Consultation on Specialist Affordability & Excessive Fees

The Department of Health, Disability and Ageing has opened a consultation on options to address excessive fees charged by private specialists. USANZ Members are encouraged to provide responses to make sure any definition reflects the complexity and real costs of urological practice. 

The survey closes 12pm, Monday 19 October 202

The Department states it is targeting a small minority of providers and not fees that are reasonable. In this consultation paper, the Government is considering:

• Defining "excessive": The Department suggests three ways to do this. A fee could be judged case by case on reasonableness. It could be compared with the median fee peers charge for the same MBS item. Or it could be measured as a multiple of the MBS Schedule Fee (the Grattan Institute uses 3×).
• Possible interventions: These include publishing fee thresholds and flagging high-charging providers, stronger informed financial consent, and "nudge" letters to providers to notify them of concerns. Further options are referral for peer review, fee caps on MBS items, and an annual review of each provider's average billing, with penalties if fees are found to be excessive. 

There are several issues for members to consider when submitting their response, the most notable of which is that no consideration has been given to inflation and the lack of MBS and health fund indexation. Issues include:

Cost trends

• Rising out-of-pocket costs are blamed on fees; MBS indexation and the rebate freeze are never mentioned.
• Health fund benefit levels and "No Gap / Known Gap" arrangements and levels are excluded from scope, though rising gaps are attributed to fees.
• Headline cost totals are not inflation-adjusted and include growth in service volume (Section 3.1 - consultation paper).
• The CPI comparison uses two out-of-hospital consultation items (104,110) not procedures.
• Fee distributions cover one year only (2025).

Median benchmark

• Bulk-billed and no-gap services drag the median down.
• One national median ignores location costs and variations in provider service offerings, training and experience
• It measures what's unusual, not what's unreasonable e.g. case complexity, higher practice costs, differences in caseload and case mix among surgeons.

Schedule Fee benchmark

• The Schedule Fee isn't based on cost and is not intended to cover cost. Therefore multiples of the Schedule Fee are not a fair test as it does not consider cost.
• The benchmark chosen changes the result: 1.1% vs 3.9% of in-hospital services depending on whether the median is used or whether the schedule fee is used as the benchmark.
• The 3× MBS fee threshold borrowed from the Grattan Institute is flawed as it will inevitably lag inflation.

"Reasonableness" test within the Reasonableness definition

• If a fee is flagged by a complaint or audit, it would be judged after the event as "reasonable" or "excessive".
• No criteria are set, so doctors can't know in advance what will be judged excessive.
• No process is described: no triggers, evidence requirements, timeframes or right of appeal.
• It doesn't say who would decide; existing regulators have so far treated fees as outside their remit.

Other issues

• Fees for multi-item operations ordinary total fees may look excessive for one item and reasonable for others depending on whether the fee has been demonstrated to split across items using the 100/50/20 rule or whether it is lumped together as one fee under one item. 
• Complexity within an item is ignored.
• No data on practice costs.
• Per-service caps would penalise doctors who charge higher fees to some patients so they can bulk bill / no gap others e.g. financial hardship, severe complex medical issues, disabilities, terminal illness.
   

Members can provide their responses by completing the survey or by sending written comments via email to the Department.