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Tuesday, May 29, 2018

Australians must understand and question surgical fees for better health outcomes



Dr John Batten


By John Batten
Launceston General Hospital orthopaedic surgeon and University of Tasmania senior lecturer John Batten has been elected the president of the Royal Australasian College of Surgeons.

In 2017, Australia's hospitals admitted about 748,000 patients, an increase of almost three per cent in both emergency and elective admissions from the previous year.
Finding out that you, or a loved family member, needs surgery can be scary, overwhelming, and challenging physically, mentally and financially.
As the number of surgical procedures available grows, it's never been more important for patients to feel empowered and in control of the choices that will benefit their long-term health and wellbeing.
As president of the Australasian College of Surgeons (RACS), an organisation that advocates for the highest surgical standards, I want Australian patients to know that they can, and should, ask questions to give them peace of mind about both their care and the costs they can expect.
I also want Australians to know that high fees do not necessarily guarantee quality of treatment, care or outcomes.
While the vast majority of Australian surgeons aim to deliver affordable, lifesaving, quality patient care, there are a small number within the surgical industry who charge excessive, or sometimes even extortionate, rates.
These rogue operators charging excessive fees are in breach of the RACS Code of Conduct which seeks to ensure full disclosure and transparency in all aspects of surgical financial consent.
No one in a health system such as ours should have to contact a financial planner, re-mortgage their home, touch their superannuation or seek crowd funding to access surgical treatment. Urgent, acute or cancer related surgery can be timely and adequately dealt with in the public system and all surgeons have a duty to advise their patients of this.
What factors affect surgical fees?
Like all medical practitioners, surgeons do not have a standard set of fees, and RACS does not set fees. Fees related to an operative procedure account for many factors, including the difficulty and duration of the procedure and the cost of providing care before, during and after the operation, such as theatre costs, anaesthesia, pathology and dressings, bandages and other hospital costs. The surgical procedure itself is only one component of a number of different fees the patient receives.
There's also the evolution of technology in our sector and the impact it has on patient outcomes to consider.
Just like every sector around us, from manufacturing to financial services, the healthcare industry is benefitting from the development of innovative technology to enhance the lives of Australian people.
We've all seen, or at least heard of, surgical robots which are used most commonly to complement a surgeon's skills, increase accuracy and offer a minimally invasive procedure to patients.
Take an appendectomy (the removal of the appendix) for example. There are multiple ways that this operation can be undertaken; with or without technology, or a combination of both. If we put that into the context of fees, that's three different prices a surgeon might quote depending on how they complete the procedure, and which method best suits the needs of the patient.
Interestingly, when we look at all day and overnight hospital procedures (2014-15) about 95 per cent of patients face no gap payments, with the average gap payment for the remaining 5 per cent at $130. So the tail end of high fees comes from a very small percentage that needs to be looked at more closely.
At a systemic level, purchasing or contracting arrangements between private health insurers and hospitals can impact upon out of pocket costs and continue to remain opaque to patients and medical practitioners.
RACS encourages greater transparency of any conditions which may affect clinical decision-making.
To varying degrees, all these influences can impact the cost of a surgical procedure but should in no way influence the outcome of patient care.
Before agreeing to any procedure, patients should understand all available treatment options and associated fees and should seek a second opinion if they are concerned.
Be informed and educated
We want every Australian to feel confident, educated and to understand what to look out for when selecting a surgeon and agreeing to the fees for a procedure.
First, ensure that your surgeon is a FRACS. These are surgeons who are Fellows of the Royal Australasian College of Surgeons. They undergo rigorous training and commit to ongoing learning and maintenance of knowledge and skills demonstrated through various Continuing Professional Development (CPD) programs.
This ensures Fellows not only maintain competency but also continuously build on and improve their clinical knowledge and skills in order to provide high-quality contemporary healthcare to the public.
You should also take the time to contemplate the procedure and ask questions about care and fees, before agreeing to the surgery.
All patients should assess the financial implications of their surgery, which is a hugely important aspect of informed financial consent.
While the duty of patient care rests on the shoulders of surgeons and their dedicated teams, patients shouldn't be afraid to ask as many questions as possible to ensure total confidence in their choice.
There are several considerations that patients should think about when it comes to building a holistic view of their fees:
·         Ask for an estimated total cost of your procedure up front before you agree to the surgery
·         Where there is concern about fees, seek a second opinion or raise your concerns with your referring practitioner
·         If you have private health insurance, confirm what you are covered for with your insurance company and ask if there will be any out-of-pocket costs. In most cases even if you have private health insurance there will be some out of pocket costs
·         Before you go into hospital as a private patient ask your surgeon about the fees to be charged by all of the health professionals that might be involved in your care, including anaesthesia, pathology services, medical imaging, physiotherapists etc
·         If you continue to feel unsure of the proposed course of treatment or fees to be charged, ask your referring doctor to recommend another surgeon
Support for fair fees
As an advocate for sustainable and affordable fees, RACS strongly supports the full disclosure and transparency of fees as early as possible in the patient-doctor relationship and champions the need for patients to understand all treatment options available to them.
If you have any complaints or concerns about a surgeon you can raise these directly with the surgeon or the hospital or you can contact the relevant authority — the Australian Health Practitioner Regulation Authority.
We take a strong position on this issue, and also encourage all patients who consider their fees unreasonable to contact the RACS Professional Standards Department about any concerns on professional.standards@surgeons.org.

You can also read our frequently asked questions guide and other information that will help you make an informed decision about your medical care on the Royal Australasian College of Surgeons website.

John Batten is president of the Royal Australasian College of Surgeons.