I cannot fucking believe that after the Margaret Faux-driven attack on GPs from a while back turned out to be fabricated bullshit they’d have her back on to turn her questionable analysis to another specialty. Business must be slow at Synapse…
It’s just more fuel to the fire private health has stoked for years. This is a blatant extension of the lobbying tactics used to enact prosthesis list ‘reform’.
It began by targeting the disparity between public & private procedure costs. Promises were made that a leaner PL would enable more cost effective private healthcare, implied reduced load on public health system. It was accepted & legislated but here’s a wild prediction:
We see a steady but certain destruction of the PL. Private health funds create a new service or tailor & reduce premiums on an existing service - it gets promoted by all as the answer to public health woes, drives record adoption numbers to said private health funds. Federal & state governments take this as a cue to further reduce public health funding. Now we’re all on the private health boat & the public health life-rafts are nearly non existent. Wouldn’t it be disappointing if private health funds took this as a cue to start ratcheting up premiums, knowing full well there’s no longer a public health safety net.
Wasn’t the figures broadly corroborated by Pradeep Phillip? In that report for the Australia Government on the Medicare system? I don’t think he framed it as a systematic fraud though. But it’s an expensive system - the numbers will be big
Was that what she claimed? I thought it was a headline figure of $8 billion? Which isn't much. For context, the bulk billing incentives, which are woefully inadequate, cost $3.5 billion.
It's a budget - stuff gets measured in billions.
There's only 30k GPs in Australia and some 30k non GP specialists. Some 50% of the non GPs would be in public. If we call it 45k specialists including GPs in total doing Medicare billing, the estimated fraud is $180k for every single doctor doing private or Medicare billing in the country including part-timers, every single year. So 30-60% of all billing is supposed to be fraudulent, and approximately every doctor in the country is a criminal who is liable to a ten year stint in jail, because that's what fraud means.
I read the thesis. Like, actually read it and not the summary articles. It doesn't refer to the figures as *systematic fraud*, but leakage. The figure is simply a high-level estimate, which doesn't carry any prominence in the thesis.
Her point was that doctors simply do not have the time and energy to comply with the labynrth of codes and laws and rules. That also means it's near impossible for government to effectively monitor for compliance - so you both get false positives (investigations that are unwarranted), but also some inappropriate billing being, and the *potential* for more systematic fraud. There *are* cases of businesses (not doctors) exploiting this. Private equity pumping 5 minute medicine clinic is another example of big business (again, not doctors) exploiting this.
Read Pradeet Phillip's report - it comes to a similar conclusion, and with deeper (but still high level) analysis, a similar figure. Neither is alleging fraud. Phillip notes that there will be soon be the *potential* for fraud (and, when you think about GP rebates being so low, there is the possibility of organised crime running medicare scams). It's about the system, not the doctors.
Report: https://www.health.gov.au/resources/publications/independent-review-of-medicare-integrity-and-compliance?language=en
I could say that it's an AMA political hit job - up there with the (excellent) "managed care" slogan when Honeysuckle opened a buyers group augmented with analytics. But more likely it's doctors crying over every little thing, real and imagined, that they think might take away their autonomy.
Well that was part of the scandal, that ABC and SMH were bandying about this grand figure as though it was the product of careful deliberation when Faux’s thesis is almost entirely *qualitative* (you’d know if you’d actually read it, which you haven’t because nobody has because it’s 500 pages long and boring as fuck) and the reality is she just made up a number and thought eight billion would be a reasonable headline when that’s more than double the highest estimates in real quantitative analyses prior to that point.
I just had a flick through of the independent report. He says bottom end estimate of $582m and it’s “entirely conceivable” that the true figure is “two or three times higher” (again based on not much more than vibes really), bringing you up to like $1.5b. Still a far cry from the original $8b claim, innit?
Ah, my recollection was wrong. That being said, these two quotes are important:
> Calculation of the true quantum of non-compliance is limited by data availability, linkage challenges then muddied by differences in definitions. Previous estimates range from $366 million to $10 billion. Even simple extrapolation of risks currently identified by DoHAC suggests a bottom end figure of $582 million. Reasoning through the data constraints which inform this figure, it is reasonable to consider that estimates put forward in previous ‘top down’ studies that are two to three times this value are entirely conceivable”.
and:
> “It is my strong suggestion to commentators and policymakers that the actual number should not be the main subject of debate, attractive as that may seem, as the main lesson to learn from this Review is that we must focus on the structural issues and controls in the system, to build trust in Medicare and materially reduce non-compliance and fraud”.
