Some new third party fee structures still don't pass muster with SMC a week ahead of deadline

File photo of a doctor wearing a stethoscope.
File photo of a doctor wearing a stethoscope.PHOTO: AFP

SINGAPORE - Third party administrators (TPAs), which usually represent employers or insurers who pay for a patient's treatment, have reconfigured their fee structures to meet a new requirement.

But with just a week more to the deadline for this, not all have passed muster.

This is according to a statement issued by the Singapore Medical Council (SMC) issued on its website on Friday (June 23).

Unless this issue can be resolved within the coming week, it could leave tens of thousands of patients whose medical care is paid for by insurance or by their companies, out in the cold.

SMC's latest Ethical Code and Ethical Guidelines 2016 stipulate that doctors have to stop paying TPAs fees that are linked to their bills.

To meet this new requirement, many TPAs have reconfigured their fee structure from a direct percentage of a patient's bill to different formulas.

 

But SMC said in its Friday statement that some of the revised fee structures appear to be tiered and based on the fees payable to the doctor, the amount claimable by the patient or on the Ministry of Health's (MOH) table of surgical procedures.

SMC said that while it is not against tiered fixed fee structures, they cannot be based on the doctors' services or fees.

So, it said "some of the revised fee structures - insofar as they appear to calculate the fees payable by doctors to the third parties based primarily on the services the doctors provide or the fees that doctors collect - will not be in compliance with the guideline when it comes into force on July 1".

The SMC again reiterated that fees should reflect only work done by the third parties. Doctors must be sure of that before entering into any agreements with TPAs, it said.

The reason for this, SMC explained, is its concern that such fees "will lead to rising medical costs for patients and/or a compromise in the treatment of patients".

It stated that any breach of this guideline will be treated seriously.

However, it appears that the SMC will not act unless it receives a complaint.

Said the statutory board: "Should the SMC receive any complaint or information that a doctor has paid a fee to a third party in breach of the guideline, the SMC will refer such complaint or information to the chairman of the Complaint Panel, and a Complaints Committee will inquire into the complaint or information."

Many patients, whose medical care is paid for by insurance or by their companies, could be affected if the matter is not addressed in time.

Doctors who used to be on various panels may fear providing such service from next month, given the lack of clarity on which TPA's fee structures would land them in the soup otherwise.