Surgeons in private hospitals will be reluctant to help clear the public elective surgery backlog for the Medicare schedule fee rate, according to medical lobbyists who believe the work should be contracted as a last resort and at the standard commercial rate.
The comments from the Australian Society of Ophthalmologists (ASO) and the Australian Medical Association (AMA) follow announcements of an elective surgery blitz across Australian state health systems to tackle waiting lists in wake of the COVID-19 pandemic.
Public treatment in private hospitals and twilight and weekend surgery lists are among the key features of the programs recently unveiled by the New South Wales, Queensland and Western Australian governments, which total $675 million collectively.
ASO president and Sydney cataract and refractive surgeon Dr Peter Sumich said public hospitals should look to perform the additional surgery themselves, saying they had both the capacity and workforce to do so if funded adequately.
“As a last resort the work could be contracted [to private hospitals] but at the usual standard commercial rate for contracts – the Veterans Affairs rate – rather than the MBS schedule fee rate,” he said.
“Many surgeons and anaesthetists would be willing to help out to clear wait lists at the standard fee, as is usually offered by public hospital contracts in normal times, but not at the emergency rates they propose after the emergency has passed.”
Sumich said he believed state health systems were attempting to use the COVID-19 crisis as an excuse to save money on surgeries and blame the pandemic for pre- existing backlogs. They were also trying to use it as an opportunity to contract the work at non-commercial rates offered during the lockdown emergency.
His views were echoed by AMA NSW president Dr Danielle McMullen who said private hospitals had agreements through the Commonwealth about keeping their doors open at the COVID-19 peak.
“But we would view that COVID surge work, which those agreements were built for, is a very different thing to wait list reduction work, and we wouldn’t be supportive of large-scale reduction work being done at MBS rates in the private system,” she said.
Given the size of the backlog, McMullen said the additional funding is not a complete solution. Waiting lists were existent in NSW long before the pandemic and she called for a better solution that works to break the cycle.
“In the short-term, it will provide a boost but really only serves to highlight the cyclical pattern we see in elective surgery: waiting lists get long and the government of the day puts a patch on the system,” she said.
McMullen said surgeons performing public work in private hospitals would also have to take out additional indemnity insurance at great expense, because they would not be covered by a state government scheme despite performing public work.
“Surgery is more than just an operating theatre, people who have been on a public waiting list for some time are unwell and have a lot of other medical problems, and the public hospital system is often better equipped to manage those complex cases. The whole episode
of care needs to be thought through and funded carefully, it’s not just about surgeons’ fees in the operating theatre,” McMullen said.
Year-long backlog
Following the elective surgery shutdown in late March, Australian public hospitals have embarked on a gradual reintroduction of non-urgent procedures.
Referencing a study from the CovidSurg Collaborative project, the Australasian College of Surgeons said the varying levels of surgery disruption is estimated to have created a backlog of 400,000 operations in Australia.
Further highlighting the issue, the college said if the hospital system increases the number of surgeries performed each week by 20% compared with pre-pandemic activity, it would still take 22 weeks to clear the backlog.
In the largest of the state government announcements, NSW Health Minister Mr Brad Hazzard committed an additional $388 million to fast-track disrupted elective surgery.
In Queensland, the government has unveiled $250 million in new spending to provide non-urgent procedures outside of regular hours.
Queensland Deputy Premier and Minister for Health Mr Steven Miles said as of 1 June 52,240 patients were ready on elective surgery lists, with more than 90% (47,016) of those waiting within clinically recommended timeframes.
However, the state’s modelling indicated more than 7,000 people could be waiting longer than clinically recommended by 1 July due to the pandemic.
Queensland Health director general Dr John Wakefield said the funding would allow hospitals to return to pre-COVID levels of elective surgery much sooner than planned, while working through the backlog at a quicker rate.
“This investment will require us to expand over and beyond our usual levels of activity, plus work in partnership with the private sector,” he said. “It may take up to 12 months to clear the backlog, but could be longer if we have further disruption to our system, such as a second wave of COVID-19 cases.”
In WA, Premier Mr Mark McGowan said his government would invest $36 million, enabling the public system to perform 5,800 more procedures than was projected before COVID-19 this year.
WA health providers are implementing twilight and weekend surgery lists, increasing the hours of existing staff, and deploying additional staff.
“The significant success of WA’s whole- of-community response to COVID-19 is what has enabled our health system to return to normal sooner than expected, and this blitz will deliver excellent clinical outcomes,” McGowan said.
In March, the Victorian Government committed more than $60 million for additional surgery before a predicted pandemic peak. South Australia previously invested $45 million to reduce overdue waiting lists. By March, it had halved that, however, COVID-19 has since caused overdue cases to triple.
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