Hospital accused of cost-shifting specialist outpatient care

Medical politics

By Tessa Hoffman

3 Nov 2017

South Australian public hospitals stand accused of deliberately cost-shifting specialist outpatient care onto Medicare, disadvantaging patients and annoying GPs.

The Rural Doctors’ Association of South Australia (RDASA) claims it has become common practice for public hospital administrators to contact GPs requesting they rewrite general referrals to outpatient services specifying the name of the specialist to be seen, in order to pass on the bill to Medicare.

“It’s a widespread practice that has been in place for some time; it involves pretty much every hospital and clinic in South Australia,” RDASA vice president Dr Scott Lewis told the limbic.

GPs say the practice is also occurring in Queensland and Tasmania.

The cost-shifting exercise is likely to have little impact on specialists, who as visiting medical officers are paid the same amount regardless.

But it means patients who don’t have private referrals wait much longer to get an appointment that those who do, Dr Lewis claimed.

It also annoys GPs who are expected to rewrite the referrals.

South Australia’s health department did not respond directly to allegations of cost-shifting, and did not provide requested data on the proportion of patients seen under general and private referrals.

But it denied patients who hold general referrals are disadvantaged when it comes to accessing care at its 675 outpatients’ clinics.

“All patients are prioritised according to clinical need, regardless of whether they are private or public patients,” a spokeswoman said.

“We are not aware of any formal complaints from GPs about specific incidents relating to named referrals for outpatient appointments, however we seek to incorporate any feedback GPs have raised concerns so improvements can be made.”

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