Capping Medicare Saftey Net for IVF/ART

[juniper76]

I found this article when I was surfing yesterday:

More choice for mums-to-be but a penalty on IVF | The Daily Telegraph

The Government reform to the Medicare safety net, capping benefits to those patients who access IVF and also obstetric services.

From July 2010, a patient whose doctor or IVF provider charges more than $5000 per cycle will not receive the rebate, which covers 80 per cent of out-of-pocket expenses.

I also saw a lot of the articles you've already got posted...

Wow, I can't believe how much some clinics charge. Do you pay $4-5000 to the clinic AND then the clinic also bulkbills the same again to Medicare? Did I read that right?

I go to QFG in Brisbane and we pay $6300 upfront, then the anaesthetist and my Dr's fees after (another $500-ish). We pay upfront then take the receipts to Medicare, the clinic doesn't bill anything to Medicare directly.

Just claimed my March cycle and it was:
13209 162.20 (planning/management - my Dr's fee - 143.20 rebate with safety net)
13200 6,263.85 (ART/IVF - 4,477.60 rebate with partial safety net)
13221H 36.15 (semen prep - 36.15 rebate)

Now to start again... Third time lucky right?

[onthefly]

Could we set up threads for each major centre where people could post costs for particular clinics as an easy reference? I know there's a thread for cost of IVF but they're all just jumbled in together

Thanks again to the ladies keeping us up to date - really appreciate it

[Lovenhope]

I went for my orientation at IVFAustralia today. I asked about the changes and she was pretty sure some changes will take effect from end of June, even though I pointed out that the media is reporting it to be Jan next year. Very scary!
I paid $4450 for cycle plus $120 for Synarel (hos & athes charges seperate)

[buliej]

BecD - thanks for posting the article!

[willy74]

thanks for all the info
I'm new to this - first appt next week and now really worried
starting to think it's not worth bothering as we just can't afford this.

i'll keep writing emails to ministers and hoping they see sense.

[Sara69]

Hi Sandy, IVFAustralia is wrong, it definitely only starts 1 Jan 2010, please see the media release below:

2 May 2009

The Rudd Government will support the long term sustainability of the extended Medicare safety net (EMSN) by making sure public money is spent on reducing costs for patients, not on providing excessive windfalls for medical specialists.

This measure is an important part of the Rudd Government’s commitment to reform and modernise the health and hospital system and to ensure that Australians’ hard-earned tax dollars are used efficiently to provide better health outcomes.

The EMSN will continue for all Australians and for all services currently covered. The safety net thresholds have not been changed from $555.70 for Commonwealth concession cardholders and recipients and $1111.60 for all others and are indexed each year by the Consumer Price Index (CPI).

However, there is evidence that the EMSN has enabled some specialists to charge excessive fees – resulting in excessive windfalls being paid by taxpayers through Medicare.

The Government will take action to ensure EMSN funding is used to benefit patients and reduce their costs.

In this Budget, the Government will change the EMSN to provide a maximum safety net benefit, or ‘cap’, for a small number of MBS services where there is evidence that the EMSN is being used to excessively increase the income of specialists, rather than reduce costs for patients.

These changes will apply to obstetrics, assisted reproductive technology (ART), cataract operations, the injection of a therapeutic substance into an eye, hair transplants for alopecia, and varicose vein treatment. In all these areas, some specialists are charging excessive fees, however very little of the taxpayer funding of these procedures is helping patients.

For each item that is capped, the Government will only provide safety net benefits up to a maximum amount. Patients who are charged reasonable fees will continue to be supported by Medicare and the EMSN, but specialists will no longer be able to increase their fees excessively, assuming that taxpayers will pick up most of the cost.

This measure starts on 1 January 2010.

This initiative responds to an independent review of the EMSN which found:

* doctors have increased their fees as a direct result of the EMSN, resulting in increased costs for some services where families have not qualified for the EMSN; and
* for every dollar spent on the EMSN in 2007, as much as 78 cents was spent on meeting providers’ higher fees rather than reducing patients’ out-of-pocket costs.

These excessive fees have resulted in taxpayers funding million dollar incomes for some specialists:

* the top earning 10 per cent of obstetricians were each paid an average of $1.1 million a year per specialist through Medicare, including $612,000 through the EMSN; and
* the top earning 10 per cent of ART specialists were each paid an average of $4.5 million a year per specialist through Medicare, including $2.2 million through the EMSN.

For all inquiries please contact the Minister's office – 02 6277 7220

[buliej]

Changes may put pressure on IVF doctors
in case anyone is interested (also see last sentence about restructure of system)

[tamtim01]

Hi Everyone,

I have just read all of your posts and have just emailed my local government again regarding the susbidies and levies. These are the people I sent my requests to (per below)

I have basically asked if these cuts can be reviewed and would like somone or maybe more to be a voice for all us IVF patients. I have told them that I have not started yet as we have been saving for our upfront fee & paying for private health insurance (we are a normal hard working couple whom are no means RICH).