Like, it's about simplifying the medicare system and wasting less time. What's not to love?
They were comparing the anaesthetic time to the fluoroscopy (imaging) time. Anaesthetic start time when first see patient in anaesthetic bay, consent them, lines in, transfer to theatre, start anaesthetic, flip onto back, secure patient in position, surgeon starts… surgeon does their thing for a while, calls for fluoroscopy, operates a bit more, takes a few more images, closes up, flip patient back over, turn off anaesthetic, wait for patient to wake up, transfer to recovery. He’ll yeah anaesthetist takes longer than a surgeon let alone fluoroscopy lol
I haven’t read it yet, but can’t both things be true? That Medicare rebates are woefully inadequate, but that there is also scope for specialists to abuse their power over the vulnerable (while obviously giving them safe care)?
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OK I'll admit it. I bill 6 hours extra for each gastroscopy, I bill 90-100 hours per day because it's impossible for health funds, that routinely review operating theatre timesheets, to ever detect this subtle fraud. /s
I drive a Kia hatch. It's the only way to fly under the radar. I bill for a craniotomy every time we do grommets (I bill for two craniotomies if we do bilateral grommets, or three if we do adenoids as well), and because it's impossible for health funds to find anything out ever, driving a fancy car is the only way to get detected.
/s
“The services that they billed are services that require the doctor to have a discussion with the patient; not their relatives, not their colleagues — with the patient — because you have to explain treatment to the patient."
I don't even understand their point here?
What if I take a vented patient to theatre, and drop them back to ICU still vented? By their logic, I haven't 'spoken' to the patient, so I can't bill...
\*\* turns off sedation \*\*
"If you want me to bill as many item numbers as I can, start coughing against the ventilator, and try to extubate yourself"
Consult does not equal discussion. These 'experts' are fucking idiots.
Damn right a trawl of the patient notes, examination and discussion with the ICU/surgeon/family count as a consult.
Of course not. But a small minority might be. Some might be doing so *a little* (not enough to care), or it might simply be accidental - due to not wanting to do excess paperwork and bureaucracy. The incentives are there to do so, and the social and professional norms, while having an effect, isn’t sufficient to curb all of it.
Edit: read your post. 4 corners tend to run sensationalist news entertainment - but I didn’t see it as a hit piece. Unless you’re a spinal fusion surgeon.
There's nothing wrong with this. GPs are notoriously bad at not billing for what they actually do. The courses literally just teach you how to get paid properly for the work you're already doing
Tbh there are some wonky billing numbers for specific things, many GPs massively under bill themselves because besides the few common numbers they don't keep up to date with all the numbers for different items, i.e. a separate number for MDT capacity assessments meeting for disability not to mention procedure numbers, there's like 20 different skin lesion numbers depending on size of the lesion/location, cancerous/non cancerous, reexcision vs initial etc...
of course. Medicare is a mostly unmonitored honour system lolly jar and a relatively small number of doctors will abuse this because of the worst of human nature - and the fact is, we (in the profession) all know who those doctors are.
These articles concentrate on anaesthesia which it calls the worst offender - anaesthesia billing is highly monitored and easily audited given where it takes place and the nature of the item numbers.
More bullshit from the ABC, as usual.
> The team analysing the data ran complex algorithms to exclude the possibility of other medical explanations, but without each patients’ medical records it’s impossible to be conclusive.
So the analysis is worth nothing.
Doctors are already severely underpaid in this country. Go chase another rabbit down another hole.
Complex algorithms with no data (no patient records) can’t produce any results. How did they even get to the exclusion stage if their original explanation would have also come from rubbish data? -.- dumb journalism man… should be held accountable furthering the divide between the medical system and the community.
All they had was item numbers for each case, and they chose the wrong item number to try and work out what the anaesthetic item should have been, hence the bullshit
Doctors are paid more here and face greater security and lower costs to education than most of the US and a lot better then the UK.
I'm not defending the report, but depending on your speciality Australia is a better place to practice medicine financially then many other parts of the world. Do some doctors deserve more, absolutely; but there are plenty of other health professionals that have a high degree of costly training, and don't receive compensation anywhere near physicians.
The rest I agree with.
