Specialists to quote consult fees direct to patients

Medical politics

By Tessa Hoffman

21 Aug 2018

A new website allows specialist doctors to provide patients with a confidential online quote on the cost and wait time for care.

The site is being hailed by its founder as a solution to the twin problems of lack of transparency in medical costs, and giving doctors with empty diaries the chance to drum up business.

But critics claim the site could trigger a “race to the bottom” as patients abandon their GP’s professional judgement in favour of cheaper rates.

Private Patient Connect currently allows patients to obtain quotes from around 300 surgeons in western Sydney, and will soon open up to include physicians working anywhere in Sydney.

The secure platform, developed with support from a NSW Government $25,000 grant, allows patients with an open referral to request quotes from doctors, by outlining their medical needs and uploading any relevant documentation such as x-rays. Doctors can respond with an online quote outlining fees, availability and location of service.

It offers a secure interaction between a doctor and patient and is free for patients, while surgeons pay a 4.9% referral fee for all consultations and operations, while the physicians’ fee is not yet finalised, said the company’s founder and CEO, Tess van der Rijt.

The platform is designed to protect patient confidentiality: staff review patient requests to ensure necessary documentation such GP referral is present, then de-identify the data before sending it on to specialists with the right sub-specialisation and location, who are signed up to the site. It also meets the strict rules around advertising of medical services set by the National Law, she said.

Ms van der Rijt said her website will increase choice for patients by providing them with information on wait times and costs, avoiding the potential to have to return to a GP who has referred them to an unsuitable specialist, noting that transparency of medical costs has become a hot-button issue and the subject of a new Senate inquiry.

It will also help specialists who are struggling to fill appointments, something she said is a problem not only for new fellows who have yet to build a referral base, but also experienced consultants in areas of oversupply, a phenomenon that stems from a “market failure” in Australia’s system for specialist referrals, claimed Ms van der Rijt who has worked in health system policy and reform for ten years, the past four as a consultant advising State and Federal health departments, health service providers and digital health agencies.

“Specialist doctors spend decades studying only to find that they become a consultant and have to run their own business, this is something they are not trained in or exposed to,” she tells the limbic.

To attract new patients they need to advertise themselves to GPs and then passively wait for GP referrals. There is a market failure where a GP has their three preferred cardiologists, and constantly refers to them. A new GP joins the practice, doesn’t have a referral network, asks their colleague and they start referring to the same cardiologist. But there are other cardiologists who are available but they just don’t have their referral networks with their GP. ”

Concerns have been raised that the site will undermine the role of GPs as gatekeepers of specialist referrals, who have professional knowledge of the specialists working in their areas.

Western Sydney GP and AMA (NSW) president Dr Kean-Seng Lim said his organisation did not support technology “that would seek to replace a general practitioner’s role in referring patients to specialist treatment”.

He said while fee transparency was important, GPs refer based on a broad spectrum of issues with the ultimate goal of doing what is best for them.

“Making the decision without the input of a GP and solely on price will lead to poorer outcomes for patients.”

But Ms van der Rijt rejected the criticism.

“We’re not changing the current way the health system works, currently the GP is still the gateway to specialist doctors and we’re not planning to tamper with that in any way. The patient still goes to the GP and the GP is still the one determining that they need to see a specialist doctor. We will not process any patients who come to us who do not have a GP referral letter.”

She also shrugged off concerns that people using the site would make their choices based on cost alone.

“A few people have said ‘is this a race toward the bottom?’ It’s not and it can’t be because when you respond to a patient you can’t see what the next doctor has responded. It’s around allowing patients to compare information based on what’s important to them.

“What we are helping specialists do is proactively grow their practice by being able to directly communicate with patients who are already looking for their skills.”

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