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Optometry fees lag despite Medicare indexation

Medicare fees for all optometry items have increased 1.5% this month as part of reintroduced annual indexation, however advocates warn that scheduled fees still come in at less than half the actual cost of providing care in some instances.

Optometric consultation fees rose on 1 July in line with Medicare Benefit Schedule (MBS) indexation for 2020. The rate still comes in below the Consumer Price Index (CPI), which increased 2.2% at the end of the March 2020 quarter.

Lyn Brodie.

Annual indexation of optometry items was reinstated from 1 July 2019 as part of a phase reintroduction across the healthcare sector. It was 12 months earlier than had originally been announced by the government but came after a lengthy freeze that was imposed almost seven years earlier in 2012.

Optometry Australia (OA) CEO Ms Lyn Brodie said that while the sector welcomed the move, the intervening years without indexation had created a significant gap.

“Optometry Australia believes that patient rebates for optometry services lag well behind the true cost of providing clinical care,” she said.

“Prior to 2019, optometry item fees had not been indexed since November 2012, when government freezes on MBS indexation were first introduced. Prior to 2012 indexation of the MBS had occurred using an index often well below the CPI and the real increases in costs of providing healthcare.”

OA publishes an annual fee guide for its members, which lists fees directed at covering average costs associated with providing optometric care, with a profit margin to support a viable practice.

Brodie said this suggests that an appropriate fee for an initial comprehensive consultation with a patient would be $127, nearly $60 above the current scheduled fee on the MBS.

As part of its work, Brodie said OA updates members when indexation occurs, and ensures indexation updates are also highlighted to optometry software practice providers.

Due to the schedule of optometry items not being accessible as a standalone document via Medicare, OA also publishes direct extracts from the MBS of all optometry items in one document for its members.

“We regularly advocate for more appropriate Medicare fees for optometry items, and will continue to do so,” Brodie added. “We recognise this as a very challenging advocacy space and note that no professions have had success in securing a preferable indexation rate.”

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