Re: [ACPA] Fw: Generalist Fees
The aps did a survey some time ago that found non-specialist psychs charged more than specialists....citing overhead costs. Clin psychd were more likely to bulk bill less well off patients. This is considered by the 4+2s and possibly the aps as grounds for a 1 tier system...doha Is is adament 4+2s will not get a higher level of rebate... judy
sent from my Telstra NEXTG handset
-----Original Message-----
From: hardman.marie@bigpond.com hardman.marie@bigpond.com
Sent: Saturday, 4 September 2010 7:15 AM
To: Tony Merritt tony@sydneyclinicalpsychology.com.au; ACPA office@list.acpa.org.au
Subject: Re: [ACPA] Fw: Generalist Fees
Re: [ACPA] Fw: Generalist FeesHi Tony,
I couldn't agree more Tony in regards to the costs of running a private practice and the overheads etc. My point was that generalist psychs are charging $200 per hour in one practice that I know of, and there are probably more practices who do this.
A particular patient was referred to this practice and when she inquired about the fees, was told that the consult would cost $200.00. There was no consideration to bulk billing or even reducing the cost for this patient. She was told that she could 'pay off' the balance after rebate from Medicare. The estimated cost for 4 sessions was $800.00, and the rebate was only $313.60 from Medicare, leaving a balance of $486.40 for her to 'pay off'.
When I inquired about the cost and checked qualifications with the Board, not one of the psychs was a Specialist psych. I guess what Im saying is that I believe it is unethical for lesser qualified psychs to be able to charge the Specialist rate, even given the cost of running a practice. You obviously take the financial status of the patient into consideration with your fees. However, not everyone does this and it goes against the grain that 4 x 2 psychs are able to charge out at Specialist rates.
Of course, if a patient 'shops' around, they will find Specialist psychs like yourself who will reduce the fees for patients who cannot afford $200 per hour (and I have seen patients and just bulk billed as you do). As you point out, this then gives the patient an opening to see a Specialist psych at a reduced cost because the rebate is greater for the Specialist psych (and most of the Clinical Psychologists I know in private practice will reduce fees for patients who cannot afford the Specialist fees).
In this particular case, and Im sure there are others, as above, the patient could not afford to pay the consult cost of $200. I did manage to find a Specialist psych who did reduce fees such as you do. But I personally was amazed that this particular practice which consisted of only 4 x 2 psychs were charging $200 for a consult. Whilst we may like to think that money is not the motivation for seeing patients, obviously in some practices this appears to be the case. If fees were 'capped' for the 4 x 2 psychs, the opportunity to overcharge for a consult would not be an option.
Warm regards,
Marie
From: Tony Merritt
Sent: Saturday, September 04, 2010 6:26 AM
To: hardman.marie@bigpond.com ; ACPA
Subject: Re: [ACPA] Fw: Generalist Fees
Dear Marie
The difference in fee structure for generalists/specialists is particularly apparent but also important for low earning clients, those on disability pensions etc. In Sydney's inner west where my practice is located the rent and overheads are such that I could not run a practice by bulk billing clients at $80 an hour. You only have to look at the hourly rate for a public service clin psych to see how this is not a viable figure. In my practice we bulk bill /ATAPS about 25% of the clients at $117/$110 an hour and it really is not profitable to do so, but I do it because of my values and beliefs. My point is that the differential rate actually improves the chances, at least in metro areas, that the disadvantaged get to see the more highly qualified clinical psychs rather than generalists, because it is only the clin psych bulk billing rate that is even vaguely viable. Cheers Tony
On 3/09/10 10:45 PM, "hardman.marie@bigpond.com" hardman.marie@bigpond.com wrote:
Hi everyone,
I am forwarding Ray's email for everyone to see how much effort he has already expended in regards to fees charged by 4 + 2 psychologists, and the need to 'cap' the fee. I'm not certain of how fees are structured for medical practitioners, but I have the impression that there is a 'cap' for whatever service is provided. In the event that the patient is referred to a 'Specialist', then the patient will expect the consultation to cost more. For example, the Specialist's recommended fee maybe $250.00 for the initial consult, but the GP cannot charge $250.00 for a consult because they are not 'Specialists'. I believe it is generally accepted that a 'Specialist' will charge more for a consult than a GP.
Warm regards from Perth,
Marie
From: ray rudd mailto:ray.rudd@yahoo.com.au
Sent: Friday, September 03, 2010 12:58 PM
To: hardman.marie@bigpond.com
Subject: Re: [ACPA] Generalist Fees
Dear Marie
Yes, the overall situation with Better Access permitting 4+2 is unacceptable, and will of course require further sustained lobbying from our profession. Together with my colleague, Prof Henry Jackson, we have submitted to government on this issue since our appearance at the Senate Enquiry on Mental Health in 2005, prior to program inception, and again for the second enquiry in 2008 (see Senate web site for record of submissions). We have also written to the Minister DoHA, other Members, and others with a substantive MH interest. Henry was also in the Australian, when he and three other senior clin psych academics resigned from APS on this issue. Some senior psychiatrists have also criticised the program publicly, e.g., Prof Mendoza resigned; Ian Hickie in the Australian. Federal govt is not listening at this point.
After 5 years in which I have spent dozens of hours on this, I have been ongoing disappointed by my clin psych colleagues for their lack of action/lobbying Canberra on the issue. Sad. Continuing effort is still required, and it needs to come from as many clin psychs as possible because the more different voices the better. Can be done individually or through ACPA. Both is best. Judy has copies, I believe, of both UniMelb and UNSW submissions to the federal govt taskforce working on a plan for the national MH workforce. Those submissions say it all, including the need for salaried clin psychs in CMHC's as the main model, and a cap on fees if a fee for service model is to continue. I fully concur: as Henry says in his submission, Better Access was meant to provide better access for clients, not better access for psychologists to make money.
I encourage you and committed colleagues to continue making criticisms formally in writing to the Mental Health Division (or ?Branch) of DoHA. To that end, the academic submissions by UniMelb and UNSW to which I referred are very helpful.
If you wish, this email may be distributed to other ACPA members.
regards
Ray
--- On Fri, 3/9/10, hardman.marie@bigpond.com hardman.marie@bigpond.com wrote:
From: hardman.marie@bigpond.com <hardman.marie@bigpond.com>
Subject: [ACPA] Generalist Fees
To: "ACPA members" <office@list.acpa.org.au>
Received: Friday, 3 September, 2010, 4:28 AM
Hi All,
I'm not sure I've got the correct email, but I just thought I'd put something out there that I was reflecting upon in relation to the Medicare rebates for 'Specialist' and 'Generalist' fees; whilst the rebate maybe less for 'Generalist psychologists', there is nothing preventing lesser qualified psychologists charging consultations at the 'Specialist' rate. For example, a 4x2 'psychologist' charging $200.00 per hour. I know of 'psychologists' in at least one practice where the fee is $200.00 per hour and not one of the psychologists is a 'Specialist'. Even less incentive to complete Masters/Doctoral degree if the aim is private practice...Kind regards to all, Marie
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