Capping Medicare Saftey Net for IVF/ART

People - we are just scarring ourselves.

There is no point looking at what is currently being charged in certain line items and then extrapolating the figures to say what we are going to be charged in the future.

Kristy has the right idea.

At the moment most line items aren't really being used because it is just easier for the clinic to whack it all onto the management fees and it makes no real difference to us because under the safety net we still get about the same amount back.

What the government is trying to do is make the clinics better reflect what services are actually provided.

Hands up who has had an ultrasound? or seen a Nurse? Anyone ever seen one on their bill? I know that I haven't. So by making the clinics better account for the actual services that they provide it will add a lot of transparency to the process and people will be better able to compare clinics and work out which ones are rorting the system.

What most clinics will do is [hopefully] change their billing practices so that patients can claim the maximum that they can from Medicare and in doing so show medicare exactly what services are being used.

I am not saying that people aren't going to be worse off - I for one know that I will be because my clinic is one of those who have really nigh fees and I can't imagine that that is going to change.

But what we have to remember is that the changes won't yet be reflected in your bills by way of line items because there is not yet a need to do so and behind the scenes the clinics will be working to produce the best outcomes for their patients. In the end we have to remember that they are effectively a business and need to be doing the right thing or they won't have nearly as many customers and a business without customers wont' make any money no matter how much they charge.

Great point Muppity.

Like Krikkit my clinic moved last year to charging the whole amount onto the one line item (management) 13209 which worked in my benefit as it was all under my name even though my sister was my ED and she had the majority of the treatment for me. Hence it went towards my Medicare Safety Net (MSN) rather than Em's.

As I pay for the whole cycle this worked out well for us as she was only having any treatment for my benefit. Potentially under the new system, the costs now will be split between Em and I (depending on who has treatment for what) and I will be paying for the two of us to reach the MSN separately IYKWIM. Which will increase my costs significantly {sigh} and take a lot longer to reach.

well we finally received a letter from the clinic. apparantly our case had been put forward as an example of a couple who had a couple of frosties, but due to the hike in prices come Jan '10 want to do a full IVF cycle now.

We were OOP roughly $2000 for one cycle of IVF with ICSI (roughly $4000 has been handed over so far, and we have 2 frosties) Obviously the plan was to not put myself through another full cycle but our hands have been forced.

The letter from the clinic advised clients to consider making hay while the sun shines this year....because as of Jan IVF with ICSI OOP expenses will go up by $4600

so that'll be $6600 roughly per cycle.:wall: Does not help with the bitterness already felt re. having to pay in the first place.

Feeling so low right now.:rolleyes:

If you want to read what was said in the House - see here - starts on page 7 - ***warning - this is a link to a large PDF document***
http://www.aph.gov.au/Hansard/reps/dailys/dr150609.pdf

Thanks Julie
I have just read the couple's story read by Mr Dutton and was in tears. I then moved to the MP Mr Cook's speech about his wife and his experience with IVF and burst into tears. I will have to come back to it later to finish reading the debate.

I know - each story is so touching and personal - I haven't been able to finish reading it either.

I think it's great they read them into the record (and obviously took the time to read some of the letters).

Personally, I like that Dutton called Gillard out on her statement from 3 years ago which was "It is a cruel thing to do to Australian women particularly older Australian women, whose only hope of falling pregnant is through the IVF process." When they only focus on young women, I feel that people like me get lost or are thought of not worthy of IVF assistance.

It gives me hope when the Parliament can hear real people's stories with all their uncomfortable, sad and happy parts. It makes the impacts of what changes they are making more real.
I too found that interesting as to what Julia and the labor party said a few years ago when the Howard Govt were looking to make changes to IVF. Sadly ironic.

I have renamed and made this a sticky thread for easier reference.

I found this abstract while on a massive google search on something completely unrelated to the funding cuts...Here's an abstract (I cannot access the full article without paying US$36 as it's from a professional journal) about how "valuable" an ivf baby is in terms of tax dollars to be contributed in the future vs the cost of providing ivf funding! It concerns a study in the UK but I'm sure it has general applicability. Just take a look at the conclusion!

BACKGROUND: Over the past decade, demand for fertility treatments has increased as a result of delaying time to first pregnancy and growing awareness and acceptance of available treatment options. Despite increasing demand, health authorities often view infertility as a low health priority and consequently limit access to treatments by rationing and limiting funds.

