Employees’ compensation surgeon charges face scalpel – Regulatory & Authorities – Insurance coverage Information

Manpower ?? Compensation surgeon charges face scalpel

February 15, 2021

The State Insurance Supervisory Authority (SIRA) has given surgeons and medical groups until the end of next month to respond to plans to lower fees under the NSW Workers Compensation Scheme.

SIRA plans to remove charges paid on top of the Australian Medical Association (AMA) tariffs to better align the agreements with the mandatory third party (CTP) system and employee compensation in other countries.

“Increasing costs under the system are ultimately borne by NSW employers through higher employee compensation premiums,” said SIRA on Friday. “The savings from changes in operation fees will bring approximately $ 40 to 55 million back into the program each year.”

Under the proposal, encumbrances would be removed from surgical fee orders and surgeons would be paid according to the rates included on the November 2020 AMA list and paid on the CTP system. They would still be among the highest in any Australian jurisdiction.

A recent benchmark study found that surgeon fees for the NSW system are between 50 and 400% higher than other personal injury systems, CTP and the broader market. The nominal insurer for the system is administered by state-owned icare.

The regulator says the cargo removal is part of a broader package of initiatives to address rising health care costs in employee compensation. Actions also include improving insurers’ controls on treatment payments and approvals.

“SIRA intends to develop value-based care models together with surgeons and medical groups, starting with a round table at the end of March,” it says.

The models will be used in developing future charging methodologies, and SIRA says it will work with insurers to monitor surgeon and orthopedic surgeon participation in the employee compensation scheme.

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