Why is there a gap payment?
I want my patients to feel safe. To make them feel safe I need to control as many aspects of their care as I possibly can. I can control more of their care in the private system than I can in the public.
Caring for head and neck patients is complex. It requires skill, concentration and attention to detail. In order to keep patients as my primary focus I need a support team who relieve me of the less complex problems that are part of caring for patients and provide additional eyes and ears to help me identify problems and intervene as quickly as possible. I cannot run a private practice with the standard of care I demand on the funding Medicare provides. The maths does not add up.
Bulk billing works for routine procedures but not for head and neck
I do not bulk bill for surgical procedures and I do not participate in no gap or known gap schemes. These health fund agreements are designed around simple and low risk procedures. Very few head and neck procedures are simple or low risk. Many of my patients are referred to me by other specialists in recognition that they lack the experience and expertise to handle the problem themselves.
Private patients pay for a higher level of service, both clinical and administrative
You do not get the same surgery and the same care in the public health system as you do in the private. In the private you have more control over the timing of your surgery, more access to your surgeon, and your surgeon is more personally accountable for your outcomes and ongoing care. Please read through the Public vs Private timeline on my website for concrete examples.
Medicare does not reward experience
Medicare pays me as much to perform a surgical procedure as it does a first year specialist surgeon. If I perform that surgery in thirty minutes it’s because I spent thirty years learning how to do that in thirty minutes. The learning curve for complex, specialised skills is intense. Patients benefit from my expertise by spending less time under general anaesthetic, plus my ability to quickly solve unexpected problems, manage unusual anatomy, minimise side effects, and effectively manage complications. It is reasonable that I am remunerated for this expertise.
Medicare is slow to adapt to change
Medicare is slow to adopt new clinical approaches and treatments. Minimally Invasive Surgery (MIS), such as robotic surgery, is a prime example. There are no Medicare item numbers which apply specifically to Trans Oral Robotic Surgery (TORS). When I bill for TORS I use the same Medicare Item Numbers as a surgeon using traditional surgical approaches even though TORS requires extensive additional training, experience and expertise.
Medicare pays the same amount regardless of complexity
I pride myself on looking after patients and problems with levels of complexity many surgeons refer on to others. I enjoy the challenge but these patients require a lot of time and attention from both myself and my staff. A recent example is a patient I had in hospital who was recovering from complex head and neck surgery and treatment. The patient was in hospital for 42 days. My Nurse Practitioner and I rounded on him in person 37 days of those 42 days including two public holidays. Seeing a patient face to face each day is only the tip of the iceberg as far as the time required to manage the patient’s care. I also liaised by telephone with nursing staff on the ward, my practice staff processed hundreds of pages of pathology, I liaised with speech pathologists and dieticians, and I was available 24/7 to answer questions from the patient and their partner. Medicare pays surgeons the same amount for caring for patients regardless of whether they see the patient once or one hundred times in the days after surgery.
Why do I have to pay my surgical fee prior to my surgery?
I have not always asked for payment of surgical fees prior to surgery. I used to even offer payment plans. I had to abandon these options after experiencing too many patients defaulting on their payments. I also had patients fail to attend follow up appointments because they were embarrassed about outstanding fees, even though my staff would explicitly tell them that their clinical care was more important.
Asking patients to pay up front is confronting but I believe that these conversations need to happen sooner rather than later in the cancer journey. I stand by my fees. I know that my practice team and I offer service and expertise superior to most of my peers, and that patients always have the option of receiving quality treatment in the public system.
Financial Resources for Surgical Patients
I believe it is important to be up front and informative about the costs associated with being a private surgical patient. All my patients are provided with written Informed Financial Consent (IFC) prior to surgery. We try to get this to you as promptly as possible although sometimes this can be difficult when surgery is urgent. A cancer diagnosis is shocking, and we don’t like patients feeling pressured, but unfortunately this is sometimes the unavoidable reality of making financial choices about emergency medical treatment.
