Doctors' fees: Administrators must change formula by July 1

SMC wants to stop fee splitting, where portion of charges is paid to third party

National University Hospital staff nurses and doctor moving a patient for a procedure to explore blockage of heart blood vessels.
National University Hospital staff nurses and doctor moving a patient for a procedure to explore blockage of heart blood vessels. PHOTO: ST FILE

Thousands of patients might find themselves with no access to doctors covered by their insurer or company unless third-party administrators (TPAs) make further changes to their practice by July 1.

That is the deadline given by the Singapore Medical Council (SMC) for doctors to stop using a fee structure where TPAs are paid a portion of the doctor's fees, a practice known as fee splitting.

TPAs are agents who represent employers or insurers who pay for a patient's treatment. They also help process medical claims on behalf of healthcare providers or doctors.

Until recently, they had charged their fees according to a portion of the doctor's bill, but this led to concerns that third parties may be profiting from patients who are being overcharged, or provided with unnecessary services.

In an advisory issued yesterday, the SMC said it is against fee splitting as it is concerned that such fees "will lead to rising medical costs for patients and/or a compromise in the treatment of patients".

The statutory board said that while most TPAs have changed the way they charge, these new formulas still 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 table of surgical procedures.

SMC said they will not be in compliance with the guideline when it comes into force.

This has led to concerns among doctors who have been asking SMC if some of the new fee structures are compliant.

SMC said fees should reflect only work done by the TPAs, and not what a doctor charges, among other things. If doctors are unsure, they should refrain from the arrangement since the "onus is on doctors" to comply, and any breach will be treated seriously.

Any complaint or information that a doctor has paid a fee to a third party in breach of the guideline will be referred to the chairman of the Complaint Panel.

The Academy of Medicine (Singapore), the College of Family Physicians (Singapore) and the Singapore Medical Association yesterday issued a joint statement strongly urging their members "to ask the TPAs to justify the... fees that are charged".

Dr Desmond Wai, a gastroenterologist in private practice, said the advisory has made it very clear that any form of fee splitting is out and that SMC would be strict about it.

He has left all TPAs and is facing difficulties explaining to TPA patients why he cannot see them from July 1 until the matter is resolved.

Dr S.C. Huang, an ear, nose and throat specialist in private practice, is with a few TPAs that cover hospital staff and blue-collar workers.

He said: "I'm not able to ascertain which TPAs meet SMC's guidelines. I will continue to treat these patients unless it becomes clear to me these TPAs are in breach of SMC (guidelines)."

Dr Chia Shi Lu, head of the Government Parliamentary Committee for Health, said the guidelines are "part of the effort to make medical fees more transparent and more affordable".

Mr Adrian Lee, chief executive designate of Parkway Shenton, said he agrees with the SMC stand and is "confident that our tiered fee structure fully reflects the effort done to process, adjudicate and support the administration of claims, and is aligned and compliant with SMC's guidelines".

A version of this article appeared in the print edition of The Straits Times on June 24, 2017, with the headline 'Doctors' fees: Administrators must change formula by July 1'. Subscribe