Author: Team

AMA and Private Health Insurance Duke It Out

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[vc_row][vc_column][vc_column_text]This week the battle between the Australian Medical Association (AMA) and the private health insurance industry continues with revelations in the Daily Telegraph of a leaked copy of the AMA’s list of fees showing that some doctors are charging well in excess of the AMA fee.

Dr Dwayne Crombie, Managing Director of Bupa Health Insurance says patients must be given the chance to have informed financial consent.

“The number one concern we hear from our customers is the affordability of healthcare and their anger when they have an unexpected out-of-pocket cost,” he says.

“This data highlights exactly why Bupa members want transparency around gaps fees.”

“While the majority of doctors are doing the right thing, patients should know when a fee is higher than usual and be able to question why that is so.”

“Any out of pocket costs, such as doctors’ fees or hospital fees, must be known in advance.”

In response AMA President, Dr Michael Gannon says “I think those doctors charging multiples above the AMA fee need to be able to explain to patients why that is the case. I’m very comfortable with an environment where patients talk about fees before they make an appointment. The most important question is, is your surgeon a no gap provider? Is the anaesthetist they use a no gap provider? I think that very simple information should be available to patients before they make an appointment. Doctors are often uncomfortable talking about money, and they often do leave that conversation to their staff at the front desk. But we do not stand behind egregious unreasonable fee setting.”

Further, on Monday, AMA President, Dr Michael Gannon launched the AMA Private Health Insurance Report Card 2018, provides an overview of how private health insurance should work to benefit patients, and explains how proposed new arrangements will result in less choice and value for policy holders.

“The AMA Report Card provides patients and consumers with easily understood information about the private health insurance industry and how it works, which will help them make informed decisions when buying a policy,” Dr Gannon said.

“Our Report Card shows that the profits of the insurers continue to rise, the growth of policies with exclusions continues to grow, and policy holder complaints continue to rise.”

“We explain what insurance may cover, what the Medicare Benefits Schedule (MBS) covers, and what an out-of-pocket fee may be under different scenarios.”

PulseLine will be interested to see if the Government’s forthcoming private health reforms deliver the much-needed transparency for consumers and puts downwards pressure on healthcare costs.

Last year the medical device industry signed an Agreement with the Government to deliver $1.1 billion in benefit reductions for private health insurers, in exchange for various reforms that ultimately are intended to provide patients better access to life-changing and life-saving technology. However now we’ve heard claims of the real “fat in the system”, claims that certain doctors contribute to more than $1.6 billion a year in uncovered gap payments and also private patients in public hospitals costing the system $1.1 billion. Reform in healthcare is clearly a hot issue and will continue to be as we hurtle towards the next Federal election.[/vc_column_text][/vc_column][/vc_row]

Domo Arigato Dr. Roboto

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[vc_row][vc_column][vc_column_text]The first use of robots in medicine, however, came much later. Robotic surgery originated alongside minimally invasive surgical techniques in an effort to improve sight of the surgical field, as well as extend dexterity beyond that of a surgeon’s hands in the confined spaces of the body. Surgical robots helped provide the fine-motor control and magnified three-dimensional imaging and depth perception generally lost in keyhole surgery.

In 1985, a surgical robot was developed for neurosurgical biopsies, and this was quickly followed by specifically designed equipment to assist in prostate removal and total hip replacements. The da Vinci® robot evolved out of work with telemedicine, and enabled a surgeon to work remote from the patient while directing robotic arms via controls and a display. It was FDA approved for laparoscopic procedures in 2000.

While robotic surgery offers considerable technical advantages over traditional laparoscopy, the improvement in patient outcomes measured in trials ranges from significant to marginal at best. When looking at clinical studies, the appropriate comparison is laparoscopic versus robotic-assisted, not open technique, which generally has a higher complication rate. Disadvantages of robotic surgery, in addition to the up-front capital and maintenance costs, include increased set-up and operating times, and the requirement for additional training. Cost is the key factor in any debate regarding the place of robotic surgery in modern practice.

