Advice given by an optometry practice is not limited to a patient’s vision and eyecare. Cost of treatment is also an important subject to discuss.
A new patient’s eye exam reveals advanced cataracts. They do not want to wait for public treatment and ask for a private referral. Whose role is it to discuss treatment costs?
Both optometrists and ophthalmologists have professional obligations to ensure patients provide informed financial consent before proceeding with treatment.
The practitioner providing care is responsible for making sure patients understand the expected costs of their treatment. However, patients need guidance on costs as early as possible so they can consider options and plan their treatment path. From the initial consultation, all healthcare providers involved in the patient’s treatment journey play a role in the informed financial consent process.
Optometrist referring for specialist investigation
Planning treatment with a patient should involve consideration of the potential costs of treatment, follow-up care and ongoing fees, in addition to the clinical issues. Expenses could include consultation fees, costs of surgery including hospital, anaesthetic, medication expenses, as well as, for example, the continuing need for glasses after surgery.
As a referring optometrist you are not expected to give details of other providers’ fees or private surgery costs. However, you should help patients understand that costs are likely and direct them to appropriate sources of information.
That might include referring them to websites for the ophthalmologist’s practice and private hospital. Another helpful site includes the Australian Government Medical Costs Finder page.
Ophthalmologist consultation
As an ophthalmologist, you are responsible for ensuring the patient is informed about your consultation fees as well as anticipated costs of recommended treatment or surgery.
Patients should be advised about costs before they incur them. Charges should never come as a surprise. They need to be told about consultation fees and payment policies before or at the time they book an appointment.
It can also be helpful to publish this information on a website or share it with referring practices so that patients receive consistent information and expectations are appropriately managed.
Planning for surgery
When discussing surgery with the patient, you are not expected to provide exact figures for other providers’ costs, but you do need to flag potential costs and clearly explain where patients can confirm the details.
Hospitals are also required to disclose their costs to patients and obtain informed financial consent. They may rely on the information you provide to meet these obligations. Private health providers will also rely on details of planned procedures to advise patients on their likely out-of-pocket expenses.
So, the patient needs to leave the appointment with clear information about:
• Surgery fees, including relevant MBS item numbers and rebates
• Where to get details of any hospital or clinic charges
• Details, including item numbers, of all planned procedures so they can confirm benefits with their private health insurer
• Likely out-of-pocket costs from other providers, such as anaesthetists
• Device costs, if applicable
• Potential variations, ongoing or follow-up costs
• A total estimated cost or range, clearly identified as an estimate.
Wherever possible, provide information in writing and give patients time to consider their options. Make sure you document this.
Risk planning
When discussing risks of any planned treatment or surgery, also flag that complications may involve additional costs. As with the other aspects of the consent discussion, you would not be expected to explore costs of every conceivable complication no matter how fanciful, but patients do need to understand material risks and any potential associated fees.
Disclosure of interests
Always disclose any direct financial interest you have in any of the services, products or locations involved in the patient’s care.
Role of practice staff
Discussions about fees and potential costs can be delegated to practice staff. However, the practitioner providing the service remains ultimately responsible for ensuring informed financial consent is obtained. That means practices need clear policies, good documentation and up-to-date information so their teams can fulfil this responsibility.
Key takeaway – avoid surprises
A good financial consent process benefits practices as well as patients. It may not stop patients being concerned about the costs of healthcare, but it can help to avoid complaints.
If someone has been unhappy with some aspects of care, receiving a bill they did not expect can escalate dissatisfaction into a formal complaint or claim.
To make sure patients are never blindsided by their bill, everyone involved in the patient’s treatment journey plays a role in providing clear and consistent information about what costs to expect.
About the author: Dr Sally Parsons BMBS DCH FRACGP, is a GP and medical adviser for Avant.
