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. Rheumatologists charged $236 for an initial consult, which translated into an average of $107.70 out-of-pocket cost 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.

Speaking to the limbic rheumatologist and President of the ARA Rachelle Buchbinder noted that the analysis of fees was based purely on 2015 medicare claims data and it was therefore not possible to draw any conclusions about why there was such variation.

“As well as quality of care there will be lots of other factors that will influence fees… variations may relate to costs borne by the specialist such as staff wages, rent, insurance… the duration and complexity of the consultation may also vary greatly” she said.

“It is usual practice for rheumatologists to be transparent about their costs including out of pocket costs, and as far as we know private rheumatology earnings are similar to those in full time hospital based employment,” she added.

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