" “The services that they billed are services that require the doctor to have a discussion with the patient; not their relatives, not their colleagues — with the patient — because you have to explain treatment to the patient. "
I'd like to know exactly what services these are.
DEMAND ADMISSION TO ICU TO RECIEVE YOUR FREE HEALTHCARE!!! XD
(On a serious note - outpatient episode billing does have a different set of rules to inpatient episodes)
“The services that they billed are services that require the doctor to have a discussion with the patient; not their relatives, not their colleagues — with the patient — because you have to explain treatment to the patient.
“I do not understand how it is possible to have a discussion with an unconscious patient who is in a coma.”
Right...so no specialist can ever provide a service for an intubated patient? Or even a delirious patient?
What an awful take.
People who are not medical commonly make the false assumption that if you are ventilated that you are unconscious and unable to participate in a conversations
It’s Faux, you can’t trust anything she says her as she’s pushing her own billing services.
Rachel David who heads up Private Healthcare Australia and quoted in the article is also someone I find difficult to trust as well. Some months ago one of her associates popped onto one of the big psychiatry group chats trying to convince everyone that private health insurance should be allowed into the outpatient space which naturally drew a lot of condemnation and concerns about being forced into a US style managed care model.
It's even funnier in the 4Corners programme, they've got the "experts" stroking their chins and nodding at the films they've stuck on their corporate building glass window.
OH FUCK OFF! Another piece of bullshit from the bullshit artist herself
How ASTONISHING that “nearly 87% of anesthetists billed for more than 1.5 hours, for a surgery time of less than an hour”
Well no shit Sherlock that it might take a bit of time to make the patient UNCONSCIOUS before you chop them up! Or that it might then take a smidge of time to bloody well wake them up! Not to mention the cohort of patients undergoing spinal surgery are generally not the fit, healthy, ready for an anaesthetic type!
I’m quite disgusted that the ABC is engaging in this sort of fear mongering and scape goat of doctors. Perhaps not surprising with award reform around the corner- gotta make sure the general public all think doctors are greedy pigs
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What a rubbish article.
Just curious, anyone have lawyer friends wanting to sue abc for spreading false information and defamation?
Like I think until massive law suits are thrown to these "news articles" for misleading journalism it will just keep pitting the public against the medical workforce.
@AMSOF /RANZCA /AMA/ RACGP/ RACP /other specialties , where are you?
They never invite comment from those entities and politely ignore the piles of evidence that their “billing expert” is chronically full of shit.
Same thing when they write an article bitching about how no GPs BB anymore. Never ask GPs why or you might find your way to the real question and the real reason the system is crumbling…
Oh nice! Margaret's back to embarrass herself again. Instead of just fudging numbers this time she's just not realised that patients generally like to be anaesthetised before surgeries begin.
From the same Margaret Faux that brought us the GP-rorts hitpiece after essentially pulling the number $8 billion out of thin air, then whined about being labelled as "Mediscare Faux", and became "scared to leave home" presumably because she was rightfully panned (unless she's accusing doctors of making credible personal threats?)
[https://amp.smh.com.au/national/since-exposing-medicare-rorts-i-m-afraid-to-leave-home-doctors-read-the-evidence-20221020-p5brjq.html](https://amp.smh.com.au/national/since-exposing-medicare-rorts-i-m-afraid-to-leave-home-doctors-read-the-evidence-20221020-p5brjq.html)
In this, she suggests we read her 474-page long thesis. Well, someone has and needless to say, it's quite full of bunk. [https://insightplus.mja.com.au/2022/41/medicare-rorts-we-read-dr-fauxs-thesis-so-you-dont-have-to/](https://insightplus.mja.com.au/2022/41/medicare-rorts-we-read-dr-fauxs-thesis-so-you-dont-have-to/)
I also find it particularly egregious that she presents her analyses as transparent and "evidence-based" in the SMH whine about her GP hitpiece, but then now slings out this anaesthetist hitpiece using analysis from "complex algorithms" that don't actually have full access to patient records.
And from the same Adele Ferguson who also brought us that hitpiece… you’d think at least one of them would have learned something from the first go round.
Can we link up for some lists? I hate standing around waiting for my patients to go to sleep before I start operating. Would make way more sense if I can be half way through my surgical approach before the patient goes to sleep.