I believe in being up front about fees and giving patients the option of being a private or public patient. A cancer diagnosis does not just mean short term treatment expenses. It may also mean extensive time off work for you and members of your family. When you commit to private treatment, we want you to understand the costs, the advantages, and the long term implications. That is why I am listing financial resources on my website which will help you assess your financial position.
Doctors who list these resources are sometimes accused of trying to coerce their patients into going privately. Unfortunately, this leads to doctors avoiding the topic and talking less about fees, not more. I hope you view these resources in the manner in which they are offered. If you feel pressured to go privately then please remember that the public system offers very high standards of care.
Super-related insurance
Anyone who is diagnosed with a serious illness that impacts on their ability to work may not be aware that they have entitlements to claim insurance benefits attached to their superannuation. These benefits can include income protection for temporary time away from work, total and permanent disablement (TPD) where the condition is serious and long or a terminal illness payment. All super funds have their own unique policy and insurance arrangements. The Australian Government mandated that from 1 January 2014 all funds must have default life, terminal illness and total and permanent disablement (TPD) for all superannuation funds on an opt-out basis.
To check what life insurance you have with your super fund, either call your super fund, check your annual super statement or access your super account online. More information can be found at https://www.moneysmart.gov.au/superannuation-and-retirement/how-super-works/insurance-through-super
Accessing superannuation
There are a number of grounds for early access to superannuation, including medical treatment, medical transport and mortgage assistance. Grounds for early access to superannuation vary between funds. You will need to contact your fund to see if you can access your superannuation early. More information can be found under the heading “Access on compassionate grounds” on the ATO’s website https://www.ato.gov.au/Individuals/Super/Withdrawing-and-using-your-super/Early-access-to-your-super/
Loan Options
Loans exist for unexpected expenses in the forms of personal loans, mortgage equity and credit cards. These loans are typically secured by property ownership. Your capacity to repay a loan needs to be carefully considered in light of your prognosis. The Australian Securities & Investments Commission’s MoneySmart website provides a guide to the golden rules of borrowing https://www.moneysmart.gov.au/borrowing-and-credit/borrowing-basics
Paying your surgical fee in installments
I do not offer this option to patients. I have done so in the past but too many patients took advantage and failed to repay what they owed. This also created clinical care problems because patients would avoid follow up appointment and compromise their care. That is why it is important that I am not involved in providing instalment payment options and encourage patients to explore borrowing from reputable lenders.
Other financial resources available during treatment and recovery
Sick leave and personal care leave
Remember to check with your employer for personal care entitlements https://www.fairwork.gov.au/leave/sick-and-carers-leave
Cancer Council
The Cancer Council provides means tested financial assistance to patients experiencing financial hardship. This service requires referral from a social worker https://www.cancercouncil.com.au/get-support/financial-assistance/
CanTeen
CanTeen does not provide financial assistance but it will provides counselling and social support to young people aged 12 to 25 who have a family member diagnosed with cancer. https://www.canteen.org.au/
Financial planners and counsellors
Financial counselling is a free and confidential service offered by community organisations, community legal centres and some government agencies. https://moneysmart.gov.au/managing-debt/financial-counselling
For country patients
Isolated Patients Travel and Accommodation Assistance Scheme
IPTAAS is the Isolated Patients Travel and Accommodation Assistance Scheme. This is a NSW Government scheme providing financial assistance towards travel and accommodation costs when a patient needs to travel long distances for treatment that is not available locally. Equivalent agencies exist in other States and Territories. http://www.iptaas.health.nsw.gov.au/
Can Assist
Can Assist is committed to ensuring that all people, regardless of where they live in NSW, have access to cancer treatment and care. By providing accommodation, financial assistance and practical support to people from rural and regional areas, we ensure that country people are given the same opportunities and treatment choices as those who live in city centres. https://www.canassist.com.au/