Correction of workers compensation surgeon fees

State Insurance Regulatory Authority

Changes made by the State Insurance Regulatory Authority (SIRA) to correct high surgeon and orthopaedic surgeon fees in the NSW workers compensation scheme come into effect today.

Until this point, rates for surgery in the NSW workers compensation scheme were significantly higher than fees in the broader market.

SIRA Acting Chief Executive Dr Petrina Casey said the changes bring workers compensation surgical fees into line with the Australian Medical Association (AMA) rates and fees paid in the NSW motor accidents scheme.

“Surgeons operating in the NSW workers compensation scheme have been receiving payments significantly higher than their own industry standard for many years,” Dr Casey said.

“Today SIRA is bringing surgeon and orthopaedic surgeon fees in the NSW workers compensation scheme back into line with AMA rates.

“This change is about ensuring that every healthcare dollar spent delivers value and quality care, as the evidence shows that higher fees in NSW do not result in better surgery quality or access.

“Eighty per cent of the top earning surgeons in NSW workers compensation scheme are already performing work at AMA rates in the NSW motor accidents scheme, despite the difference they can charge.

“Through this measure SIRA is returning savings of between $26 million and $42 million – that would have otherwise been in the pockets of surgeons – back to the workers compensation scheme each year.”

SIRA’s changes to surgical fees form part of its Review of Regulatory Requirements for Healthcare Arrangements in the NSW workers compensation and motor accidents schemes.

The review was aimed at improving regulatory and fee setting approaches to ensure that injured people have access to value-based healthcare.

State Insurance Regulatory Authority 2 The changes to surgical fees align with recommendation 35 of the McDougall Review to address excessive medical fees in areas where no benefit exists to injured workers from the fee disparity.

The changes from 1 July 2022 include removing loadings on surgical procedures, aligning with AMA fees, and consolidating surgeon and orthopaedic surgeon fees orders into a single fees order.

SIRA announced the changes in November 2021 after a lengthy consultation with the AMA, surgeons, surgeon organisations, and other stakeholders.

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