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“Most people are doing the right thing, but there are some bad apples out there,” said one Royal Melbourne Hospital surgeon, who did not want their name published because they were not authorised to speak publicly.
“This will knock them of their perch. It takes the carrot away.”
Australian Medical Association Victoria president Dr Simon Judkins warned that changes to remuneration could prompt surgeons to leave public hospitals for better-paying work in the private system.
“Victoria has a great system of trauma care for victims of traffic and workplace accidents,” he said. “Anything that threatens that is clearly going to be a concern.”
But Judkins said the changes would lead to greater oversight of the day-to-day practices of clinicians and simplify billing.
Under current arrangements, surgeons are paid an hourly rate from their hospital and can then bill the TAC and WorkSafe for each covered patient they treat.
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Hospital insiders say this creates a perverse financial incentive for some surgeons to harvest insured patients.
Health services and diagnostic providers also bill the TAC and WorkSafe, which are funded by Victorian motorists and employers to pay for the treatment of those injured in transport and workplace accidents.
The TAC is preparing to launch legal action to recoup millions of dollars from several surgeons at the Royal Melbourne Hospital who allegedly billed the insurer for procedures that were never performed to generate additional income.
It has subpoenaed some surgeons’ records as part of its long-running investigation.
A separate investigation by IBAC is forensically examining computer records that show discrepancies between what some surgeons billed the TAC and WorkSafe, and what surgeries were actually carried out on patients.
Another Royal Melbourne Hospital surgeon, who did not want to be identified because they did not have authority to speak publicly, said they were concerned the new funding arrangement would put pressure on hospitals to treat patients as cheaply as possible.
“They will get paid a set amount of money based on how sick or injured the patient is,” the surgeon said. “For the hospital to make money, they will be wanting to cut costs ... the pressure will be on to use cheaper prostheses so they are not out of pocket.”
But the TAC and WorkSafe told hospitals that the amount of funding they provided to care for Victorians injured in transport and workplace accidents would not change.
They said the overhaul would “ensure funding arrangements are modern and simplified into the future”.
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Deputy Premier and Minister for WorkSafe and the TAC Ben Carroll said: “The vast majority of surgeons in our health system do the right thing, but for the very small number who engage in this unacceptable behaviour, these changes will stamp it out.”
Medical fraud and compliance expert Dr Margaret Faux cautiously welcomed the changes but warned that they would not clamp down on all rorting.
“It will stop a lot of this bad behaviour, but not all of it,” she said. “They will move patients, when they can, into the private system, and that might become the new headache.”
Dr Damien Loh, chair of the Royal Australasian College of Surgeons (RACS) Victorian state committee, said he was working with the insurers to ensure the new process was fair, transparent and sustainable.
“RACS will continue to advocate for surgeons to be appropriately remunerated for the care they provide, recognising the skill, responsibility and commitment involved in surgical practice,” he said.
“RACS and the surgical community support any changes that improve the healthcare system, provided they do not compromise patient care.”
WorkSafe and the TAC said: “There will be no impact on the care levels TAC and WorkSafe patients receive in public hospitals. TAC and WorkSafe’s funding levels will remain consistent, ensuring all services required will continue to be provided.”
A spokeswoman for the Royal Melbourne Hospital welcomed the new arrangements.
“We will work closely with our partners to ensure the seamless integration of these changes in order to continue to deliver improvements to our robust governance practices,” she said.
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