Had a gutful

Well, it's kind of ironic that over the weekend there's been a small flurry of interest in the issue of non-admitted hospital patients being charged a fee in South Australian country hospitals (see The Australian p7 24/3/12)...and yet at the same time this issue arose locally.


I understand that the Minister of Health is not a happy bunny currently - being the Health Minister must be an unforgiveable job, especially when the budget is squeezed tight. 


And I've recently been criticised for raising this issue - on the basis that it's been going on for a while and may impact on doctor's hip pockets (some rural docs are doing OK charging a $50 gap for non-admitted patients and may be reluctant to see a change in the status quo). 


It's also a fairly intense time at the moment - the contract between Country Health SA and rural doctors remains 'in negotiation' - even though a finalised deal was supposed to have been in place by 30/11/11...and we are on our second 3 month extension. There may be anxiety that politicising this issue will affect negotiations.


I agree and think this issue transcends whichever party is currently in power.


Anyhow I was on for anaesthetics this weekend and was called in by the hospital for a 'cardiac arrest'. I arrived ahead of the A&E oncall doctor and the patient, who was transported by ambulance.  


Suffice it to say that when they arrived at the hospital, the patient was very much alive and indeed combative from another cause. 


After a quick ABC assessment I was stood down and left the patient in the capable hands of my A&E colleague. I understand that the patient left the ED some time later, discharged to the care of a capable adult.


Today I emailed the head of Country Health fee-for-service, asking how this attendance should be billed.


The response? Well, as the patient was not admitted, it is apparently 'a private matter between the patient and the doctor and CHSA is not liable'


I've had a gutful of this. I really don't mind being called in, whatever the hour, whatever the reason. If the hospital feels they need my services, and I am oncall, then I am available and will come in.


But to then turn around and say they won't pay?


Now, this will no doubt be sorted out after the usual barrage of emails to-and-fro until someone (usually the CHSA medical advisor) makes a determination. I will expend many hours chasing the debt, my BP will climb...but ultimately I will get paid.


But it is all so tedious and mind-mumbingly unnecessary. I am fed up with having to chase payment from a health service that seems to apply rules inflexibly and illogically.


I sure as hell am not going to charge the patient - they arrived by ambulance with four paramedics in attendance, two doctors, extra nursing staff etc and were transported to the appropriate place - a nice shiny hospital.


My expectation is that if the hospital feels a matter is urgent, and calls a doctor, then they should pay that doctor regardless of outcome, of subsequent diagnosis or of triage score. I think most common sense people would agree. However the wording of current arrangements opens the door to cost-shifting from State funds (public hospital) to the patient (Medicare reimbursement if compensable).


I don't care, I just want to get paid without fighting every bloody time!


Is this really so unreasonable or hard to understand?