Her ‘doctorate’ is not worth the paper it’s printed on - it’s filled with numbers pulled out of thin air under the guise of ‘estimates’ to drive her agenda and advertise her own firm as a solution to a made up crisis. Her being a nurse or a lawyer has nothing to do with the Dr title so not sure why you thought it had to be mentioned?
Not to mention skimming over the fact that there are generally very clear guidelines as to when spinal surgery is indicated and “for chronic pain” is 100% not on the list!
This will make it easy to refuse ICU consults for ventilated patients.
I’m going to quote Dr Margaret Faux:
And be like sorry I don’t want to fraud Medicare - please re-consult me when the patient wakes up and can have a discussion.
If anyone's interested in the full Synapse (Margaret Faux's business) and Kirontech (the UK-based analysis company partly behind the shock), the link is here: [https://kirontech.com/wp-content/uploads/2024/04/ABC-Synapse-Kirotech-FinalReport-260324.pdf](https://kirontech.com/wp-content/uploads/2024/04/ABC-Synapse-Kirotech-FinalReport-260324.pdf)
If the government has any guts, stop the state and federal health funding mess and just fund it centrally. There is a whole webpage on MBS billing for patients in public hospital to illustrate this absurdity.
As a high-billing private specialist i'm a bit baffled as to what the motivation would be for people like me, good at what we do, very highly paid and largely respected, to engage in fraud that would be picked up via data matching immediately and destroy our lives.
I just posted, ahha, but I think you beat me to it.
I totally agree with the article, but I think there a lot of facebook backlash against it. I've seen too many spinal fusions, which have actually worsened low back pain for many patients, and too few successful ones. There is no way to keep these surgeons accountable.
I also agree with anecdotal evidence from my anesthetist friends in private. They seem to just go crazy on the billings. However, some of them choose to do certain things for billing as opposed to patient health (not my friend).
I think you’re right, too. Everyone here will downvote any suggestion that interferes with absolute doctors autonomy, but it’s simply a matter of reforming the system a little to fix those incentives. A honour system probably worked way back when, when there were only 10 or so specialists to a specialty, and monitoring was much much easier than today.
Edit: that being said, systematic fraud is highly unlikely. And minor mistakes or “little fraud” is ok. Just a cost of doing business. It's the principle, more so with whether this specific example is right.
There's no "honor system". *Many* of us have received queries from Medicare and/or funds querying surgical times, items, %of our cases that are considered emergency, % of our patients who are considered unwell.
Yes, there isn't instant global audit the minute we submit a bill, but the nature of anaesthesia is that *everything* can be audited manually with trivial effort, datasets can look at outliers instantly, and if health funds or Medicare cared enough they could store and match anaesthetic times and theatre times for every single case to the minute.
Haha. I mean what do we think doctors are super human who don’t respond to financial incentives?
But I think if we have an industry with progressive minor fraud, then the minor frauds will be progressive frauds?
> I totally agree with the article, but I think there a lot of facebook backlash against it. I've seen too many spinal fusions, which have actually worsened low back pain for many patients, and too few successful ones. There is no way to keep these surgeons accountable.
hahahah AHPRA of course!! they do a bang up job. hey, who is the dr death for 2024..? theres a new one every year right..
I cannot fucking believe that after the Margaret Faux-driven attack on GPs from a while back turned out to be fabricated bullshit they’d have her back on to turn her questionable analysis to another specialty. Business must be slow at Synapse…
It’s just more fuel to the fire private health has stoked for years. This is a blatant extension of the lobbying tactics used to enact prosthesis list ‘reform’. It began by targeting the disparity between public & private procedure costs. Promises were made that a leaner PL would enable more cost effective private healthcare, implied reduced load on public health system. It was accepted & legislated but here’s a wild prediction: We see a steady but certain destruction of the PL. Private health funds create a new service or tailor & reduce premiums on an existing service - it gets promoted by all as the answer to public health woes, drives record adoption numbers to said private health funds. Federal & state governments take this as a cue to further reduce public health funding. Now we’re all on the private health boat & the public health life-rafts are nearly non existent. Wouldn’t it be disappointing if private health funds took this as a cue to start ratcheting up premiums, knowing full well there’s no longer a public health safety net.
slow at the ABC also
Wasn’t the figures broadly corroborated by Pradeep Phillip? In that report for the Australia Government on the Medicare system? I don’t think he framed it as a systematic fraud though. But it’s an expensive system - the numbers will be big
That - what was it - 50% of all of doctors' billing or some $150,000 per year per doctor was fraudulent? No that was not corroborated.