Handmer and colleagues conducted a randomised study to demonstrate this point. They showed that despite the wide-spread ‘hype’ and adoption of robotic-assisted laparoscopic radical prostatectomy (RALP), Australian Fellowship-trained laparoscopic radical prostatectomy (LRP) surgeons achieve comparable functional outcomes to their robotic-assisted peers. Their advice to patients is to select a surgeon based on experience and trust rather than the ‘tech’ they use.

Private health facilities were early adopters of robotic technology in Australia with a da Vinci system installed at Victoria’s Epworth Hospital in 2003 to perform robotic-assisted radical prostatectomies. In 2008, the Royal Brisbane and Women’s Hospital (RBWH) became the first public hospital in Australia to have a da Vinci Surgical Robot purchased by government funding ($AU 3.5 million, at the time) and thus making the technology available to public patients. Hall and colleagues conducted a cost analysis at the RBWH comparing open radical prostatectomy (RRP) and robotic-assisted radical prostatectomy (RALP) and found, due to the activity-based funding formulas in place, the average expense of a RALP admission was approximately $AU 12K while a RRP cost the hospital $AU 2K on average. As indicated above however, that the readmission rate and associated costs for the open group were significantly higher than that of the robotic group. Although not included in his analysis, Hall surmised that these readmissions would impact waiting lists and so ultimately cost the hospital.

To justify its cost, robotic surgery is more suitable for patient groups where there is clear evidence of greater benefit, such as obese patients and those with cancer of the lower rectum, where space is extremely limited. Total knee replacement surgeries, where alignment and positioning of the prosthetic is critical to long-term performance and quality of life. The most obvious use for and benefits of robotic surgery in a country as large as Australia is as a technological add-on for telemedicine in remote and rural areas. For public patients in NSW, the wait has been a long one with robotic assisted procedures only becoming available in 2017 with the opening of the Surgical & Robotics Training Institute at Sydney’s Royal Prince Alfred Hospital. For many patients, robots will continue to be in the realm of science fiction into the foreseeable future.

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Is Australia’s Healthcare System Being Americanised?

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[vc_row][vc_column][vc_column_text]In a letter dated 23 February Bupa informed doctors that from August insured patients would only qualify for gap cover if they were treated at a Bupa-contracted hospital or day-stay facility, causing the Australian Medical Association (AMA) to warn of “US-style managed care” and policyholders to leave.

Last week the AMA Federal Council passed two motions against private health insurer Bupa over plans to change to its policies and coverage.

Dr Dwayne Crombie, Managing Director of Bupa Health Insurance, said he always supported maintaining the Medical Gap Scheme, as long as Bupa could confirm the hospital admission really was a pre-booked private admission.

“We’ve always recognised that a patient should be able to make the choice to receive a private experience in a public hospital, and in fact a public hospital may be the best setting to do so. So, we support patients and doctors and we believe that making sure any Bupa customer receives the private experience they are being billed for, is a good thing for all involved.

“When a patient is admitted to a public hospital as an emergency or acute patient and treated as a public patient, they should use Medicare to fund that treatment as it is designed to do so,” Dr Crombie said.

AMA President Dr Michael Gannon described the announcement as a big leap towards US-style managed care and he demanded a ‘please explain’.

“The fact that the change has occurred straight after a premium increase, straight after agreement was made to retain second tier rates for non-contracted facilities, and straight after an announcement by Government to work collaboratively with the sector on the issue of out-of-pocket costs, is unconscionable,” Dr Gannon said.

“The AMA will not stand by and let Bupa, or any insurer, take this big leap towards US-style managed care.

“The care that Australian patients receive will not be dictated by a big multinational with a plan for vertical integration.”

Bupa has and will continue to work to remove (or reduce) out-of-pocket costs for its customers, while at the same time tackling unnecessary waste in the system which is one of the many factors driving up private health insurance premiums.

If you’d like to watch Dr Dwayne Crombie response:

[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_video link=”https://youtu.be/gANQV-ET8Ls “][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]It will be interesting to see if the Government’s forthcoming private health reforms deliver the much-needed transparency for consumers regarding the myriad of confusing private health insurance products and transparency around out of pocket costs associated with doctors services and private hospitals.[/vc_column_text][/vc_column][/vc_row]

Johnson & Johnson Partners with Monash University on MedTech Commercialisation

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[vc_row][vc_column][vc_column_text]The partnering office, JJIPO@MONASH, will be the Victorian headquarters for Johnson & Johnson’s scientific, investment and commercialisation arms to identify medtech projects that can be partnered towards commercialisation.

