AMA SA secures fairer anaesthetic fees
AMA SA has secured a win for anaesthetists. For the past 18 months, we’ve been working with ReturnToWorkSA (RTWSA) to help them understand that their anaesthetic fees have fallen well behind the pace of inflation. And now, they’ve heard us.
As a direct result of our advocacy and advice, RTWSA is proposing to increase most of its anaesthetic fees by 85%.
Please read the updated fee schedule below. There’s also an opportunity to provide your feedback through AMA SA.
AMA SA is campaigning to bring all RTWSA fees into line with the rates published in the AMA Fees List. An 85% increase to anaesthetic fees falls a little short of our goal, but represents a significant step in the right direction. Our work doesn’t stop here.
AMA SA works strategically with a range of stakeholders to influence the policies and decisions that affect all of our members.
Being a part of AMA SA ensures you have a seat at the table with groups like RTWSA.
ReturnToWorkSA is seeking to gazette fees for medical services for 2025-26, effective 1 July 2025.
The Return to Work Act 2014 (the Act) requires ReturnToWorkSA to consult with stakeholders prior to a fee schedule being published. This paper describes the proposed changes and fee calculation methodology and forms part of the formal consultation process. We invite your feedback throughout the formal consultation period, which will be for 5-weeks commencing Monday 24 February 2025.
ReturnToWorkSA will consider all feedback received before finalizing fees for 2025-26.
Please provide your feedback to providers@rtwsa.com by close of business Friday 28 March 2025.
Fee calculation methodology
The Return to Work Act 2014 requires ReturnToWorkSA to set fees based on the average charge to private patients for the relevant service. The amount fixed for the service must not exceed the amount recommended by the relevant professional association.
ReturnToWorkSA obtains data from Medicare Australia and the Private Hospital Data Bureau (PHDB) to calculate the average private charge for the relevant service, except for public hospitals and other non-gazetted services (such as remedial massage and aquatic & gymnasium facilities). The Medicare data includes both the Medicare scheduled fee and the actual charge raised by providers across Australia for the service (i.e. the gap charged in addition to the Medicare scheduled fee).
This enables ReturnToWorkSA to:
- derive an hourly rate/actual charge for services/items,
- compare year-to-year charges to determine the change in average private charge, and
- determine the percentage difference between ReturnToWorkSA fees and the average private charge.
Fees are then adjusted relative to these benchmarks.
Medical Practitioner attendance fees
ReturnToWorkSA has agreed to increase General Practitioner and Specialist attendance fees to the published Australian Medical Association (AMA) rates.
The following table illustrates the change in Average Private Charge (APC), ReturnToWorkSA’s fees compared to the average private charge and Medicare fees, and the proposed changes to ReturnToWorkSA medical fees for 2025-26:
In addition, ReturnToWorkSA may review the Medical 1B, Permanent Impairment Assessment Services and Independent Medical Examiner fee schedules and policies to ensure terminology is clear and accurate.
Dental Independent Medical Examiner fees
Dental Independent Medical Examinations are not currently provided for in the Independent Medical Examiner Services Fee Schedule. ReturnToWorkSA is proposing to introduce a dental IME fee for general and specialist dentists, as outlined in table 1.
The proposed fees align with hourly rates provided by the Australian Dental Association SA (ADA) and are comparable to other compensable schemes.
Anaesthetic fees
In 2023-24, ReturnToWorkSA commenced a review of anaesthetic fees in collaboration with AMA(SA). ReturnToWorkSA undertook a detailed analysis of Medicare charges to determine the average private charge and in doing so, identified that Medicare had not provided private charges for relative value units, modifier and incentive fees. Extensive consultation occurred with both the AMA and Medicare to better understand why these items were suppressed from the dataset and an amended request for the full dataset was submitted in July 2024. Despite this extensive consultation, the data supplied by Medicare did not contain private charges for these items and work continues to obtain the full dataset. Given the existing delay, an analysis was undertaken on anaesthetic items where private charges were supplied (matched items), representing 65% of all anaesthetic fee items. This analysis identified that ReturnToWorkSA’s fees were 85% lower than the average private charge. As a result, it is proposed to increase the matched items by 85%. Please refer to Attachment 1 for a list of fee items to be increased.
ReturnToWorkSA are continuing to consult with Medicare to obtain average private charges for the remaining fee items (relative value units, modifier and incentive fees) and will advise of any updates to the fee schedule when the necessary data has been obtained.
Next steps
To enable fees to take effect from 1 July 2025, ReturnToWorkSA will:
- consider all feedback provided by stakeholders
- seek the approval of the ReturnToWorkSA Board and the Minister for Industrial Relations and Public Sector to publish medical, allied health, and public and private hospital fees in the South Australian Government Gazette to be effective 1 July 2025
- provide a written response to feedback received following approval to gazette fees (late May/early June)
Further information
If you have any questions, please contact Elyse Lloyd, Regulatory Policy Analyst, Scheme Support on 8233 2172 or email providers@rtwsa.com.