I hope that I get some sort of reply or recognition, I did receive a few responses when I emailed them a couple of months ago when this was a so called rumor.

Please be aware that the list below is my local members in Victoria which are Frankston, Mornington, Cranbourne, Dandenong and have also emailed a couple of other well known MP's even Julia Gillard. So I hope those of you that live near me can also email them like I have.

wayne.swan.mp@aph.gov.au
alister.jordan@pm.gov.au
ankit.kumar@pm.gov.au
alistair.harkness@parliament.vic.gov.au
jude.perera@parliament.vic.gov.au
john.pandazopoulos@parliament.vic.gov.au
david.morris@parliament.vic.gov.au
john.brumby@parliament.vic.gov.au
Julia.Gillard.MP@aph.gov.au

All we can do now is hope and pray that this works for us all.

[tamtim01]

I just got a reply from one local member, he must be working late. See below. Great to get a response now I will email Mark Dreyfus.

Hi Tammy and i thank you for your email.

I have read your email with interest.

As your matter is related to the Federal Tier of Government, i suggest that you also take the opportunity in contacting your local Federal Member of Parliament for the Skye area, Mr Mark Dreyfus MP.

Mr Dreyfus' details are as follows:

Mr Mark Dreyfus QC, MP
Parliament House Contact
PO Box 6022
House of Representatives
Parliament House
Canberra ACT 2600

Tel: (02) 6277 4305
Fax: (02) 6277 8484

Electorate Office Contact

Keysborough Office:
Location/Postal Address:
Shop No.6, Parkmore Shopping Centre
Cheltenham Road
Keysborough Vic 3173

Tel: (03) 9769 1955
Fax: (03) 9769 1977

Once again i thank you for your email.

Regards
Jude Perera MP
Chair
Family and Community Development Committee
State Member for Cranbourne District
157A Sladen St, Cranbourne
Tel: 5996 2901,
Fax: 5996 7494

[~BecD~]

These excessive fees have resulted in taxpayers funding million dollar incomes for some specialists:

* the top earning 10 per cent of obstetricians were each paid an average of $1.1 million a year per specialist through Medicare, including $612,000 through the EMSN; and
* the top earning 10 per cent of ART specialists were each paid an average of $4.5 million a year per specialist through Medicare, including $2.2 million through the EMSN.

This is the part that bothers me so much - they keep quoting this stat to get people to agree that it's ridiculous, and yes absolutely some clinics charge a fortune!
But the cost of my clinic covers 24 hour phone coverage when I have questions, and around 20 staff including embryologists, nurses, reception and accounts staff etc. It's not like my specialist is getting the $8k straight to them for each cycle!

Absolutely, let's look at ways to get these prices under control, but punishing the patients is not the way to do. What clinic in their right mind is about to drop their fees by thousands of dollars?! And will our chances at IVF suffer because of this? Will my clinic not use embryo glue because its just that tiny added expense that they dont want anymore. Or go back to 3 day transfers, because its cheaper than going to blastocyst.

I think they have just opened a huge can of worms.

[Lovenhope]

Bec- I couldn't have said it better myself

[juniper76]

If you're going to start writing letters at this stage, the best people to be petitioning now are the senators. The budget has to get through the senate before it can become reality.

[Sara69]

Bec: Absolutely agree, it bothers me too it, sounds like my FS earns 4.5 million but in actual fact she is running a business and while she may earn a pretty good salary the money covers the nurses, scientists, facilities, blood test, ultrasound and medications.

For contact details of senators by State/Territory, go to http://www.aph.gov.au/Senate/senator...asp?sort=state

Sara

[Lenny]

If you're going to start writing letters at this stage, the best people to be petitioning now are the senators.

Done.

[mrs_zeg]

Done.

Ditto!

Infertility is never a choice - we the intending parents, should not be penalised or discriminated against on this issue.

[dusty]

There is now some more information from the Health Department at the MBS ONline portal.

See here for direct link to the changes to teh Extended Medicare Safety Net MBS Online - Changes to the Extended Medicare Safety Net

[Sara69]

Thanks Dusty, it is definitely not as bad as I thought, I think for me it means around $2500 extra out-of-pocket - coudl be less or more depending on how my clinic will adapt its billing process.

Hopefully for patients at clinics which charge less it won't make a big difference. I wonder whether there are other item numbers in IVF that we could insert such as BT and ultrasounds. It would be worthwhile to pressure the clinics to take the BT out of ART services and to bulk bill for them.

Sara

[Muppity]

Thanks for posting that link Dusty.

Isn't totally bad - I will do some maths later.

the bit that I like is that that is the refund every time you do it - rather than a once off which is what was originally feared.