Third-party administrators adjusting fees to heed SMC ruling

Third-party administrators (TPAs) are rushing, before the July 1 deadline, to come up with a new set of fees to comply with the Singapore Medical Council's (SMC) ruling that doctors should only pay fees that reflect the TPA's work.

The current practice is for TPAs, which usually represent employers or insurers who pay for the patient's treatment, to take a percentage of the total medical bill as their fee.

But the SMC's new ethics code and guidelines for doctors said "such fees must not be based primarily on the services you provide or the fees you collect" which, in general, would preclude payment of a percentage of the bill.

While the updated code and guidelines came into effect at the start of the year, a six-month extension was given for TPA fees to give doctors time to get out of their agreements, or for the TPAs to change the way they charge doctors.

Examples of new TPA schemes that doctors have been told about include fixed fees for different things, such as consultation and medicine; fees that vary depending on how complete the information given by doctors is, with those requiring to-ing and fro-ing being charged more; several tiers of fixed fees based on total bill or the type of treatment; or combinations of the above.

Fullerton Health, for example, said it will charge from $1.50 to $12 for a GP and $11.50 to $60 for specialist outpatient consultation.

New TPA schemes that doctors have been told about include fixed fees for different things, such as consultation and medicine; fees that vary depending on how complete the information given by doctors is, with those requiring to-ing and fro-ing being charged more; several tiers of fixed fees based on total bill or the type of treatment; or combinations of the above.

MHC charges different fees for consultation, procedure, drugs and tests. Consultation fees, for example, can range from $1.95 at a general practitioner clinic to $18 for a first consultation with a specialist.

Alliance Medinet has a tiered charge for GPs ranging from $1.90 to $32.80 for bills exceeding $8. For example, the fee for bills between $26.01 and $45 is $5.50. A doctor said those who charge the lower amount will be paying Alliance Medinet a bigger portion of the bill, which might get doctors to raise their bills to be near the top of the range, pushing up healthcare costs.

The widest-ranging fees are those for inpatient operations, which usually carry the biggest bills.

MHC is at the lower end with fees ranging from $20 to $180; Alliance Medinet charges from $25 to $440; and Parkway Shenton's iXchange charges from $100 to $1,000.

A spokesman for Parkway Shenton said its fees reflect the combined fees for both surgeon and anaesthetist, and not just for the surgeon alone.

Despite the changes to the TPA fee structure, some doctors have decided to opt out. Gastroenterologist Desmond Wai is one of them as he "didn't want to take the risk".

He is with three TPAs, one of which is iXchange. He said should he be asked by the SMC, he would find it difficult to explain why the fee he pays can vary by several hundred dollars, when each TPA is doing essentially the same work.

The various fee tiers, he said, mean "I'm still reimbursing the TPA according to what I do and charge".

As only a small part of his business comes from TPAs, he has decided "to opt out first and see what SMC does". If the SMC accepts the way TPAs now charge and does not take action against any doctor, he would go back to them.

For some doctors, however, the business they get from TPAs accounts for more than half of their patients. They have decided to stick with the TPAs.

They hope that with so many doctors still on such schemes, it is unlikely that the SMC would go after all of them, and feel it would be unfair for the SMC to pick on a few doctors.

A version of this article appeared in the print edition of The Straits Times on June 13, 2017, with the headline 'Third-party administrators adjusting fees to heed SMC ruling'. Print Edition | Subscribe