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Wednesday / June 29.
HomemistoryGrandma Not the Only One Unhappy

Grandma Not the Only One Unhappy

From this month, the Federal Government has taken a step which is a threat to the eye health for many Australians and is vehemently opposed by all eye health professionals in the nation. By now, just about all of Australia is aware of the high profile and aggressive ‘Grandma’s Not Happy’ campaign waged against the proposed cuts to Medicare rebates for cataract surgery.

Campaigns War

In fact, so determined is the Federal Government to continue its bloodymindedness on the issues that it has engaged in a highly insulting YouTube campaign accusing ophthalmologists of being greedy money-grubbers.

Dr. Russell Bach, President of the Australian Society of Ophthalmologists (ASO) retorts by saying: “The reason they’ve taken the insulting line of painting ophthalmologists as being greedy is they’ve got no other good reason to actually justify the decision they’ve taken; so they’ve resorted to the oldest trick in the book and that’s to say that doctors are greedy”.

The Australian Society of Ophthalmologists (ASO) has been inundated with emails and telephone calls from members of the public following the launch of its ‘Grandma’s Not Happy’ radio advertising campaign, which calls for a reversal of the Federal Government’s decision to halve the Medicare rebate for cataract surgery.

The advertisement threatens to pour petrol onto an already smouldering dispute between the Government and the ophthalmology profession…

The campaign is a joint initiative of the ASO and the Independent Ophthalmic Network and is a series of hard-hitting ads being run on radio stations throughout the nation.

The campaign was becoming so successful and had whipped up so much feeling within the community as well as the eye care professions that the Government together with the Australian Labor Party retaliated with a hostile counter attack by posting a video on YouTube accusing eye specialists of waging a “dishonest scare campaign” simply to protect their incomes.

The accusations of “greed” by the Government hit the mainstream media with headlines in The Australian screaming “Labor ad takes on ‘gouging’ surgeons” and in the Fairfax newspapers “Labor lambasts eye specialists with YouTube video”.

Feds Compromise – But Still Not Enough

As mivision was going to press, the Federal Government made an eleventh hour concession to eye specialists by doubling the Medicare rebate for “complex” cataract surgeries. In an attempted move to head off a major political debacle, Health Minister Nicola Roxon announced the Government would introduce a new rebate of AUD$850.75 for complex surgeries that take 40 minutes or more.

“In setting this higher fee the Government is recognising that some procedures are more complex and take longer to complete,” Ms. Roxon said in a statement.

However, ophthalmologists immediately rejected the Federal Government’s announcement of a new Medicare rebate for “complex” cataract procedures, saying that it fails 95 per cent of Australians needing this vital sight-restoring surgery. And they have stressed that the inference that they agreed with the Government introducing a new, so called “complex” Medicare item for cataract surgery is misleading.

Dr. Iain Dunlop, President of The Royal Australian and New Zealand College of Ophthalmologists, said that all cataract surgery is complex, regardless of the time it takes to perform.

“Time is never the most important element in any surgery,” said Dr.Dunlop. He said the statements
attributed to the Health Minister were misleading in a number of aspects.

“While we have had discussions with the Minister and her staff since the issue was raised in the Federal Budget in May, there has never been any agreement from us to a new item being an alternative to the savage reduction in patient rebates for cataract surgery. This approach fails the vast majority of Australian patients needing cataract surgery, be they elderly, from the bush, or from the city.

“Today, cataract surgery is one of the most effective medical procedures, in effect a modern miracle. It is vital that this sight-restoring surgery remains within the financial reach of the many thousand
Australians who will need it each year,” said Dr. Dunlop.

The Rural Doctors Association of Australia (RDAA) has also warned that the Federal Government’s plan to cut the Medicare rebate for cataract surgery will result in many rural and remote Australians being unable to afford the procedure, and could also dramatically reduce the number of city-based ophthalmologists willing to provide visiting cataract services in country Australia. RDAA says a ruralloading should be added to the cataract rebate to better support resident and visiting ophthalmologists in providing cataract surgery in the bush, given the higher costs to these doctors in doing so. RDAA has also joined the AMA in voicing its strong disapproval at the advertisement being webcast by the ALP, which attacks ophthalmologists for their fees in providing cataract surgery.

The calls on the Government to rescind the Medicare rebate cut for cataract surgery has now reached a crescendo that will be impossible to ignore.

According to the Fairfax press, Labor’s online strategy reflects concern within the Government that the campaign by the eye specialists – who have been linked with the Council of the Ageing – is damaging its bid to shift spending from expensive doctors to more pressing health areas.

The Government’s Stance

The Health Minister, Nicola Roxon, has already compromised on cuts to Medicare payments for fertility treatment and macular degeneration and faces a Senate block to the cataract changes.