METHODS: To assess the long-term economic benefits attributed to in vitro fertilization (IVF)-conceived children, we developed a health investment model to evaluate whether state-funded IVF programmes in the UK represent sound fiscal policies. Based on the average investment cost to conceive an IVF singleton, we describe the present value of net taxes derived from gross taxes paid minus direct government transfers received (e.g. education, health, pension) over the lifetime of the child. To establish the present value of investing in IVF, we have discounted all costs from benefits (i.e. lifetime taxes paid) using UK Treasury department rates based on a singleton delivery with similar characteristics for education, earnings, health and life expectancy to a naturally conceived child.

RESULTS: The lifetime discounted value of net taxes from an IVF-conceived child with mother aged 35 is ?109 939 compared with ?122 127 for a naturally conceived child. The lifetime undiscounted net tax contribution for the IVF-conceived child and naturally conceived child are ?603 000 and ?616 000, respectively.

CONCLUSIONS: An investment of ?12 931 to achieve an IVF singleton is actually worth 8.5-times this amount to the UK Treasury in discounted future tax revenue. The analysis underscores that costs to the health sector are actually investments when a broader government perspective is considered over a longer period of time.

Keep baby hope alive with IVF | Herald Sun

Thanks so much Buliej. I nearly cried reading that! Fantastic article.

And if ONLY it took 2 or 3 goes....

Hi there,

A few weeks back I well and truly got my knickers in a knot and set about contacting politicians galore to plead our case. I thought it may interest you all to read an excerpt from my Federal MP (who incidentally is the only one who has bothered to reply!).

A chance to explain is particularly important as there was a lot of speculation that some MBS items might be means tested or removed from the EMSN in the lead up to the budget.

In fact, the changes made by the Government in the budget ensure that all items currently covered by the safety net remain covered by the safety net and no items will be means tested for eligibility. The changes we have made are to restrict taxpayer funds being spent on excessive fees that have been charged by some specialists. We are protecting those doctors who do the right thing, and encourage patients to look closely at any fees being charged by their specialists.
By way of background, you may be interested to know that a recent independent review of the EMSN, the Extended Medicare Safety Net Review Report 2009, clearly showed that in certain areas, such as IVF, the EMSN has been used by specialist doctors to raise their fees, knowing the taxpayer would cover 80% of the cost of the fee rise.
For example, according to this report between 2003 and 2008, the fees charged by obstetricians for in-hospital services reduced by 6%, whilst the fees charged out-of-hospital increased by 267%. Similarly, the fees charged for Artificial Reproductive Technology (ART) services fell by 9% for in-hospital services, whilst the fees charged for out-of-hospital services increased by 62%.
This meant the taxpayer was picking up the tab through the safety net, and patients didn?t get the full benefit.
All of the areas that will be capped under this measure were identified in the EMSN Review Report as having large increases in the fees charged as a result of the EMSN, a service where the majority of the EMSN benefit is going towards funding doctors? increased fees rather than helping patients with their out-of-pocket costs, or having a very high safety net benefit per item.
The new caps are on the following items: obstetrics, Assisted Reproductive Technology (ART) including In-Vitro Fertilisation (IVF), hair transplantation for alopecia, the injection of a therapeutic substance into an eye, one type of cataract operation, and one type of varicose vein treatment. An upper limit or EMSN benefit cap will be placed on the amount of benefit that will be paid through the EMSN for these Medicare services. The Government is capping EMSN benefits for these services to discourage doctors from charging excessive fees- and to make sure that the EMSN is sustainable into the future.
On average, patients are charged around $6,000 per IVF cycle and yet there are some doctors charging in excess of $10,000 per cycle.
Patients who see specialists who charge $6000 or less for a typical IVF cycle will not be worse off under these changes.
From 1 January 2010 the Medicare items for ART services will also be restructured to better align the items to the phases of treatment involved in an ART cycle. This will help to spread the cost and caps across the treatment cycle to better reflect the cost involved at each stage of the treatment cycle.


So there you have their justification....

"Patients who see specialists who charge $6000 or less for a typical IVF cycle will not be worse off under these changes."

What total load of unmitigated BS.

I am truely sickened by the excuses and lies coming from these politicians.

SammieJam - do you have information that leads you to believe the $6,000 statement isn't true? I haven't heard much about the numbers since the budget first came out.

Well I was talking about it with the girl in charge of all the fee's etc at my FS clinic. She has done all the maths based on the info they have been given via THe People In Charge, and she told me that :

of the $6500 we are paying now to them (which includes nurse management of cycle, drugs, scientisty things etc) we will end up with out of pocket of about $3500 - $4500 as opposed to the $935 OOP we have now. Our FS will be charging about $1500 for all scans, appointments, EPU and ET. ATM he is only charging $900 for all that (!?! he is a truely great guy) but appenently under the new legislation he will lose to much money and so he will have to put the price up $600. He is unsure how much of that we will get back but he has a feeling it will be about $500.

