I want to talk about fairness – or the lack of it.
My husband went to the dentist recently and had his six monthly check up. It took 30 minutes. He had an examination (it has a separate code), a clean (it has a separate code), a filling (it has a separate code) and the total of the bill was $298 and the rebate on that total was $259 therefore around $38 out of pocket (and the dentist very kindly accepted the rebate only for that). This cleaning of teeth and check up (and healthy rebate) with the dentist can happen twice a year. Pretty great!
Last year, I went to the podiatrist for a orthotic for my plantar fasciitis. The whole consultation took 20 minutes. I had an assessment (it had a separate code), a walk on the treadmill (it had a separate code), I had a cast made of each foot (pressed each foot into a foam box- it had a separate code) and then there was the making of the orthotic themselves (yep, separate code again). My total bill for this appointment was $715 and the rebate from the health fund was $400. Staggering amount of money for the pair of orthotics and 20 minutes but a very healthy rebate. This one consultation used up my complete podiatry allowance for the year.
When a patient comes to see a physiotherapist at our practice with pelvic floor dysfunction, we comprehensively assess the patient which most often includes amongst many other facets of an assessment, an internal examination because the pelvic floor muscles are situated on the inside of the pelvis (there is no separate code), there are measurements taken with a digital biofeedback device (no separate code), we comprehensively educate the patient about (for example) what is the normal bladder and bowel function (no separate code), and we comprehensively educate about how to treat what has gone wrong (no separate code). We regularly do a pre and post void residual measure with a real time ultrasound (no separate code). We regularly fit pessaries, a life-changing internal device for helping women with prolapse (again no separate code!)
The codes available to us at the rooms: Initial consultation 500, subsequent consultation 593 (or 505 depending on your health fund).
When I see a new patient, especially if the patient has a pain condition, it takes a minimum of an hour and more often is 1.5 even 2 hours to help that patient. The charge for an initial consultation to see my physios is $195. The patient receives a rebate of $35. They are $160 out-of-pocket.
This is grossly unfair for the patient.
Should I charge less?
The overheads at our practice are huge. As I said, we fit pessaries (we have many different types of fitting kits for patients to try to a large stock of pessaries so patients can leave with their pessary) and we have a steriliser for these pessaries. We have two secretaries on most of the day. We give a 15 page handout to the patient to assist them with remembering all the information they have learnt; a copy of my book; a witches hat to allow the patient to do a bladder diary; plus if they have a pain condition they will get a specific pain handout and perhaps depending on the severity of their pain/anxiety also maybe get a 50 page booklet on managing pain and anxiety.
I could go on about the continuing education that my staff and I undertake each year. For example I am about to do a Norman Doidge 2 day workshop $760; an Explain Pain course (my 4th one- I do one every 3 years because they are so fantastic and the research is updating all the time) $1250 – it’s in Melbourne, so there’ll be airfares, accommodation etc; our CFA National Conference in Hobart – it’ll be around $700 plus airfares and accommodation to name just a few – last year I went to Florence for the International Continence Society 4 day conference. Was it amazing? Absolutely. Did it change and enhance my practise with patients? Absolutely. There are many, many others but I want to get to the point.
The point is that the Health Funds do not recognize the complexity of pelvic floor dysfunction and the time involved in seeing these patients.
The point is that the health funds do not value treatment of pelvic floor dysfunction the way they obviously value good healthy teeth or getting an orthotic for your foot.
What I can’t understand is they don’t see the health burden of pelvic floor dysfunction.
They don’t recognise the tremendous value in investing in preventative health measures like we offer patients.
If women can’t run or exercise properly because they leak urine or faeces or they have prolapse, then their cardiovascular health, their bone density and their general body strength will be compromised. It is a much bigger health issue. It affects Australia’s bottom (financial) line.
If women can’t have sex with their partners because they have vaginal pain, then their relationship is put under strain. The mental health of each partner may suffer. The relationship breaks down and then the children suffer. It becomes a much bigger health issue and it affects Australia’s bottom (financial) line.
If men leak urine or have pelvic pain and subsequent sexual dysfunction, it severely affects their mental health. It affects Australia’s bottom(financial) line.
As Professor Julius Sumner Miller used to say
Why is it so?
Professor Julius Sumner Miller