ABC Radio Adelaide program interview with Dr Rachel David on Medicare reclassification of surgeries

Station: ABC Radio Adelaide
Program: Afternoons
Date: 7/6/2021
Time: 1:20 PM
Compere: Sonya Feldhoff
Interviewee: Dr Rachel David, CEO, Private Healthcare Australia


SONYA FELDHOFF: Let’s bring into this now Dr Rachel David. She is from the- she is CEO of Private Healthcare Australia. Thanks for your time, Dr David.
SONYA FELDHOFF: Now, let’s talk about this from your point of view. Is that how you see the situation around the Medicare re-classification of these surgeries?
RACHEL DAVID: Well, Sonya, I think the first thing I should say is some of the stories that have appeared in the press over the weekend, which talk about massive, thousands of dollars of co-payments to patients resulting from the changes are a massive beat up. And what I want to do is reassure people that while this is a big change, and while there inevitably are going to be some teething problems, that we’ll move Heaven and Earth to make sure that people aren’t paying those huge co-payments. The impression was also given that because some items are coming off, people would need to pay the full cost of those procedures and that’s just simply not true.
SONYA FELDHOFF: Well, I’m glad you address that first up, because one of our texters says, this is not the way the new services on TV made it sound yesterday. They said some surgeries weren’t being covered at all. And you can categorically say that’s not the case?
RACHEL DAVID: I can categorically say that’s not true. What’s happened is some obsolete items is, as Dr Martin said, some obsolete items have been removed, and some items have been removed and replaced by other ones that are more up-to-date. And it’s absolutely critical that we keep this schedule of procedures up to date, otherwise the benefits are not going to match [indistinct]…
SONYA FELDHOFF: [Interrupts] Well, David seemed to suggest that too, and he said that what he’s concerned about is the implementation. Are you concerned about the implementation?
RACHEL DAVID: Look, with a change this big, it’s inevitable that we will have some teething problems. But I don’t think that that should be an excuse for anyone in the sector to charge anyone an excessive co-payment, more than they would usually, or to just simply cancel surgery as a result. I think the first step should be if there is a concern that reimbursement might not occur in a timely fashion, is to call the health fund and find out the situation there and when payment might- payment of claims might be possible. But I can reassure people that at all levels these claims will be paid. If there are delays, we’re talking about weeks, not months or years. And we’ll do- we’ll move Heaven and Earth to make sure the changes take place smoothly.
SONYA FELDHOFF: Are you on track to transition by 1 July? You’re talking about possibility of delays, but how’s it working? I mean, would more time make a difference?
RACHEL DAVID: Look, honestly, I- look. Honestly, I mean, every fund has different systems, but really, I don’t think it’s going to make a lot of difference by blowing this out for another few months. The system is complex, and the changes inevitably are going to cause some hiccups. But I don’t think that prolonging the process is necessarily going to make it any better.
SONYA FELDHOFF: Will people have to go ahead with surgeries then, not knowing, I guess, blindly, not knowing what their gap payment might be?
RACHEL DAVID: Look, I don’t think that’s necessary. If anybody is concerned about what they’re hearing, they should give to health fund and their doctor a call and just say, look, you know, we’ve heard these reports. Can we sort something out? But I don’t think there is any reason for anybody to go into surgery not knowing what is going to be charged. And we can certainly do everything that we can to help there.
SONYA FELDHOFF: Dr Rachel David, the first changes of this matter, I think, happened back in 2018. So we’re talking about three years ago, is that right?
SONYA FELDHOFF: Yeah. And there were some criticisms of how it was implemented back then. Should we have learned between then and now with these changes? I think both you and David are on the same page as to this. These changes need to happen, to keep up to date with the changes. But could we- should we have learned about how to introduce this better?
RACHEL DAVID: Well, look, we’ve had a couple of rounds, and in each stage, there was some uncertainty as to whether, say, for example, doctors will get their full gap payment. The changes are designed to ensure that, overall, there’s- that the funding is neutral in that respect. So, there should be no changes to the gap funding that doctors are getting as a result. But sometimes, as a result of the sheer complexity of this system, there are some things that fall through the cracks. And they’ve actually been different teething problems each time.

When it came to the spine changes, which were incredibly complex. We worked very closely with the orthopaedic and neurosurgical spine surgeons to monitor what was happening and what we were paying. So there was a heightened awareness of some of the issues that could occur after, you know, a couple of the first rounds created difficulties. And I think this time we will be acutely aware of- any difficulties that come up, so that we can address them quickly. What I can’t do is guarantee that it will smooth sailing the whole way. I mean, the health system is complex, and making any kind of change does leave you open to some of these difficulties. But we will make sure that if there are individuals who are falling through the cracks, that we will help them, and ensure that they have certainty about what they’re able to claim.

SONYA FELDHOFF: So, as you can imagine, since we’ve been talking, I’m getting quite a few texts from people who are due to go in for specific surgeries over coming months, or who are on waiting lists for those surgeries. In this time, prior, they can have- they should ring their health fund directly, have that conversation. Is that where you’re advising?
RACHEL DAVID: [Talks over] Yeah, look, [Indistinct]. Yeah, look, they should ring their health fund and their doctor to make sure that if they do have concerns, to make sure that they’re on the same page. I mean, bearing in mind that not every surgical treatment will be changing. There are some that- there’s big changes coming through in orthopaedics and some of the heart surgeries that people might be down for. But not every procedure is changing.
SONYA FELDHOFF: I appreciate that you are CEO, Dr Rachel David, of the Private Healthcare Australia. But these- given these changes are impacting Medicare, is it likely to have any impact on public patients too, from your understanding?
RACHEL DAVID: Well, look, it would if- I mean, not everybody who presents for surgery in a private hospital has health insurance. Some people have the- have raised the funds in other ways. So yeah, there- they could potentially be impacted if they’ve been billed in a different way. So, I mean, that’s something to be aware of. But overall, I think that the funding for the- for Medicare benefits paid to private doctor’s is actually going up. So overall, I think once the teething problems have been worked through, we should be in a position where we’ve got a more modern schedule that better reflects clinical practise, and they’re actually less likely to [Indistinct] high out-of-pocket.
SONYA FELDHOFF: Am I understanding this correctly to say that it’s- that while those decisions may be made, it may take a while for it to flow in through the computer systems? So that information may be known, and so if you ring up and talk to someone, you have an idea, but it may take a bit longer to go through to the computer systems?
RACHEL DAVID: Well, look, that’s right. And I think that like a lot of people, particularly in health care and even at the government end, you’re dealing with some pretty clunky hardware that’s been around for many years. But that being said, I think on an individual level, people can still get a heads up about whether changes are likely for affect them or not. We’ll get some reassurance that – which I could absolutely give – that if the claim is a legitimate clinical treatment, it will be paid.
SONYA FELDHOFF: Dr Rachel David, thank you very much for your time. CEO of Private Healthcare Australia.
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