NEWS 5
ausdoc. com. au 18 JULY 2025
NEWS 5
Make specialists charging‘ extreme fees’ pay back Medicare rebates?
The Grattan Institute says a million patients are delaying or skipping specialist care because of costs.
$ 700,000
$ 600,000
Ranked: Mean pre-tax income by profession
Ophthalmologist
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Paul Smith SPECIALISTS routinely charging so-called‘ extreme fees’ should be forced to pay back all Medicare funding at the end of the year, a new report says.
The Grattan Institute released a 100- page assessment on access to specialist care in June, saying the current system
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$ 500,000
$ 400,000
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Plastic and reconstructive surgeon Otorhinolaryngologist
Cardiologist
Neurosurgeon Urologist Orthopaedic specialist
Judge Vascular surgeon
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has become a lottery. Called Special Treatment, it defines“ extreme fee chargers” as doctors whose |
$ 300,000 |
Cardiothoracic surgeon |
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fees are typically three times the average |
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MBS scheduled fee. |
$ 200,000 |
GP |
Cafe worker or leaflet deliverer |
‘ Most patients lack the information or ability to shop around to avoid them.’ |
$ 100,000 |
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“ A single consultation with an extreme fee-charging psychiatrist was $ 670 in 2023, and $ 350 for endocrinologists and cardiologists,” the report said.
It said some 240,000 patients saw a dermatologist charging an extreme fee in 2023, with 132,000 patients seeing an extreme-fee obstetrician or gynaecologist, and 92,000 patients seeing an extreme-fee ENT specialist.
Overall, there were six specialties where more initial consults attracted an“ extreme fee” than were bulk-billed.
“ There is no good reason for these extreme fees,” claimed the report, co-authored by Peter Breadon, health program
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250th |
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750th |
1000th |
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director at the Grattan Institute.
“ They aren’ t needed for specialists to be fairly compensated for their skills, or to provide quality care.
“ They don’ t cross-subsidise care for poorer patients. But they do stop people from getting care they need, and most patients lack the information or ability to shop around to avoid them.”
The report dismissed the idea of introducing bulk-billing incentives for non-GP specialists, saying it would be too costly and would probably have limited overall impact.
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However, it said that specialists who charged extreme fees should be required to repay the government the value of the Medicare rebates paid for their services that year.
“ The government should publish a list of extreme-fee specialists, to give patients and GPs more information and discourage extreme fees.
“ If current practices were continued, we estimate this would affect fewer than 1500 specialists across 29 specialties— less than 4 % of all specialists.”
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Peter Breadon.
Warning over COPD misdiagnosis
Jamie Thannoo A 31 % collapse in spirometry testing rates and ballooning scripts for triple therapy suggest COPD cases are being missed and patients incorrectly treated, experts say.
Spirometry tests under Medicare have fallen from 4114 per 100,000 people aged 35 and older to 2848 in seven years, the Australian Commission on Safety and Quality in Health Care says.
In the same 2015-16 to 2022-23 period, PBS prescription rates for combined inhaled corticosteroids, long-acting muscarinic antagonists and LABAs increased from 2501 to 5750 in the same cohort.
It suggested doctors were using the treatment to cover both asthma and COPD without using the gold standard for COPD diagnosis, said GP Dr Lee Fong, a medical adviser to the commission.
“ We know that spirometry essentially came to a halt during COVID-19 … but we’ ve only had a partial recovery, which is significant given the importance of spirometry for making an accurate diagnosis,” he told Australian Doctor.
He said triple therapy was not recommended as first line for COPD and carried risks such as pneumonia.
The commission’ s report on spirometry, published in June, found the decline was mostly in
Dr Lee Fong.
GP practices and in regional locations. Cost and the difficulty of finding trained staff to conduct the tests were factors, said Dr Fong.
He said clinical advice from the COVID-19 pandemic had remained in place, including to use inline viral filters on devices and conduct tests in separate rooms with minimal furniture or equipment, requirements which further complicated testing.
Even before the COVID-19 pandemic, spirometry had been underused, said Dr Jennifer Perret, a respiratory epidemiologist from the University of Melbourne, who was not involved in the report.
“ Another major factor is the persistently low reimbursement from Medicare for GP practices
‘ Spirometry essentially came to a halt during COVID-19.’
to perform spirometry, as well as the extra costs to upskill practice staff after the pandemic,” she said.
She agreed with Dr Fong that declining spirometry rates and increasing triple therapy prescriptions were linked.
“ With the decline in spirometry testing, clinicians are likely to be less reliant on the results and probably prescribe this medication more often as it covers both an asthma and COPD diagnosis,” Dr Perret said.
Bupa pleads guilty
Ciara Seccombe HEALTH insurer Bupa has pleaded guilty to“ unconscionable conduct” after incorrectly rejecting thousands of hospital cover claims by its members.
Between 2018 and 2023, Bupa told them that hospital treatment where multiple procedures were performed was not covered under their policies.
This was untrue, however, and it led to members delaying or cancelling care, paying for their own care or purchasing new and more expensive plans they did not need.
Bupa has agreed to a penalty of $ 35 million, subject to approval from the Federal Court of Australia.
Bupa CEO Nick Stone issued a formal apology in June, saying,“ This should never have happened.
“ We are deeply sorry for failing to get things right for our customers and are saddened by the impact this has had on them and their families.”