The ALP national secretary, Karl Bitar, said the Government needed to make savings to restore the health system after years of neglect. “We are not going to sit back and let the Society of Ophthalmologists run a deceptive scare campaign, unfairly targeting seniors in our community.”

But medical leaders were unrepentant. A senior ophthalmologist, Bill Glasson, declared: “Our fees will not go down. The patient will pay increasing gaps and services will be closed.”

The President of the Australian Medical Association (AMA), Andrew Pesce, said the YouTube video was “a blatant ideological slur on doctors” and called on Ms. Roxon to ‘”distance herself from this ad by condemning it as political propaganda'”.

The former Health Minister, Tony Abbott, said the campaign showed how cashed-up the Labor Party was that a year out from the election it was mounting an internet campaign to attack third parties.

The advertisement entitled ‘Facts on Cataract Surgery’ concludes, against a soundtrack of ringing cash tills, with “the campaign … is about a few specialists who can’t see beyond their own financial self interest”.

According to The Australian newspaper: “The advertisement threatens to pour petrol onto an already smouldering dispute between the Government and the ophthalmology profession, which responded to the Medicare cuts by placing advertisements in The Australian claiming the Government was ‘blind to the facts’.

“But it may also be designed to change the positions of independent senators Nick Xenophon and Steve Fielding, who earlier this month said they would side with the opposition in a disallowance motion in the Senate to prevent the rebate cut going through. If either of the two independent senators sides with the opposition, the regulations introducing the cuts will fall.”

The Government says new technology has allowed the operation to be done much more quickly and cheaply than before and the old rebate is no longer justified.

The Ophthalmologists’ Opinion

But ophthalmologists counter that the cataract surgery rebate has already been slashed on previous occasions, and cutting it further will force patients who can afford it to pay more for their surgery through bigger out-of-pocket bills. They warn that those who cannot pay the hundreds of dollars’ difference between the new rebate and the doctor’s fee will be forced into the public system where they will have to wait longer for treatment. One angry response has come from New South Wales with cataract surgery in remote areas of the State is in doubt after more than 50 eye surgeons threatened to stop operating on public patients in protest against cuts to the Medicare rebates.

The outback eye team, run by the Prince of Wales Hospital and inspired by Fred Hollows, has been travelling to outback NSW for 14 years to treat patients with eye problems, but fears it might have to stop offering cataract surgery after a decision by the Federal Government to halve the Medicare rebate.

The Sydney Morning Herald reported that the threatened ban by ophthalmologists, which will affect thousands of people, most of them elderly, is expected to cause a massive blow-out in hospital waiting lists, already about two years in some country areas. But eye surgeons are furious, saying they are being expected to perform life-changing surgery for the price of a pair of spectacles.

“It’s most certainly worth more than AUD$300. I think the Federal Government will find a lot of surgeons will take their bat and ball and go home,” Orange eye specialist Dr. Basil Crayford said. He said many eye surgeons would withdraw their services for emergencies at public hospitals and patients unable to travel to Sydney or Newcastle for treatment would go blind.

Dr. Russell Bach said doctors treated patients in western NSW because they saw it as part of the Australian tradition of community service. “But if the Government won’t come to the party and give these guys a reason to go out there, they’ll stop. We will survive, but the patients will suffer and that’s why we are making a noise,” Dr. Bach said.

The NSW Opposition’s health spokeswoman, Jillian Skinner, said a ban on public patients receiving cataract surgery would be devastating.

“These are people who cannot see and it’s an operation which can give back their independence. You can’t blame the doctors. They are so demoralised they are walking away from the system,” she said.

The outback eye team, which has six ophthalmologists, travels with the Royal Flying Doctor Service to centres such as Bourke, Brewarrina, Walgett, Broken Hill, Griffith and Lightning Ridge.

The Federal member for the local electorate Calare, John Cobb, said cataract surgery made up about ten per cent of its work, but a cut to services would severely affect residents.

“Already our country eye surgeons accept a discounted fee for their work. This move to cut their pay by half means it will be unviable for them to work in the public health sector,” he said.

A spokeswoman for NSW Health said it had no plans to subsidise the money ophthalmologists would lose when the rebate cut came into force, but the situation was being considered.

Dr. Russell Bach Takes on the Feds

Dr. Russell Bach, President of the Australian Society of Ophthalmologists is unashamed and unabashed in answering the “false” and “insulting” comments by the Federal Government. This is what he has to say:

“I think the YouTube reaction was composed by an out of touch political media machine and it shows their anxiety and concern that we’ve engaged them to the degree that we have. The community groups are on side and it’s the real issues that they haven’t addressed and they are preparing themselves for a political confrontation.

“The reason they’ve (the Government) taken the insulting line of painting ophthalmologists as being greedy is they’ve got no other good reason to actually justify the decision they’ve taken so they’ve resorted to the oldest trick in the book and that’s to say that doctors are greedy.