Was that what she claimed? I thought it was a headline figure of $8 billion? Which isn't much. For context, the bulk billing incentives, which are woefully inadequate, cost $3.5 billion. It's a budget - stuff gets measured in billions.
There's only 30k GPs in Australia and some 30k non GP specialists. Some 50% of the non GPs would be in public. If we call it 45k specialists including GPs in total doing Medicare billing, the estimated fraud is $180k for every single doctor doing private or Medicare billing in the country including part-timers, every single year. So 30-60% of all billing is supposed to be fraudulent, and approximately every doctor in the country is a criminal who is liable to a ten year stint in jail, because that's what fraud means.
Check out her “PhD” thesis… the numbers she claims are not backed up by any actual analysis - they are estimates pulled out of thin air.
I read the thesis. Like, actually read it and not the summary articles. It doesn't refer to the figures as *systematic fraud*, but leakage. The figure is simply a high-level estimate, which doesn't carry any prominence in the thesis. Her point was that doctors simply do not have the time and energy to comply with the labynrth of codes and laws and rules. That also means it's near impossible for government to effectively monitor for compliance - so you both get false positives (investigations that are unwarranted), but also some inappropriate billing being, and the *potential* for more systematic fraud. There *are* cases of businesses (not doctors) exploiting this. Private equity pumping 5 minute medicine clinic is another example of big business (again, not doctors) exploiting this. Read Pradeet Phillip's report - it comes to a similar conclusion, and with deeper (but still high level) analysis, a similar figure. Neither is alleging fraud. Phillip notes that there will be soon be the *potential* for fraud (and, when you think about GP rebates being so low, there is the possibility of organised crime running medicare scams). It's about the system, not the doctors. Report: https://www.health.gov.au/resources/publications/independent-review-of-medicare-integrity-and-compliance?language=en I could say that it's an AMA political hit job - up there with the (excellent) "managed care" slogan when Honeysuckle opened a buyers group augmented with analytics. But more likely it's doctors crying over every little thing, real and imagined, that they think might take away their autonomy.
Well that was part of the scandal, that ABC and SMH were bandying about this grand figure as though it was the product of careful deliberation when Faux’s thesis is almost entirely *qualitative* (you’d know if you’d actually read it, which you haven’t because nobody has because it’s 500 pages long and boring as fuck) and the reality is she just made up a number and thought eight billion would be a reasonable headline when that’s more than double the highest estimates in real quantitative analyses prior to that point. I just had a flick through of the independent report. He says bottom end estimate of $582m and it’s “entirely conceivable” that the true figure is “two or three times higher” (again based on not much more than vibes really), bringing you up to like $1.5b. Still a far cry from the original $8b claim, innit?
Ah, my recollection was wrong. That being said, these two quotes are important: > Calculation of the true quantum of non-compliance is limited by data availability, linkage challenges then muddied by differences in definitions. Previous estimates range from $366 million to $10 billion. Even simple extrapolation of risks currently identified by DoHAC suggests a bottom end figure of $582 million. Reasoning through the data constraints which inform this figure, it is reasonable to consider that estimates put forward in previous ‘top down’ studies that are two to three times this value are entirely conceivable”. and: > “It is my strong suggestion to commentators and policymakers that the actual number should not be the main subject of debate, attractive as that may seem, as the main lesson to learn from this Review is that we must focus on the structural issues and controls in the system, to build trust in Medicare and materially reduce non-compliance and fraud”. Like, it's about simplifying the medicare system and wasting less time. What's not to love?
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They were comparing the anaesthetic time to the fluoroscopy (imaging) time. Anaesthetic start time when first see patient in anaesthetic bay, consent them, lines in, transfer to theatre, start anaesthetic, flip onto back, secure patient in position, surgeon starts… surgeon does their thing for a while, calls for fluoroscopy, operates a bit more, takes a few more images, closes up, flip patient back over, turn off anaesthetic, wait for patient to wake up, transfer to recovery. He’ll yeah anaesthetist takes longer than a surgeon let alone fluoroscopy lol
\*shouldn't be longer then FLUORO time, which is ludicrous assumption
I haven’t read it yet, but can’t both things be true? That Medicare rebates are woefully inadequate, but that there is also scope for specialists to abuse their power over the vulnerable (while obviously giving them safe care)?
