Changes to the unit values for anaesthetists

Last month, I wrote about the changes to billing schedules for defence force personnel and what this could mean for anaesthetists. In this blog, I’d like to talk about the new changes to unit values.
The ASA has recommended a 2.99% increase in the unit value, increasing the maximum RVG unit value to $77. As has been standard approach, the change is effective from 1 November 2013.
By comparison, both the government and Medibank Private are deferring the increases to the MBS and the MBP schedule (respectively) until 1 July 2014.
As part of its response to the proposals of MBP and the government, the ASA states that continued acceptance of health fund rebates as full fee for services does nothing to dispel the myth that health fund rates are reasonable.
So, my question is, what is more appropriate, no gap or gap?
To give you an understanding of how the current unit value varies, it’s important to note that the ASA recommends anaesthetists charge $77 per unit. The MBS is set at $19.80. Health funds must pay, as a minimum, the MBS rate – however to manage their patient costs and membership fees health funds have adopted a rate that they think is appropriate. As a result of this, you end up with a range of payments from $24 right up to $38, depending on which health fund is paying. The prime example in WA is HBF.
If your patient is covered by HBF (as are 50% of privately insured patients in WA), there are two pathways you can take as an anaesthetist. The first allows you to opt in and opt out and so charge a gap as you see fit – they will pay the HBF Schedule ($29.85/unit) provided you charge a gap of no more than the schedule amount + 10% ($32.85/unit). Alternatively, you can choose to be a ‘fully covered’ anaesthetist. This means you accept the HBF ‘fully covered’ schedule unit price (which is currently $38.30/unit). To change from being a fully covered provider to the opt in opt out option, you must allow for a three month cooling off period after you notify HBF of your decision to change from one scheme to the other.
Confused? Join the club. The point of explaining all this is to demonstrate that we believe in the ASA’s recommendations but we’re not practising anaesthetists. So I ask, who is the best person to determine the value of your services? You, the government or the health funds?
It would be great to hear what you think of price setting in your industry and what it means for you. Leave your comments in the box below.
I’m looking forward to hearing your thoughts,
Ben.
Ben Dudley is the principal of Doctors Accounts Services, and is focused on removing the burden of admin from Perth’s anaesthetists. If you’re interested in how Ben can help your established private practice, then click here. If you’re new to private practice and need help, click here to see how we can easily transition you into your own practice.

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