“Doctors will charge what they deem is appropriate for their service. If the government is seeking to control doctors’ fees they need to honestly pursue it and they need to address the issues we’ve raised…that being the increase out of pocket expenses for patients and the decreased access to cataract surgery.

If you go through this (YouTube) ad you’ll see they’ve actually lost the plot. They’re saying we’re running a campaign claiming the government is cutting back on the number of cataract surgeries. It’s got nothing to do with that. We’re claiming that the government is reducing the Medicare rebate for cataract surgery, which it is.”

The claim that cataract surgery takes 15 minutes:
“Well that’s an anecdotal comment. They have got no raw data that tells them it’s a 15 minute procedure. I’ve given them the real data. They’ve got access to that. We’ve given them the data that has come out of the two largest ophthalmic day surgeries in Australia. The average time for cataract surgery in one unit is 28 minutes and in the other its 31 minutes. Their campaign is not only based on a false premise, but it’s based on a budget decision to take money out of Medicare because it’s costing them too much.

“Now they’re looking around for reasons. They haven’t foreseen the consequences we’ve flagged with them. It’s been done by someone who is out of touch with reality and the delivery of health care at the coal face. They’ve been unaware of these issues and they’ve failed to recognise them to date even though we’ve put it in front of them…and that’s the scary part from our point of view that they’ve failed to actually address these issues.

“We would have felt that our patients were being looked after had they come back and said: ‘Yes, there will be increased strain upon the public hospitals. Yes we do anticipate that. Yes we will do something about it’. But no… they haven’t even flagged the issues.”

Political Opposition:
“We will be forcefully supporting any political process that looks after the interests of our patients. As I’ve said, ophthalmologists will charge what they think is a fair price for the service and the only way forward so patients do not have increased out of pocket expenses and that we don’t clog up the public hospital system is to put the rebate back where it was. If there’s a political process by which we can do that, then we’re wholeheartedly behind that in the interests of patients and ophthalmologists and in the interests of patients in the larger communities because if nothing is done about this, the Government will get the message that it can go about attacking Medicare and disembowelling Medicare and removing their support from it in this surreptitious way.

“The Government is portraying this image of an evidence-based process by which they’re assessing the situation and the modern technology and reviewing Medicare item numbers and yet they’ve done this in such an unprofessional way, it really questions their ability to use evidence and come to the right conclusion.

“This whole process getting to where it has, really questions whether the Minister is not dizzy with power and is more interested in an ideological way forward and whether she’s abusing the housekeeping role of normal regulations by making a unilateral decision without getting it out there to the community, the stakeholders and the rest of the Parliament.

“I am still hopeful that we have a democratic process to allow us to address such an ill-conceived decision that’s going to have such a drastic affect on our community. There will also be a political price to pay.”

AMA Hits Back

Australian Medical Association (AMA) President, Dr. Andrew Pesce, said that an AMA survey of ophthalmologists highlighted why the Government should reverse its Budget decision to halve the Medicare patient rebate for cataract surgery.

Dr. Pesce said that older Australians would be hit hardest by this callous Budget cut at a stage of life when they are struggling to keep their sight and afford a good quality of life.

“The Budget decision was based on poor advice that does not reflect the reality of performing quality cataract surgery and providing professional follow-up care for patients,” Dr. Pesce said.

“The Government believes that most cataract surgery is performed in 15 to 20 minutes – wrong. The Government claims that ophthalmologists are overcharging their patients – wrong.

“The Government believes that halving the Medicare patient rebate for cataract surgery is good health policy – wrong and unfair. The Government has put a modest saving to the Budget bottom line ahead of the health and welfare of some of the most vulnerable people in the community,” Dr. Pesce said.

“It is time for the Government to do the right thing by these people, many of whom who may be denied the vital operation that could save or improve their sight because they can no longer afford it. The rebate must be restored to its proper level.”

Dr. Pesce said that the AMA survey showed that more than two-thirds of private ophthalmologists would cut back their public patients if State Governments followed the Federal Government and cut the contract rate for cataract surgery.

“MBS fees no longer reflect the true cost of delivering medical care,” Dr. Pesce said.

“The Medicare patient rebate for cataract surgery has been significantly cut twice since 1987. On this occasion, the Government has failed to acknowledge that the Medicare rebate must cover at least two post-operative visits to the doctor, with most doctors providing three visits, and some doctors providing four or more.

“On top of this, the income that doctors generate from providing professional medical services must cover their practice costs, which include their staff and equipment.

“These costs are met entirely from the fee charged by the doctor. The fees that ophthalmologists are actually charging have increased by just 1.8 per cent a year between 1993 and 2008, which is less than the CPI increase of 2.5 per cent or the increase in average earnings of 3.7 per cent over the same period.”

