The fees charged for your anaesthesia have been formulated in accordance with guidelines published by both the Australian Society of Anaesthetist and the Australian Medical Association. Australia’s national health care funding system gives universal access to health care while allowing choice for individuals through private sector involvement. The major part of the national health care system is called ‘Medicare’.
Medicare pays benefits subsidizing part of the costs of doctors’ fees and private insurance pays an additional amount towards doctors’ fees. The Commonwealth Government’s Medicare Benefits Schedule lists a wide range of consultation, procedures and tests, and the Schedule fee applicable for each of these items. Schedule fees are used to calculate medicare benefits entitlements and if charged at this rate. However it is accepted that “Bulk Billing” does not reflect a reasonable rate of remuneration for an anaesthetic service. To this end the medical funds and the Australian Medical Association (AMA) attach a higher value to the service. There is a “gap” between the fee that the medical funds and the AMA recommend. Anaesthetists in private practice are allowed to charge a fee that they feel correctly remunerates them for the service they provide. The AMA rate is roughly double the medical fund rate. It is accepted that an anaesthetist should provide Informed Financial Consent – this means that they should explain their fee and how much they are going to charge before the procedure takes place. The Wesley Anaesthetic Practice provides an estimate to patients of their anaesthetic account as soon as the procedure is booked with the practice.
Anaesthetic fees are calculated using Medicare item numbers. Each item number attracts a unit value. The rate charged for each unit is at the discretion of the Anaesthetist however, the range will usually be between the Medicare Schedule Fee and the Australian Medical Association approved fee, which means that there is usually an ‘out of pocket’ expense.
Generating an Anaesthetic invoice
Standard item numbers
17610 Pre Op consultation – allows the doctor to assess your fitness and type of anaesthetic he/she feels will be safe for you.
20xxx Base item number – this number represents the operation/procedure you are undergoing.
23xxx Time units – this number indicates the amount of time that was required for operation/procedure.
Possible additional item numbers
25015 Age modifier for patient >70 or <1
25xxx Physical health status – this number is used when it has been determined that you have a high risk.
22xxx Invasive Monitoring and Pain relief blocking agents – are used during major cases.
25xxx After hours and emergency anaesthetics – this number is used when your surgery is performed after hours ie: 8pm to 8am Monday to Friday or any time on the weekend/ public holiday.
Two examples of how an anaesthetic account is calculated are shown below. The first is for a more simple procedure such as a knee reconstruction and the second is for a complex procedure that requires invasive monitoring. The unit values used in this example are accurate for the medicare and AMA values. However the individual medical funds each have different rates and individual anaesthetists set their own rate and these will vary between individuals.
| Anaesthetic Account Calculation | |||||
| Item |
Units
|
Medicare
|
Health Fund
|
Anaesthetist
|
AMA
|
|
$18.50/unit
|
$27.00/unit
|
$45.00/unit
|
$62.00/unit
|
||
| Preop visit |
2
|
$37.00
|
$54.00
|
$90.00
|
$124.00
|
| Knee recontruction |
4
|
$74.00
|
$108.00
|
$180.00
|
$248.00
|
| Time = 2 hours |
8
|
$148.00
|
$216.00
|
$360.00
|
$496.00
|
| Total |
14
|
$259.00
|
$378.00
|
$630.00
|
$868.00
|
| Gap above Fund |
$252.00
|
$490.00
|
|||
| Item |
Units
|
Medicare
|
Health Fund
|
Anaesthetist
|
AMA
|
|
$18.50/unit
|
$27.00/unit
|
$45.00/unit
|
$62.00/unit
|
||
| Preop visit 15-30min |
4
|
$74.00
|
$108.00
|
$180.00
|
$248.00
|
| Age > 70 years |
1
|
$18.50
|
$27.00
|
$45.00
|
$62.00
|
| Aortic Aneurysm |
15
|
$277.50
|
$405.00
|
$675.00
|
$930.00
|
| Arterial line |
4
|
$74.00
|
$108.00
|
$180.00
|
$248.00
|
| Central line |
4
|
$74.00
|
$108.00
|
$180.00
|
$248.00
|
| Pressure monitoring A |
3
|
$55.50
|
$81.00
|
$135.00
|
$186.00
|
| Pressure monitoring C |
3
|
$55.50
|
$81.00
|
$135.00
|
$186.00
|
| Blood transfusion |
4
|
$74.00
|
$108.00
|
$180.00
|
$248.00
|
| Time = 4 hours |
20
|
$370.00
|
$540.00
|
$900.00
|
$1,240.00
|
| Total |
58
|
$1,073.00
|
$1,566.00
|
$2,610.00
|
$3,596.00
|
| Gap above fund |
$1,044.00
|
$2,030.00
|
|||
Patients are encouraged to discuss their anaesthetic fees with the staff in the rooms before they have their procedure.