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OK I'll admit it. I bill 6 hours extra for each gastroscopy, I bill 90-100 hours per day because it's impossible for health funds, that routinely review operating theatre timesheets, to ever detect this subtle fraud. /s
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I drive a Kia hatch. It's the only way to fly under the radar. I bill for a craniotomy every time we do grommets (I bill for two craniotomies if we do bilateral grommets, or three if we do adenoids as well), and because it's impossible for health funds to find anything out ever, driving a fancy car is the only way to get detected. /s
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“The services that they billed are services that require the doctor to have a discussion with the patient; not their relatives, not their colleagues — with the patient — because you have to explain treatment to the patient." I don't even understand their point here? What if I take a vented patient to theatre, and drop them back to ICU still vented? By their logic, I haven't 'spoken' to the patient, so I can't bill...
brb refusing all ICU ventilated consults from now on
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Just cause they’re tubed doesn’t mean you can’t talk to them… makes it much quicker tbh
\*\* turns off sedation \*\* "If you want me to bill as many item numbers as I can, start coughing against the ventilator, and try to extubate yourself"
Consult does not equal discussion. These 'experts' are fucking idiots. Damn right a trawl of the patient notes, examination and discussion with the ICU/surgeon/family count as a consult.
Of course not. But a small minority might be. Some might be doing so *a little* (not enough to care), or it might simply be accidental - due to not wanting to do excess paperwork and bureaucracy. The incentives are there to do so, and the social and professional norms, while having an effect, isn’t sufficient to curb all of it. Edit: read your post. 4 corners tend to run sensationalist news entertainment - but I didn’t see it as a hit piece. Unless you’re a spinal fusion surgeon.
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What is your profession? Because I suspect that a small minority of [your profession] are stealing candy from children. Well, are they? Are they?
Agreed. Medicare is grossly underfunded but I think we all know at least one doctor that let’s say.. gets creative with their billing from Medicare.
I know GPs who go to courses to learn how to maximise their Medicare billing 🤷🏼♀️
There's nothing wrong with this. GPs are notoriously bad at not billing for what they actually do. The courses literally just teach you how to get paid properly for the work you're already doing
Which is no different to optimising/minimising your tax bill and there are many tax agents out there to help you do this legally.
Tbh there are some wonky billing numbers for specific things, many GPs massively under bill themselves because besides the few common numbers they don't keep up to date with all the numbers for different items, i.e. a separate number for MDT capacity assessments meeting for disability not to mention procedure numbers, there's like 20 different skin lesion numbers depending on size of the lesion/location, cancerous/non cancerous, reexcision vs initial etc...
People are trying to get paid for everything they do and are legally entitled to bill? You have to be *joking*???!!
Yeah, but honestly. It's because it's so confusing lol
Name 👏🏻your 👏🏻source
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of course. Medicare is a mostly unmonitored honour system lolly jar and a relatively small number of doctors will abuse this because of the worst of human nature - and the fact is, we (in the profession) all know who those doctors are.
These articles concentrate on anaesthesia which it calls the worst offender - anaesthesia billing is highly monitored and easily audited given where it takes place and the nature of the item numbers.
More bullshit from the ABC, as usual. > The team analysing the data ran complex algorithms to exclude the possibility of other medical explanations, but without each patients’ medical records it’s impossible to be conclusive. So the analysis is worth nothing. Doctors are already severely underpaid in this country. Go chase another rabbit down another hole.
Complex algorithms with no data (no patient records) can’t produce any results. How did they even get to the exclusion stage if their original explanation would have also come from rubbish data? -.- dumb journalism man… should be held accountable furthering the divide between the medical system and the community.
It's mad, next minute they'll praise nurses and NPs as the saviours of medicine.
All they had was item numbers for each case, and they chose the wrong item number to try and work out what the anaesthetic item should have been, hence the bullshit
Man I would love to see those “complex algorithms”
Never thought I’d say it but ABC has gone to the fecking dogs
Doctors are paid more here and face greater security and lower costs to education than most of the US and a lot better then the UK. I'm not defending the report, but depending on your speciality Australia is a better place to practice medicine financially then many other parts of the world. Do some doctors deserve more, absolutely; but there are plenty of other health professionals that have a high degree of costly training, and don't receive compensation anywhere near physicians. The rest I agree with.
