rebate. My GP also bulk bills. My advice? Look around and keep your private health. When our economy tanks the first thing that this LNP government willcut is the health budget.
    ozirules
    5th Jun 2019
    11:41am
    I had 5 medical procedures within a short period with different Anaesthetists all being from the same practice. When I queried why the invoices were all different I was told it was because I was charged per the time each procedure took. I pointed out that in some cases the shorter procedures incurred a higher cost and was then told that the real reason behind differing fees was to avoid being accused of collusion between doctors. Absolute rubbish as all doctors were from the same practice and a practice hourly rate is not collusion. They charge what they like and it was only the short time frame between ops which alerted me to this discrepancy in fees.
    Eddy
    5th Jun 2019
    2:32pm
    Why pick on doctors, what about other professionals like plumbers, bankers and financial advisors. Doctors are independent businesspersons, like accountants and lawyers, who, in our free enterprise economy, can charge whatever they like for their services. Why don't the politicians pick on the real price gougers, like energy conglomerates, who can fix prices between themselves with impunity.
    Paddington
    5th Jun 2019
    2:43pm
    Exactly. There are plenty of great ones doing extraordinary work.
    LNP pursue easy targets.
    jackie
    5th Jun 2019
    3:33pm
    Eddy, I did post previously that it's not just doctors that are overcharging. You will find all of those people are generally bad at what they do.
    Eddy
    5th Jun 2019
    9:53pm
    Yes Jackie, I read your post and was intrigued by your comment that sometimes Google is a better doctor. With Dr Google you can go from slightly unwell to clinically dead in three clicks. It surprises me sometimes that some people are prepared to spend heaps of dollars on their cars but baulk at spending small amounts on their own health. We are a funny lot!!!
    Not a Bludger
    5th Jun 2019
    4:10pm
    Simple - if they want too much don’t use them.
    Rely on your GP for advise and then make your own decision as to cost vs reputation
    Importantly, as an example, use BUPA and their Hospital First programme which has no out of pockets for the specialists who work in BUPA first hospitals - and of which there are a number.
    I speak from personal experience.
    This article also smacks a little to me of some rentseeking outfit trying to big note themselves by trying to tear down highly trained people.
    And, as to Go fund Me stuff, the old adage applies viz A fool and his money are soon parted.
    saintagnes
    5th Jun 2019
    4:32pm
    my husband's specialist does not charge out of pocket expenses for pensioners. Wonderful

    5th Jun 2019
    6:38pm
    Doctors (notably, but not exclusively, specialists) and dentists are all superb at performing their favourite procedure - the walletectomy. And their arrogance, brought about by a God complex, is frequently breathtaking.
    GeorgeM
    5th Jun 2019
    8:44pm
    A Govt website to compare specialists by name and price would be useful, but is not sufficient - one needs to have experiences of previous patients and ratings also included (just like in Trip Adviser for instance) for people to get a better feel of what to expect.

    Also, while Prof Murphy's comments sound reasonable, one has to be careful of the motives, e.g. I heard many surgeons are ganging up to discredit Charlie Teo who performs unusually difficult surgeries at high prices, hence the GoFundMe comment in the article. We don't want such options to be curtailed in case some people need it and other doctors are not willing to help or take the risk even if the patient wants it.
    Bellbird
    5th Jun 2019
    9:43pm
    Some doctors, especially retired ones who really did bend over backwards to accommodate patients' difficult circumstances, are appalled by the overcharging so often now seen. Yes published price comparisons might help patients in big cities, but are useless in the regions where there are few specialists. And you can for example get a good surgeon who has little or no gap for the operation but is accompanied by an anaesthetist who charges outrageous fees and often in advance! One radical tactic of course would to be a massive injection of funds into public hospitals so that they can deliver excellent, accessible and timely service. Few then would want to go private. Cost you say? If we can afford 75, probably dud fighter planes at $125 million each, and God knows how many billion on new dud subs, we can afford high quality health. GP overcharging is another problem, and it's disgusting for example to charge $20 gap to people on NSA. Laws are needed to snuff this out.

    6th Jun 2019
    3:48pm
    Considering what you pay and what you get in return, would anyone here like to compare Family Law court lawyers and 'mediators' with medical specialists?

    Q: What's black and tan and would look great on a Family Law Court lawyer?

    A: a Doberman.

    Hmmm, just thinking too, what about the bills we get from home handymen, plumbers and so on? For example, $1,700 for fitting two 'builder's quality' standard doors and painting them white :(

    What wouldn't be 'sustainable' for health services is bringing in hundreds of thousands of elderly relatives as Bill Shorten was p[ropoising to do.

    Or favouring mass immigration from the Third World countries as is being proposed by Kristina Keneally, Labor's affirmative action appointee to Deputy Senate Leader. Imagine the additional health costs of that.
    JAID
    7th Jun 2019
    10:17am
    Agree on the trades prices. How a half day's work and a few bits of pipe translate into nearly $2000 for a plumber is beyond me but it has on a couple occasions here. It is not really the amount that concerns, they can charge what they like but I would like to know in advance what that is likely to be (and would shop around if it looked over the top.)
    JAID
    7th Jun 2019
    10:17am
    Agree on the trades prices. How a half day's work and a few bits of pipe translate into nearly $2000 for a plumber is beyond me but it has on a couple occasions here. It is not really the amount that concerns, they can charge what they like but I would like to know in advance what that is likely to be (and would shop around if it looked over the top.)
    janeri9
    6th Jun 2019
    3:50pm
    I like the ancient Chinese practice of all patients paying a small retainer to their doctor while they were well and withdrawing the retainer if they became ill.
    We definitely have it the wrong way around!
    sybilla
    7th Jun 2019
    3:14pm
    So we do!
    sybilla
    7th Jun 2019
    3:13pm
    Small wonder many privately insured patients choose the public system to see specialists. The pension may just stretch to cover health insurance. However, it can snap like cheap elastic when covering the excessive gap payments often charged on even routine specialist follow-up visits. Still, seems to me they're way cheaper than money-mad vets, so I guess it could be worse.
    moama jock
    11th Jun 2019
    6:21pm
    Due to no ones fault i had to have a back procedure redone.Melbourne Specialist quotes $8300 had the operation done by the original surgeon in a rural city ( the only reason i considered change was due to a change of residence and a resulting extra four hours travel ) guess what $1900 and no gap.Five years later very happy and no problems.

    moama jock


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