Australia ranks fifth in the world for life science innovation [1] and Victoria is home to over 40 per cent of Australia’s ASX-listed health science companies.

Monash President and Vice-Chancellor, Professor Margaret Gardner AO, says the office demonstrated the university’s commitment to supporting new partnerships in biomedical innovation.

‘Monash University has established a world-class reputation for helping to solve some of the most pressing challenges of our time,’ she says. ‘The new Johnson & Johnson Innovation Partnering Office, which expands on our existing partnership with the Johnson & Johnson Family of Companies, greatly advances Victoria’s expertise in biomedical research, fostering new partnerships and innovation to create real and lasting impact worldwide.’

To mark the opening of JJIPO@MONASH, Johnson & Johnson and Monash University have announced the Victorian QuickFire Challenge: Driving Device Innovation, a joint initiative with the Victorian Government, to help kick off the search for new medical device innovation.

The three individuals or teams who submit the most promising medical device solutions in the challenge will be awarded funding from a total grant pool of A$300,000 provided by the Victorian Government to further accelerate their medical device innovations. They will also receive mentoring and special access to the Johnson & Johnson’s global network of experts in development and commercialisation.

JJIPO@Monash is the second partnering office that Johnson & Johnson Innovation has opened in Australia, following the success of the first Johnson & Johnson Innovation Partnering Office in Queensland ( JJIPO@QUT ), which was announced in 2016 in partnership with the Queensland Government and Queensland University of Technology.[/vc_column_text][/vc_column][/vc_row]

World Glaucoma Week

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[vc_row][vc_column][vc_column_text]Lois Barry is a 74-year-old Victorian who has suffered from glaucoma for many years. But thanks to a new minimally invasive surgery Lois is the recipient of micro-stent device to treat her glaucoma, potentially saving her eye sight.

Although there is no cure for glaucoma, with treatment, in most cases glaucoma can be controlled and further loss of sight prevented or delayed. Generally, there are no symptoms or warning signs in the early stages. The loss of sight is usually gradual, starting with side vision being lost before the patient becomes aware of any problems.

The primary problem in glaucoma is damage to the optic nerve, the part of the eye that transmits images we send to the brain. Although the exact cause of glaucoma is still unclear, it may occur when fluid cannot drain out of the eye, causing a build up of pressure inside the eye. The new minimally invasive glaucoma devices allow the fluid to drain out of the eye, relieving high pressure.

Glaucoma is the leading cause of irreversible blindness in Australia, affecting over 300,000 Australians, but it can be diagnosed with a simple eye test by an optometrist or ophthalmologist. During this week as part of World Glaucoma Week the Medical Technology Association of Australia, along with our ophthalmic members, will do our part in helping raise awareness.

According to a 2010 Access Economics report 75% of vision loss is preventable or treatable, but incredibly the economic cost to the Australian community was a calculated to be $16.6 billion in 2009.

Global advances in medical technology over the past 20 years have resulted in a 56% reduction in hospital stays, 25% decline in disability rates and increased life expectancy of approximately 3.2 years.

Technology allows patients to hear, to walk, to see, to live or to have a quality of life that they otherwise would not have. Innovation over the years has seen some critical devices develop from technologies that were lifesaving but their design and functional restrictions limited patients’ quality of life to technologies that now save lives and provide a high quality of life for patients.

Vision impairment can significantly impact the daily lives of patients in many ways such as reading and driving.

This week (12-16 March) marked World Glaucoma Week. PulseLine is supporting Vision 2020 Australia’s call to encourage all Australians to have regular eye tests, especially those with a direct family link to glaucoma, to help prevent and treat conditions like glaucoma.