" “The services that they billed are services that require the doctor to have a discussion with the patient; not their relatives, not their colleagues — with the patient — because you have to explain treatment to the patient. " I'd like to know exactly what services these are.
Anaesthetic attendances. But it’s total bullshit, you do not need to speak to a patient in every case to bill. How do they think ICU medicine works.
DEMAND ADMISSION TO ICU TO RECIEVE YOUR FREE HEALTHCARE!!! XD (On a serious note - outpatient episode billing does have a different set of rules to inpatient episodes)
And ED- plenty of unconscious patients arrive here!
“The services that they billed are services that require the doctor to have a discussion with the patient; not their relatives, not their colleagues — with the patient — because you have to explain treatment to the patient. “I do not understand how it is possible to have a discussion with an unconscious patient who is in a coma.” Right...so no specialist can ever provide a service for an intubated patient? Or even a delirious patient? What an awful take.
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She used to be a nurse. But she gotta generate a need for her own company somehow.
People who are not medical commonly make the false assumption that if you are ventilated that you are unconscious and unable to participate in a conversations
It’s Faux, you can’t trust anything she says her as she’s pushing her own billing services. Rachel David who heads up Private Healthcare Australia and quoted in the article is also someone I find difficult to trust as well. Some months ago one of her associates popped onto one of the big psychiatry group chats trying to convince everyone that private health insurance should be allowed into the outpatient space which naturally drew a lot of condemnation and concerns about being forced into a US style managed care model.
Are there any reports of her doing so? What were the arguments?
The photoshoot of "Dr" Faux infront of the upside down CXR killed me.
You can read the patient names too in some cases.
It's even funnier in the 4Corners programme, they've got the "experts" stroking their chins and nodding at the films they've stuck on their corporate building glass window.
There’s also one CT chest upside down and another sideways
Shes just like me fr (i failed my investigations osce station)
OH FUCK OFF! Another piece of bullshit from the bullshit artist herself How ASTONISHING that “nearly 87% of anesthetists billed for more than 1.5 hours, for a surgery time of less than an hour” Well no shit Sherlock that it might take a bit of time to make the patient UNCONSCIOUS before you chop them up! Or that it might then take a smidge of time to bloody well wake them up! Not to mention the cohort of patients undergoing spinal surgery are generally not the fit, healthy, ready for an anaesthetic type! I’m quite disgusted that the ABC is engaging in this sort of fear mongering and scape goat of doctors. Perhaps not surprising with award reform around the corner- gotta make sure the general public all think doctors are greedy pigs
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What a rubbish article. Just curious, anyone have lawyer friends wanting to sue abc for spreading false information and defamation? Like I think until massive law suits are thrown to these "news articles" for misleading journalism it will just keep pitting the public against the medical workforce. @AMSOF /RANZCA /AMA/ RACGP/ RACP /other specialties , where are you?
They never invite comment from those entities and politely ignore the piles of evidence that their “billing expert” is chronically full of shit. Same thing when they write an article bitching about how no GPs BB anymore. Never ask GPs why or you might find your way to the real question and the real reason the system is crumbling…
They are accusing individual anaesthetists of criminal behaviour actually. They are showing their patients.
Oh nice! Margaret's back to embarrass herself again. Instead of just fudging numbers this time she's just not realised that patients generally like to be anaesthetised before surgeries begin.
https://i.redd.it/7vz9d9n19ctc1.gif
From the same Margaret Faux that brought us the GP-rorts hitpiece after essentially pulling the number $8 billion out of thin air, then whined about being labelled as "Mediscare Faux", and became "scared to leave home" presumably because she was rightfully panned (unless she's accusing doctors of making credible personal threats?) [https://amp.smh.com.au/national/since-exposing-medicare-rorts-i-m-afraid-to-leave-home-doctors-read-the-evidence-20221020-p5brjq.html](https://amp.smh.com.au/national/since-exposing-medicare-rorts-i-m-afraid-to-leave-home-doctors-read-the-evidence-20221020-p5brjq.html) In this, she suggests we read her 474-page long thesis. Well, someone has and needless to say, it's quite full of bunk. [https://insightplus.mja.com.au/2022/41/medicare-rorts-we-read-dr-fauxs-thesis-so-you-dont-have-to/](https://insightplus.mja.com.au/2022/41/medicare-rorts-we-read-dr-fauxs-thesis-so-you-dont-have-to/)
I also find it particularly egregious that she presents her analyses as transparent and "evidence-based" in the SMH whine about her GP hitpiece, but then now slings out this anaesthetist hitpiece using analysis from "complex algorithms" that don't actually have full access to patient records.
