Saturday, September 9, 2017

Informed medical costs - Well intentioned actions failing in delivery

Dr Richard Zhu is reported to be on a mission to “expose” the out of pocket expenses associated with initial consultations to see specialists in Australia.  He has created a website called SeekMedi in his “battle for greater fee transparency”.

His creation of this “one-person army” is with good intent but in its current form is more misleading than helpful. If the website is about transparency, then it needs to practice what is preached. My concerns are as follows:-

1. The website should state it’s funding (even though we know from news reports that he personally funds it) and as to how the data is collected.  We also know from media reports that he personally telephones specialist practices and following discussions with their secretaries will record the cost of initial consultations into an Excel spreadsheet - this methodology should be also be recorded for transparency.

2. The website is misleading in that the standard initial consultation fee does not factor in discretionary fee discounting or bulk billing that occurs for patients who have genuine financial hardship.  The relationship between general practitioners and the specialist to whom they refer also makes a difference.  When GP’s with whom I work regularly takes the effort to call, email, fax or write to me about a patient with financial distress, I always oblige with fee reduction if not bulk billing. I know my colleagues are no different in these circumstances.

3. The website fails to time stamp the published fees.  What may be current at the time of publication on the website may not be accurate at any time in the near future. There is the potential to create unrealistic expectation from patients as to the fees and out of pocket expenses which might actually turn out to be greater.  The most accurate indication is the quote given to patients at the time of making their appointments.  The website should include a disclaimer about the fact that fees do change over time as well as to time stamp when Dr Zhu had made a phone call to a specialist office and recorded the quoted fees.

4. The data is incomplete. Many specialists are missing from the list. The website should state that this is the case and indicate if missing specialists will be included later as well as why certain specialists are included and others not. 

5. Specialist fees as recorded do not factor in the time allocated by the specialist to review the patient. Some specialists book patients in as frequently as 5 minute time slots and are able to achieve this through the use of medical and non-medical assistants. Other specialists may spend as long as an hour with their patients on an initial consultation.  Within the same specialty, the variations in time spent with a new patient can vary considerably.  The role of assistants who play a role in initial assessment is not considered in the initial consultation fees.  It is also becoming increasingly common to see advanced specialist trainees in private rooms.

6. Specialist fees do not give accurate guidance as to the likelihood of subsequent out of pocket expenses should any intervention be required.  It is not uncommon for a number of specialists to load most of their ‘income generation’ into their procedures rather than consultation fees. It is therefore not uncommon for some of the most expensive specialists with regard to procedural costs to have very average or even below average initial consultation fees. Initial consultation fees are only one aspect of out of pocket expenses.

I am not against transparency in specialist fees but if we are to embark upon this path, it needs to be done in a professional, collaborative and transparent approach.  A divisive lone wolf approach will never achieve acceptance.  I have written to Dr Zhu to seek his comments but to date have received no reply. If and when he replies, an addendum to this piece will be published. 

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