Patients set to pay thousands more as rebates cut in raft of radical Medicare changes

A chaotic attempt to modernise the 38-year-old Medicare system could see patients hit with higher gap payments – in some cases more than $10,000 – from next July 1.

Patients could find themselves over $10,000 out of pocket for common surgeries, as radical changes to the Medicare rebate scheme are introduced.

More than 900 procedures including hip, shoulder, hand, cardiac and other surgeries are impacted in the overhaul next month, with doctors warning it will create “total chaos”.

In some areas, like shoulder surgery, one in four of the existing items have disappeared altogether so there will be no Medicare or health fund rebate — patients will have to either pay the full cost or do without the surgery.

Some tendon procedures for elbow surgeries have also been wiped and with no Medicare or health fund rebate, could cost patients $7000 to $10,000.

And fee cuts for hip arthroplasty could deliver a $1200 gap.

Patients to pay more for surgery.

Young people and sports people are among those worst impacted, now faced with having to fully fund their own microsurgery for an extremely common hip condition.

Femoro-acetabular impingement syndrome (FAIS) — where extra bone grows along the hip joint causing an irregular shape and painful rubbing during movement — is no longer allowed as a diagnosis.

Australia has now become the only medically advanced country not to recognise this diagnosis or treatment — through a hip arthroscopy — the Australian Medical Association (AMA) said.

Five-time world freestyle skiing champion and Olympian Jacqui Cooper had the microsurgery seven times and blasted the move as “unacceptable”.

After dislocating her hip, minimally invasive hip arthroscopy surgery fixed the problem and meant she had such a short recovery time she was able to compete at the 2010 Olympics.

“I don’t think it’s acceptable at all. Australians need to have access to minor surgical procedures,” she said.

“This is going to put a lot of pressure on people and if they don’t have the money they’re going to be walking around in pain.”

Jacqui Cooper competes in the freestyle skiing ladies' aerials qualification on day 9 of the Vancouver 2010 Winter Olympics. Picture: Streeter Lecka/Getty Images

During her decorated career, Cooper shattered a knee, elbow, hip, shoulder and broke her back.

“It really affects your mental health, you feel like you can’t move you feel like you’re not yourself anymore, You shouldn’t have to make a financial decision on your health,” she said.

The changes are the result of the government’s long running Medicare Benefits Review that was meant to modernise the 38-year-old system.

Doctors said they would continue to charge the fees they do now but many Medicare rebates will go down or disappear, increasing the gap fees patients pay.

Health funds have not yet updated their rebate systems and doctors are currently unable to give patients proper informed financial consent about any out-of-pocket fees for surgery they are booking for after July 1.

“This is not the health funds fault, it takes a lot of time to work out the numbers you’ve got hundreds and hundreds of numbers and you got to work out what the relativities are and what the formulas are to turn an MBS rebate into a health fund rebate,” AMA president Dr Omar Khorshid said.

“It will result in larger gaps (patient gap fees) from the first of July. That’s guaranteed,” he said.

The Department of Health said it provided a data file to doctors and funds on May 28 and would provide further fact sheets and webinars before July 1 but it could be September before the complex changes can be worked into medical and health fund schedules.

“Practitioners are encouraged to consider the personal circumstances of their patients when determining the fees they charge,” the department said.