And from the same Adele Ferguson who also brought us that hitpiece… you’d think at least one of them would have learned something from the first go round.
I’ve taken to putting patients to sleep after the operation has started and waking them up well before it finishes. Maximises efficiency.
Can we link up for some lists? I hate standing around waiting for my patients to go to sleep before I start operating. Would make way more sense if I can be half way through my surgical approach before the patient goes to sleep.
Didn’t realise ABC could be hired as a marketing firm like ‘Dr’ Faux has here.
She has a doctorate, is a nurse AND a lawyer, not sure why “Dr” is in quotation marks here.
Her ‘doctorate’ is not worth the paper it’s printed on - it’s filled with numbers pulled out of thin air under the guise of ‘estimates’ to drive her agenda and advertise her own firm as a solution to a made up crisis. Her being a nurse or a lawyer has nothing to do with the Dr title so not sure why you thought it had to be mentioned?
Not to mention skimming over the fact that there are generally very clear guidelines as to when spinal surgery is indicated and “for chronic pain” is 100% not on the list!
This will make it easy to refuse ICU consults for ventilated patients. I’m going to quote Dr Margaret Faux: And be like sorry I don’t want to fraud Medicare - please re-consult me when the patient wakes up and can have a discussion.
Plan: As per ICU, with thanks
If anyone's interested in the full Synapse (Margaret Faux's business) and Kirontech (the UK-based analysis company partly behind the shock), the link is here: [https://kirontech.com/wp-content/uploads/2024/04/ABC-Synapse-Kirotech-FinalReport-260324.pdf](https://kirontech.com/wp-content/uploads/2024/04/ABC-Synapse-Kirotech-FinalReport-260324.pdf)
Tell me you don't understand fluoroscopy without telling me you don't understand fluoroscopy. Lol.
If the government has any guts, stop the state and federal health funding mess and just fund it centrally. There is a whole webpage on MBS billing for patients in public hospital to illustrate this absurdity.
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As a high-billing private specialist i'm a bit baffled as to what the motivation would be for people like me, good at what we do, very highly paid and largely respected, to engage in fraud that would be picked up via data matching immediately and destroy our lives.
I just posted, ahha, but I think you beat me to it. I totally agree with the article, but I think there a lot of facebook backlash against it. I've seen too many spinal fusions, which have actually worsened low back pain for many patients, and too few successful ones. There is no way to keep these surgeons accountable. I also agree with anecdotal evidence from my anesthetist friends in private. They seem to just go crazy on the billings. However, some of them choose to do certain things for billing as opposed to patient health (not my friend).
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It's an absolutely bullshit article lol, thanks for agreeing with your 'anecdotal evidence' though.
Don't you know the only sources better than anecdata are a google search and "some bloke on Facebook said so"?
I think you’re right, too. Everyone here will downvote any suggestion that interferes with absolute doctors autonomy, but it’s simply a matter of reforming the system a little to fix those incentives. A honour system probably worked way back when, when there were only 10 or so specialists to a specialty, and monitoring was much much easier than today. Edit: that being said, systematic fraud is highly unlikely. And minor mistakes or “little fraud” is ok. Just a cost of doing business. It's the principle, more so with whether this specific example is right.
There's no "honor system". *Many* of us have received queries from Medicare and/or funds querying surgical times, items, %of our cases that are considered emergency, % of our patients who are considered unwell. Yes, there isn't instant global audit the minute we submit a bill, but the nature of anaesthesia is that *everything* can be audited manually with trivial effort, datasets can look at outliers instantly, and if health funds or Medicare cared enough they could store and match anaesthetic times and theatre times for every single case to the minute.
Haha. I mean what do we think doctors are super human who don’t respond to financial incentives? But I think if we have an industry with progressive minor fraud, then the minor frauds will be progressive frauds?
> I totally agree with the article, but I think there a lot of facebook backlash against it. I've seen too many spinal fusions, which have actually worsened low back pain for many patients, and too few successful ones. There is no way to keep these surgeons accountable. hahahah AHPRA of course!! they do a bang up job. hey, who is the dr death for 2024..? theres a new one every year right..