The AMA says hospital doctors and health funds will face chaos on 1 July due to the government’s introduction at short notice of revisions to more than 900 MBS items.
Next month’s overhaul is the biggest change in Medicare for decades and will affect rebates for general surgery, orthopaedic surgery and cardiac procedures, including “significant” rebate cuts on certain items, said AMA President Dr Omar Khorshid.
While the AMA had agreed to engage with the MBS Reviews since 2015, Dr Khorshid said the problem was in the government’s lack of consultation and rushed inplementation.
“The problem that we’re calling out today is that government have only just released these new changes to the schedule in the last week or so, leaving only a few weeks for doctors, health funds and others to determine what their fees are and what the arrangements will be for the future,” he told the media on Sunday.
“Now, the changes to the schedule are quite significant, including very significant cuts to some rebates that patients may expect for their surgery as a result of rule changes within the MBS.
“But the bigger problem is the chaos that’s going to ensue because doctors can’t tell patients how much they can expect to receive back from their health fund because they simply don’t know.”
Dr Khorshid said patients should blame the government’s poor implementation, rather than health funds or doctors.
“It’s not the funds’ fault. They haven’t had a chance yet to develop their own fee schedules. It’s not the doctors’ fault because they’ve just got no information around which to have a conversation with their patients for surgeries that have already been booked post first of July.”
Doctors still did not have all the information needed to assess and change schedules and payment processes to reflect the July 1 changes, which involve changes to 594 orthopaedic surgery items, 150 general surgery items, and 188 cardiac surgery items, he said.
Dr Khorshid said patients needing hip arthroscopy, for example, could be “in limbo” as a result.
“Now, the MBS has really short-changed these patients for a number of years now, with changes a few years ago that affected doctors’ ability to provide this surgery. But they’ve been able to keep doing it through a creative use of the MBS schedule.
“As of 1 July, those stopgap measures that they put in are no longer possible. So patients needing that surgery are now left in limbo with the potential for thousands of dollars of out-of-pocket costs and no clear way forward. The sad thing is this was completely avoidable and the AMA was very disappointed in the government’s handling of this issue.”
Dr Khorshid said the AMA had agreed to engage with government’s MBS Review Taskforce since it began its wide-ranging reviews of 5,700 MBS items in 2015. But he said there were serious concerns about how the government was working to implement the 1400 recommendations on revised MBS items delivered by over 100 clinical committees and working groups.
“We’re now seeing the results come out into the schedule and it’s really about implementation that the biggest problems have occurred,” he said.
“There are some cuts that we don’t necessarily agree with. The process certainly had problems, and the main one being that those doctors involved in the process had to be individual doctors, they weren’t allowed to represent a group or a number of other doctors, meaning they couldn’t talk to people about the changes. And that makes it much more likely that you make mistakes. And we’ve already identified a few small but significant mistakes that will need to be corrected in coming months.”
Dr Khorshid said it looked like the government was to repeat the problems seen with the implementation of the first tranche of MBS Review changes, introduced for spinal surgeries in November 2018, he said. At that time , private health insurers did not have updated schedules in place, which meant that no-gap arrangements were not possible or were significantly delayed.
“More than two years later, we are facing the same problems, but with more than ten-fold the volume and complexity.”
This would bring significant financial and operational risk on health insurers and private hospitals, and leave doctors and patients “scrambling and confused” about what and how to bill against Medicare and private health insurance policies come 1 July.
Despite the AMA’s warnings that at least six months’ lead time was needed, the Health Department had given the sector weeks instead of months to change its entire system to support almost 1000 changes, leaving 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,” Dr Khorshid said.
Fact sheets about the July 1 MBS changes are here.