Medicopolitical

Cardiologists criticised for ‘bill shock’


Specialists including cardiologists have been criticised by a leading health economist for subjecting patients to ‘bill shock’ by charging fees that are far higher than the Medicare schedule fee.

Citing his own experience of being asked to pay more than three times the scheduled fee for an initial dermatologist appointment, Dr Stephen Duckett of the Grattan Institute says the low rates of bulk billing and high out of pocket costs for many specialities mean that many patients are missing out on care because of cost.

In an article published by the Nine News Network,  Dr Duckett says his academic expertise in the area of billing helped him avoid a huge out of pocket payment, but most Australians would not know how to navigate the system.

“I could not in conscience support price gouging at that level, and so used my referral to see a different dermatologist, who still charged way in excess of the Medicare schedule fee, but not three times,” he writes.

“I had another advantage over others, because I knew I wasn’t locked into seeing the specialist named on my referral. I also knew that only 10% of initial consultations with dermatologists are charged at more than three times the schedule fee, so the person I was initially planning to see was a high-priced outlier,” he adds.

Dr Duckett backs up his personal experience with figures from a new Grattan Institute report, showing that some specialists have out of pocket fees of more than $200 per person. Among cardiologists, more than 40% were not bulk billing and charging up to double the the $160 schedule fee for item 110 for consultant physicians, the report notes. The median out of pocket payment for cardiology was $84 and for cardiac surgeons the median was $112.

These high costs for specialist appointments show that states need to expand the number of public hospital outpatients, so there are more zero-out-of-pocket options for patients, he says.

The report shows that waiting times (90th percentile) for an initial routine appointment at a public cardiology outpatient clinic were around 544 days in Queensland and 302 days in Victoria.

“More initial-appointment slots need to be made available across all specialties to bring down waits to a reasonable time – 30 days for urgent cases, 90 days for others,” he writes.

Governments also need to act to increase the number of specialists, he adds, noting that workforce size in many specialities was not keeping pace with the ageing population demographics.

“The federal government should work with the relevant colleges and states to expand training in the specialties in short supply. The proposed outpatient and bulk-billing clinic expansion can help here too,” he says.

Other way to improve access to specialists suggested by Dr Duckett include wider use of teleconsults and co-location of specialist bulk billing clinics within general practices.

“Governments need to act, so that people who need healthcare can get it in a reasonable time frame, rather than face prolonged waits for an outpatient appointment or miss out on care altogether because of unaffordable out-of-pocket payments.”

“This should be firmly on the policy radar for the imminent federal election. Perhaps more public attention on the issue might prompt a few dermatologists to rethink how much they charge their patients, too,” he concludes.

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