SIRA to remove loadings from surgical procedure fees
SIRA has announced that loadings on surgical procedure fees in the NSW workers compensation scheme will be removed from 1 July 2022.
The change will bring surgical procedure fees in line with Australian Medical Association (AMA) rates and fees paid in the CTP scheme, while still being among the highest of all Australian jurisdictions.
Loadings on surgical consultations will be retained in response to feedback from surgeons that there can be additional administrative processes associated with the workers compensation scheme.
SIRA will work with surgeons and medical groups to streamline administrative processes, with a view to reducing or removing loadings on consultations.
Currently, surgical fees in the NSW workers compensation scheme are between 50 to 400 per cent higher than fees in other personal injury schemes (including the NSW CTP scheme) and the broader market.
The discrepancy is as a result of a unique loading on top of AMA rates that has been available to surgeon’s operating in the NSW workers compensation scheme. No other specialists in the scheme are paid loadings on top of AMA rates.
High surgical fees and a growth in the number of surgeries performed – despite claim numbers remaining relatively stable – have exacerbated rising healthcare costs in the workers compensation scheme.
Removing loadings from surgical procedures is expected to put up to $41 million back into the scheme each year.
This measure is part of a broader package of initiatives SIRA is undertaking to address rising healthcare costs, including measures to improve insurer controls around treatment payments and approvals.
SIRA’s Healthcare Review considered regulatory and fee setting approaches to ensure injured people have access to the right healthcare at the right time for optimal recovery and return to work.
In response to the findings of the Healthcare Review, SIRA is working closely with the AMA, the Australian Society of Orthopaedic Surgeons and medical groups to progress the scheme towards value-based care.
The changes to surgical fees follow an extensive consultation period, which commenced in February 2021 and was extended to 30 September 2021 to provide additional time for feedback.
SIRA is now providing an extended notice period of the changes to surgical procedure fees to prioritise continuity of care and help surgeons embed the changes.
SIRA will monitor surgeons’ participation in the scheme to determine if there are any changes and as needed will assist workers, insurers and GPs find available surgeons.
The new surgical fees order will be published in December 2021 on the Current health-related fees page, with the new fees commencing on 1 July 2022.