Also B.(The fee's/money gal) from the clinic said there is some weird clause thing they are trying to get confirmation/clarification on. Apparently from what they can understand there may be limits on what we can claim per year but that is still very up in the air.

So yeah. DOESNT LOOK GOOD. :(

That really stinks if that is how it turns out. I'd take a copy of that letter along with a statement of my out-of-pocket costs before and after 1 Jan 2010 to my MP's office if that is how it turns out. Not that this would do much good, but at least the point would be made.

That is exactly what I was thinking when I was reading the letter! WE got it in writing, can we hold them to it? lol.

I am praying so hard for a BFP within the next 5 months. Its all over for us after Jan if the costs are what B. says she expects them to be...

Thanks for sharing Taurean, obviously a Labor MP that responded to you.

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The changes we have made are to restrict taxpayer funds being spent on excessive fees that have been charged by some specialists. We are protecting those doctors who do the right thing, and encourage patients to look closely at any fees being charged by their specialists.

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This is the big flaw IMO, attack high charging FS/Clinics through those that pay (us) isn't the best way to go. Many people have little choice in who they see, especially in regional areas. It is an attempt to trickle the consequences up the line to change fees charged and also in an area where people are desparate to have treatment so will probably wear the costs the best they can going into significant debt in the process. Why not just regulate the industry directly IMO!

:

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Patients who see specialists who charge $6000 or less for a typical IVF cycle will not be worse off under these changes.
From 1 January 2010 the Medicare items for ART services will also be restructured to better align the items to the phases of treatment involved in an ART cycle.

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This politician hasn't quite got this right as it may not be the case. Different clinics can charge $6000 currently but may have very different charging structures as we have seen already in this thread. Hence spreading all the treatment line items out and moving to a cap on each of them may mean more OOP for some $6000 clinics than others. Only time will see once we see what each clinic plans to charge for treatment line items.

Does anyone know if clinics are starting to publish their proposed fee structure for 2010?

Also, Julie that UK study was fascinating. Too bad the Gov't didn't think to build that into their review (Extended Medicare Safety Net Review Report 2009) this year. Seems IVF is a fantastic investment in the future growth and prosperity of a nation, - that is if decision makers can think more laterally and broadly than direct costs of treatment.

:

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"Patients who see specialists who charge $6000 or less for a typical IVF cycle will not be worse off under these changes."

What total load of unmitigated BS.

I am truely sickened by the excuses and lies coming from these politicians.

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I completely agree. I want one of these politicians to show me the maths on that one!

We pay $6300 per cycle (no ICSI) and when I looked up the rebates and limits on the MBS website I couldn't get the OOP expense below about $2500 assuming the clinic re-structured its fees to maximise the refund. That's up from just under $1000 now.

Apparently the bill was referred to committee and is still taking submissions - I have just sent off my submission now. Just so you know, any submissions will be published on their website after all decisions are made.

Info is available from Senate: Committees: Inquiry into Health Insurance Amendment (Extended Medicare Safety Net) Bill 2009

Maybe, just maybe, this won't go forward...Medical Devices & Equipment - AMA calls for change to IVF payment plan - probably just wishful thinking on my part - but the modeling would be interesting.

I searched BB for ages when I first heard about this but couldn't find anything anywhere! :redface:

could be promising buliej...

I phoned Medicare about 6 weeks ago and asked them what was happening next year (as we've been told IVF is our 'best' option to have a bub and our fs told us we'd be way more oop next year). The lady was very nice and put me on hold to try to find out what she could, but eventually came back to say that any decisions about changes to caps and rebates for next year would not be made until November or December at the earliest. She said that no proposals of any sort had been tabled yet.

My fs has already lobbied some well-known opposition mp's but he was told the party probably wouldn't be pursuing the issue as it was not a vote grabber ie it doesn't affect enough people to get them enough votes to get back into office.

Hmmmmmm

Two things recently:

1. the senate committee has completed their report which you can see at: Parliament of Australia:Senate:Committees:Community Affairs Committee:Health Insurance Amendment (Extended Medicare Safety Net) Bill 2009

2. this article in the Australian suggests some form of cap is likely to happen: Coalition to modify, not block, Medicare safety net cuts | The Australian

An article from today's Age re: the rush to beat the funding changes:

Rush on IVF to beat funding cap

Sounds like some clinics may not close during Xmas this year.

Sounds like Wed's Senate discussions on this will be interesting.

Thanks for keeping us updated buliej.
I have been reading a few similar articles over the last few days.

We will watch with interest on Wednesday!

New thread time everyone! Here!