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Sweeping changes to Medicare surgery rebates kick in next month, but doctors are concerned

One of the biggest overhauls of the Medicare rebate system is set to kick in next month. The sweeping changes are some of the largest to happen in decades, and doctors say more time is necessary to understand what patients might pay out of pocket.

From 1 July, more than 900 Medicare Benefits Schedule (MBS) rebate items for private surgery are set to change, following a five-year review of all 5,700 Medicare rebates. The review was conducted by the MBS Review Taskforce, addressing feedback from clinicians and the broader community that some services on the MBS did not reflect clinical best practice.

The latest changes will affect rebates for orthopaedic surgery, general surgery and heart surgery. Currently, nine procedures have been deleted from the MBS entirely, and other changes could include tweaking the definitions of certain services.

The Australian Medical Association (AMA) has released a statement, concerned that the healthcare sector was not given enough time to implement the changes, as well as not receiving enough information.

With such a short window of time, payment processes and schedules of surgeons haven’t been updated. And as a results, patients could be left stunned by soaring out-of-pocket costs, particularly those who have booked surgeries somewhere in the month of July.

AMA President, Dr Omar Khorshid, says there were enough problems in November 2018, when the first tranche of MBS Review changes resulted in private health insurers, through no fault of their own, not having their schedules updated in time. No-gap arrangements were not possible or were significantly delayed leading to uncertainty for doctor and patient alike.

“Patients were left out of pocket, spinal surgeries were delayed, and doctors couldn’t provide patients with informed financial consent about potential gap fees.

“The main problem we see is [that] patients are going to feel let down by their doctors and by their funds when it’s really not their fault.

“If they’ve booked an operation for the 1 July, expecting a certain experience, might be a ‘no-gap’ experience, might be a small out-of-pocket costs experience, and then that changes… They’re going to feel very upset and they will be pointing the finger at their doctor or their health fund, neither of whom really could avoid it given this situation.

“That’s the most frustrating thing here,” says Dr Omar Khorshid.