Last year Lois along with her surgeon Dr Nathan Kerr spoke at an event in Parliament House to raise awareness of the life changing and lifesaving impact of medical technology.  The power and authenticity of her story left everyone, particularly our federal parliamentarians with no doubt, medical technology can change lives for the better.[/vc_column_text][/vc_column][/vc_row]

Getting the Best Value for your Buck

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[vc_row][vc_column][vc_column_text]Oxford-based, Professor Muir Gray of the Nuffield Department of Primary Care Health Services, describes the genesis of this movement in the United Kingdom as occurring in the aftermath of the 2008 Global Financial Crisis. The fiscal constraints on healthcare spending over previous decades that had spawned evidence-based decision making, such as the Cochrane collaboration, health technology assessment and quality improvement, were no longer adequate. The pressure on the system forced a new approach to maximising the value generated from the available, and often diminishing, resources.

An example of this approach in action is the recent National Institute for Health and Care Excellence (NICE) Guidance that recommends stopping the annual cystoscopy used to monitor bladder cancer patients for disease recurrence. The rationale being that patients will return if/when they experience symptoms, and there is no evidence on a population level that annual monitoring saves lives. Many other interventions that could be reduced without adversely impacting population health have been identified as part of a Choosing Wisely campaign. This same initiative was launched locally in 2016 as Choosing Wisely Australia and is being led by Australia’s medical colleges, societies and associations.  [/vc_column_text][vc_single_image image=”1653″ img_size=”full” alignment=”center”][vc_separator][vc_column_text]Value-based healthcare can be formally defined as a healthcare delivery model in which providers, including hospitals and physicians, are paid based on patient health outcomes. Less formally, the intent is to ‘achieve the best outcomes, do it with minimal cost and do not sacrifice quality’. The policy has now reached our national agenda with the recently published Australian Healthcare and Hospitals Association Blueprint for a post-2020 National Health Agreement titled ‘Strategies for outcomes-focused and value-based healthcare’. They advocate a whole of Government approach to primary prevention; the availability and utilisation of real-time, linked data; and most contentiously, the establishment of an independent national health authority distinct from the Commonwealth, and state and territory health departments, reporting directly to COAG, to support integration of health services at a regional level, and all within a 2-year time-frame!

In 2015, Anthony Scott, a NHMRC Principal Research Fellow based at the University of Melbourne, considered options for introducing value-based healthcare concepts into Medicare. Achieving value for money is difficult as the market for healthcare is unique: patients do not know the value of the care they receive; Governments become involved to address market failures and ensure equity of access; and resources are frequently misallocated. Scott considers best practice Medicare rebates for specialists; pay-for-performance for GPs and hospitals; re-assessing which items are included in the Medicare Benefits Scheme (MBS) and value-based payments for public and private hospitals. He concludes that re-aligning financial incentives targeted at health care providers is likely to be more effective than adjusting patient co-payments (perhaps a nod to the $7 debacle), and although changes to improve quality are possible, they will have little impact on slowing overall expenditure growth.

One primary care initiative currently being rolled out around Australia are Health Care Homes. These provide co-ordinated care for people with chronic conditions with the value-based payments different from a fee-for-service or capitated approach in which providers are paid based on the amount of healthcare services they deliver. Bundled payments are provided monthly depending upon the level of complexity of each patient’s condition (categorised by tiers).[/vc_column_text][vc_single_image image=”1657″ img_size=”full”][vc_separator][vc_column_text]The Medical Technology Association of Australia (MTAA) have organised a full-day Value-based Healthcare Summit to be held in Sydney on April 24. Value-based healthcare will be discussed in the Australian context from a variety of perspectives including the capture of real-world data to assess value; measuring Patient-Reported Outcome Measures (PROMs); the International Consortium for Health Outcomes Measurement (ICHOM) standards; and value-based healthcare in the public & private sector.[/vc_column_text][/vc_column][/vc_row]

Medicines Australia’s CEO, Milton Catelin, Announces Resignation

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[vc_row][vc_column][vc_column_text]Medicines Australia Chairman Wes Cook thanked Milton, stating, “On behalf of the Board and our members I would like to thank Milton Catelin for his contribution to the innovative medicines industry.”

‘Milton is leaving Medicines Australia following a period of significant transformation and growth for our sector.”

