AMA rejects changes to surgical assistants

The MBS Review Taskforce – MBS Principles and Rules Committee (PRC) alerted Federal AMA in early September of its recommendation that new arrangements be introduced under which the primary surgeon pays the surgical assistant directly for their services.

This remuneration proposal would replace current arrangements under which surgical assistants bill patients separately from the primary surgeon and have access to MBS items for their specific services.

Federal AMA responded quickly following overwhelming concern from members regarding the proposed changes.

In a letter to the Chair of the Committee, AMA President, Dr Tony Bartone provided strong evidence of the “potential for unintended and possibly perverse consequences” of the proposed changes to remuneration arrangements for surgical assistants.

Among the issues outlined by Federal AMA was the assertion that despite working under the leadership of the primary surgeon, as part of a multi-disciplinary surgical team, surgical assistants are independent practitioners, much like anaesthetists.

The proposed payment arrangement, which would have the primary surgeon bill on behalf of, and then reimburse the surgical assistant, would add “additional administrative and contractual complexity”. There could also be tax implications and potential for the arrangement to be viewed as an employer/employee relationship.

The AMA also stressed that this proposal sets a “dangerous precedent for a bundled payment for all doctors involved”. It is integral doctors maintain the right to practise independently and make decisions regarding fees autonomously. As well, the AMA highlighted the importance of the private sector as a training opportunity for registrars.

Another major concern with the proposal is its potential to disrupt the relationship between the primary surgeon and the assistant. It would entrench the perception of hierarchy and could undermine a professional training pathway for future primary surgeons. It is common for doctors-in-training to undertake surgical assistant roles to better their chances of selection to a surgical training program. This puts them at a disadvantage and leaves them vulnerable in fee negotiations.

The payment arrangement would create an imbalance of power, with the surgical assistant dependent on the surgeon for their livelihood. This also potentially compromises the surgical assistant’s ability to suggest a differing clinical opinion. Ultimately, this puts patient care at risk.

Another major issue outlined in Federal AMA’s response was the impact this proposal would have on GP proceduralists working in rural and remote locations. The requirement for generalists to come to financial arrangements with a multitude of primary surgeons – many of whom are fly-in, fly-out, would be an administrative nightmare for both parties. It also opens the door to financial disputes which would affect practitioners’ willingness to participate – thus reducing care in rural/remote locations.

The Committee’s proposal included a reduction of the surgical assistant’s fee from 20% to 15% of the surgical MBS item based on the assertion that surgical assistants are not involved in aftercare. Federal AMA received feedback from members citing that the rationale behind reducing the derived fee was flawed.

Furthermore, the MBS rebate has failed to keep up with the consumer price index and therefore is not reflective of the true cost of providing medical services. This change would only further increase patients’ out-of-pocket costs.

Federal AMA flagged that two other Committees have been established to examine private health insurance reforms, Informed Financial Consent (IFC) and Out-of-Pocket (OOP) Costs, and it is therefore not the remit of the MBS Review Taskforce to make changes that would significantly impact entire payment schedules for private health insurance rebates. The proposal is “entirely out of sync and detracts from other major Government reviews relating to ICF, OOP and private health insurance”.

AMA further suggested that the proposed new arrangements would not solve the problem of IFC and OOP expenses. While a small number of practitioners are alleged to be charging egregious fees, data from a major national billing service indicates that no gap rates are 93% and combined no and known gap rates are in excess of 99% for the two main MBS item numbers (51300 and 51303), against a volume of 450,000 services.

For more information, go to ama.com.au/submission/ama-opposes-changes-surgical-assistants-arrangements.