Emergency Departments face a new wave of patients

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With emergency departments at public hospitals around the country struggling daily to cope with their existing patient load, it’s hard to believe the Federal Government seems intent on increasing that burden substantially.

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But that is precisely what is going to happen when Medicare rebates for diagnostic imaging (DI) are reduced at the start of the new financial year.
The cuts, detailed in the recent Mid-Year Economic and Fiscal Outlook, will reduce Medicare spending on DI by about $100 million a year with patients expected to make up the shortfall from their own pockets.
What makes this decision truly frustrating is that not only will it generate negative flow-on effects across the health system, not only will it hurt patients individually, it will do that while failing to produce the cost savings which are at the heart of the move.
One of the major downfalls of the new policy is that it will drive thousands of additional patients into the emergency departments of public hospitals across the country… departments which are already badly overstretched.
Recent performance figures, eagerly pounced on by the mainstream media, show NSW, Victoria and Queensland reporting a surge in people attending emergency departments.
Every week in NSW they are having to cope with 1600 more patients than a year ago¹.
SA Health deputy chief executive Jenny Richter confirmed a similar scenario in her state: “…a general increase that’s occurring across our emergency departments over the last 12 months.”²
And The Australasian College for Emergency Medicine recently called for additional security at hospitals, claiming people are afraid to stay in emergency departments because of violent and aggressive patients.³
So into this pressured environment the Government is now set to inject potentially tens of thousands of new patients.
Some commentary on the rebate cuts has suggested the financial impact will be minimal, but the reality is far from that for patients needing diagnostic imaging – xrays, ultrasound, CT’s and MRI’s.
Under the plan three million people will be moved off bulk billing funding – mostly general, non-concession patients. These people will now not only expect to pay a gap, under existing Medicare rules they will expect to pay the entire fee for their imaging up-front.

General Patients
X-ray
Ultrasound
CT
MRI

Estimated gap range
$6 - $56
$12 - $101
$34 - $145
$62 - $173

Estimated upfront costs
$54 - $101
$117 - $206
$323 - $434
$422 - $532

 These financial hits will simply be too harsh for too many people, especially when they are very aware there is a simple alternative.
If your son falls out of a tree and hurts his arm, why take him to a GP and then to a private diagnostic imaging clinic – incurring costs at every stage - when you can go to the emergency department and be treated for free?
What about minor car accidents, back pain, work injuries?
With three million people, who were being treated for free, suddenly facing both out-ofpocket and up-front fees, it will only take a small percentage of them to make that decision and our already overstressed emergency departments will feel significantly more pressure.
And for every patient which makes that choice healthcare costs will rise, as diagnostic imaging conducted in public hospitals costs the health system significantly more than when carried out in a private practice.
But of course this new policy won’t just impact on emergency services; the negative consequences will go much further.
Many general patients just won’t accept the inevitable, large upfront costs and gaps. They will put off having the imaging their doctor has recommended, missing the opportunity for early intervention and increasing the overall cost to the taxpayer.
For example, where a GP recommends a breast ultrasound to access a lump in a patient’s breast, a general patient can expect the cost to be between $93 and $185 and the Medicare refund will be $83.55. If the result is abnormal, the GP will probably recommend a biopsy which will cost a further $104 to $194, of which Medicare will refund $92.75.
Even if practices wanted to provide one of the services for free, Medicare rules do not allow it – they can only bulk bill all services.
In lower socioeconomic areas some practices are likely to reduce their services or close their doors. This is not guesswork – it was happening in the late 2000s before the bulk billing incentive funding was introduced in recognition of the long-standing indexation freeze.
The pressure to bulk billing will promote ‘Churn’ radiology which in turn leads to misdiagnosis and services having to be repeated which will increase costs to taxpayers and patients further still.
People were clearly reluctant to accept a co-payment of $7, so how will they react when they are asked to pay average upfront costs of $134 to $214 and gaps of $14 to $94 for diagnostic imaging?
Australia has one of the best health systems in the world and everyone – medical professionals, providers, and the general public – can understand the government’s desire to make it efficient and sustainable.
But the decision to cut Medicare rebates for diagnostic imaging is simply bad policy – it won’t deliver the savings they envisage, but it will hurt the health system and a vast number of individual patients.
It’s also unnecessary. The Australian Diagnostic Imaging Association has identified a number of ways that the Government can achieve similar levels of saving by cutting waste and streamlining the system.
For example, ensuring that all providers comply with a Quality Framework for the provision of diagnostic imaging services and by addressing the shortfalls in arm’s length referral requirements are just two reforms which would deliver very significant savings and would protect patients.
We detailed many other improvements in our submission to the Government’s own MBS Review; ways to improve the sustainability of Medicare while still providing patient access to quality diagnostic imaging services.
The early detection and treatment of medical conditions – keeping people out of hospitals – must be a basic priority for patients and the entire health system.
And it’s undeniable that diagnostic imaging, properly interpreted by highly skilled and experienced radiologists, is a vital and fundamental tool in achieving that goal, so a policy which will actually drive people away from imaging will simply and sadly be counter-productive.
Dr Christian Wriedt, ADIA President.

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“The decision to cut Medicare rebates for diagnostic imaging is simply bad policy – it won’t deliver the savings they envisage, but it will hurt the health system and a vast number of individual patients.”

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Dr Christian Wriedt
President of the Australian Diagnostic Imaging Association
ADIA represents medical imaging practices throughout Australia, both in the community and in hospitals, and promotes ongoing development of quality practice standards so doctors and their patients can have certainty of quality, access and delivery of medical imaging services.
Visit our website www.adia.asn.au
References
1. The Australian. January 16, 2016
2. The Advertiser. January 4, 2016
3. Daily Telegraph. January 15, 2016