“As an industry body we have benefited from his leadership of a highly experienced team who together have delivered meaningful health policy outcomes, for example the successful negotiation of the modification of the Government’s skilled migration occupation lists.”

“Milton has also worked closely with the members of the Medicines Australia secretariat and member companies to build strong and meaningful partnerships with our stakeholders, culminating in the highly engaging PharmAus event at Parliament House in September last year”, Mr Cook said.

Milton Catelin thanked the Board for their support over the past 18 months.

“As a group of highly engaged Managing Directors, they have worked cohesively to support myself and the secretariat to achieve some outstanding outcomes,” said Mr Catelin.

“I leave medicines Australia and the innovative medicines industry at a time of great strength. We’ve worked hard to establish the Strategic Agreement and developed firm partnerships with Government. Importantly, we have also mobilised and united as a membership like never before,” he said.

“I am privileged to have been able to contribute to this extraordinary sector,”

“I’d also like to thank the MA secretariat and wider membership for their commitment. Throughout my tenure, I have witnessed a passion and dedication that highlights how meaningful this industry is to the health of Australians,” Mr Catelin said.

Looking forward, Mr Cook said, “Today, with a highly engaged membership and experienced Secretariat, Medicines Australia is incredibly well positioned to contribute to the development of good health policy in Australia.

“I sincerely wish Milton all the very best on his future and his important move back to the UK to join his family,” concluded Mr Cook.

A sub-committee of the Medicines Australia Board will now commence a process to recruit a new CEO.[/vc_column_text][/vc_column][/vc_row]

Q&A with Stryker’s own Kevin Lobo

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What differentiates Stryker from its peers in the healthcare/medical technology industry?

People are the magic of Stryker, and we have a unique culture that sets us apart.  We attract people who are passionate and driven to make healthcare better and improve lives globally.  Our employees are humble and hardworking and have earned numerous accolades as a great place to work, including being recognized for creating an environment that fosters diversity and inclusion.

We are intensely focused on customers and differentiate ourselves through an organizational model of business unit specialization.  Each unit has its own sales, marketing, R&D and business development teams that collaborate closely with our customers. This approach results in customer-driven innovation that improves the patient and customer experience.

How do you view your role and responsibilities in improving healthcare? What are some of the major areas in which you think you can make a significant difference?

We are guided by our mission—Together with our customers, we are driven to make healthcare better—and our values—Integrity, Accountability, People and Performance.

We are driven to improve outcomes for patients and caregivers. For example, our mechanical thrombectomy products, which remove clots from blood vessels in the brain, combined with better pathways for care for stroke victims, have the potential to significantly reduce disability and save lives. Mako, our robotic arm-assisted surgery product, enables surgeons to have a more predictable surgical experience when performing joint replacement surgery.  And our emergency powered cots help protect EMTs from back injuries when loading and unloading patients into ambulances.

What does innovation mean to you? How do you create a culture within the company that supports this, and how do you work with partners to move these innovations forward?

Customers and patients are at the heart of everything we do. We nurture innovation to solve customer challenges. That approach began with our founder, Dr. Homer Stryker, an orthopaedic surgeon in Kalamazoo, Michigan, who invented products in the local community hospital where he worked, all in an effort to better serve the needs of his patients.

Today, we collaborate with hospitals and healthcare providers to make sure we understand their practice environment, treatment protocols and unmet needs. Our deep understanding of our customers helps us design and manufacture products and services that make a difference for them. We also find new innovations through a disciplined approach to strategic mergers and acquisitions that allows us to further develop new technologies and integrate them into our product portfolio.

We have acquired over 40 companies in the past five years and have increased research and development spending significantly.  The result is a leading technology position in many areas such as hard-tissue robotics, 3D-printing of titanium, mixed-reality use by sales teams, and advanced imaging for minimally invasive surgery.

What’s your vision for the company over the next 5 years? What would you like it to be known for?

We’d like to be known as the global MedTech leader in Orthopaedics, Medical and Surgical Equipment, and Neurotechnology and Spine.   We expect to continue our impressive track record of growth by providing meaningful innovations to improve customer and patient outcomes. We think we can do that by attracting people who care deeply about making healthcare better and using their expertise to improve lives around the world.

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