Medicopolitical

Five-fold variation in specialists’ fees sparks calls for transparency


Experts are calling for more transparency around specialist fees after finding huge variations in fees and bulk billing rates within and between specialties and geographic locations.

According to the analysis of Medicare claims data from 2015 published in The Medical Journal of Australia the amount paid by patients for an initial consultation with a specialist varied more than five-fold in some specialties.

Immunology/allergy specialists charged the highest for their services with a mean of $257 for an initial consultation followed by neurology at $252. Respiratory physicians charged an average of $211 for an initial consult, which translated into an out-of-pocket cost of $82.70 for the patient.

Only three of the 11 specialties – medical oncology, nephrology and geriatric medicine – charged less than $200 for an initial consult.

The analysis also revealed that most specialties bulk billed between 30-42% of visits, with haematologists and medical oncologists the only specialties to bulk bill more than half their patients.

Coauthor Professor Gary Freed from the University of Melbourne’s Centre of Health Policy said the main issue was the lack of evidence that any variation in fees reflected the quality of care.

“Patients are best served by reliable and validated quality measures of outpatient care to help them determine the best or most appropriate physician for their needs,” he told the limbic.

Dr Ian McRae, a research fellow in the Research School of Population Health at the ANU, said patients were currently unable to make informed choices.

“At the moment people can use websites to find a doctor but they can’t find out how good they are or how much they charge,” he told the limbic.

He wrote in an accompanying MJA editorial that self-regulatory solutions by colleges had not constrained fees and lifting the current freeze on Medicare rebates would have little effect.

“If the government wants to improve the affordability of medical specialist services without incurring large, uncontrollable costs, direct regulation is one option, but one that is likely to generate considerable debate,” he wrote.

“Improving the transparency of pricing could increase competition and place downward pressure on unreasonable fee-setting, and may provide the most affordable and fair approach to the problem,” he suggested.

However, according to AMA President Dr Michael Gannon the MBS freeze was the biggest driver of out of pocket costs.

“The failure to index the MBS schedule is the driver of gap payments for both consultations and procedures,” he told the limbic in an interview.

“Doctors in private practice increase their fees in line with reasonable costs such as new technology, CPI, utilities and wages. They can either absorb these costs or pass them on to patients,” he said.

A spokesperson for the RACP told the limbic that, given the “gap that has emerged over a long time between MBS rebates and the costs of providing quality care” they welcomed discussion and debate regarding proposals that may help patients meet the costs of their care.

“The RACP does not make recommendations to its Fellows regarding fees. It does however ensure that the College’s standards of professionalism are made clear, including an expectation that Fellows have an awareness of the costs of medical care for their patients” the spokesperson added.

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