During August and September, 334 ophthalmologists responded to the AMA survey. Key findings of the survey include:
• 72 per cent of cataract operations take more than 20 minutes.
• 62 per cent of ophthalmologists provide three post-operative follow up visits as part of the cataract surgery. Ten per cent provide four or more visits; and
• 81 per cent of private ophthalmologists contracted to provide cataract services to public patients will not be able to continue to provide these services if the contract payment is reduced as a result of the cuts to the Medicare rebate.

Medicare data shows that:
• 79 per cent of Medicare rebates for cataract surgery are paid to men and women over the age of 65; and
• More than 105,000 older Australians had private cataract surgery in 2008-09.

The Government falsely believes that cataract surgery can now often be performed safely in 15 to 20 minutes when 72 per cent of cataract operations take more than 20 minutes.

Sixty two per cent of ophthalmologists provide three postoperative follow up visits. These visits are included in the Medicare rebate for cataract surgery, a further 27 per cent of ophthalmologists provide two postoperative visits, and a further ten per cent provide four or more.

MBS fees for cataract surgery were reduced to reflect efficiency gains by 32 per cent in 1987 and reduced again by ten per cent in 1996.

The actual fees charged by ophthalmologists have increased on average by only 1.8 per cent p.a. between 1992-93 and 2007-08. This is a much lower annual increase than the average increase in CPI of 2.5 per cent p.a. or average earnings of 3.7 per cent p.a. over this same period.

Growth in MBS expenditure on cataract surgery is because there is more surgery being done – demand has increased by 7.3 per cent since 1992-93. In contrast, ophthalmologists’ fees have increased by 1.8 per cent p.a. since 1992-93.

More than half of Australia’s private ophthalmologists provide cataract services to public patients under contract. In almost half of these contracts, the payment is tied to the Medicare rebate. 81 per cent of private ophthalmologists contracted to provide services to public patients will not be able to continue to provide these services if the contract payment is reduced.

The proposed fee cut (50 per cent) from November 2009 taken together with the real 32 per cent MBS fee cut in 1987, the ten per cent MBS fee cut in 1996 and the low level of MBS indexation over the entire period, will effectively result in an 80 per cent total real cut in the government’s MBS fee for cataract surgery since 1992-93.

Opposition’s Response

According to Shadow Health Spokesman Peter Dutton, a recent Australian Medical Association (AMA) survey (see breakout story) showed the public hospital system would be stretched beyond its limits was even more reason for the Federal Government to “drop its harsh proposal to halve the Medicare rebates for cataract treatment. The Rudd Government appears determined to make people, mostly senior Australians, pay hundreds of dollars more for cataract surgery as it seeks Budget savings to pay for its reckless spending”.

He called on Health Minister Nicola Roxon to abandon the cuts “which were causing great anxiety” to those who need cataract surgery.

“The AMA survey refutes the Rudd Government’s basis for slashing these rebates and the worrying issue that emerges is that a significant number of ophthalmologists say they will no longer be able to afford to treat public patients. That means that more people will have to wait longer or even miss out on treatment that restores their eyesight, enabling them to remain independent and enjoy a good quality of life,” said Mr. Dutton.

Mr. Dutton added that if the Government went ahead with the rebate cuts, the Coalition with the support of independent Senator Nick Xenophon and Family First Senator Steve Fielding would disallow regulation to implement the Medicare rebate changes when they were presented to Parliament.

The AMA has also launched a scathing criticism of the “unfair and ill-considered” plan. It is concerned that patients may be forced to put off surgery to restore their sight, resulting in falls, possible fractures and depression.

The Royal Australian and New Zealand College of Ophthalmology (RANZCO) says that as the population ages, potentially every person in Australia will eventually develop cataracts and untreated cataracts are the leading cause of blindness in the world.

It points out that poor vision, as a result of untreated cataracts, can result in a greater risk of falls and fractures, social isolation and depression and the loss of ability to perform everyday activities. At least 120,000 Australian’s each year now have surgery which involves the removal of the cataract and the implant of a sight-restoring lens.

The result is dramatic. In more than 98 per cent of cases there is an almost immediate return to normal vision, but, if implemented, the Budget decision will cut the Medicare benefit in half, from about AUD$623 to AUD$312, making this vital surgery unaffordable for most pensioners and those without private health insurance.

Poke in the Eye for Pensioners

“Fee-free access to cataract surgery will remain available to veterans, but pensioners and others on low incomes will have to pay hundreds of dollars extra for their treatment,” said Antoine Mangion, Combined Pensioners and Superannuants Association (CPSA) Policy/Research Officer.

“The Government argues that this cut will prevent surgeons from rorting the system by charging excessive fees. However, the rebate cut will do far more than clamp down on a few rogues. It will prevent many surgeons from carrying out cataract surgery and result in potentially thousands of people on low incomes losing their eyesight.”

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