SIRA cuts workers' compensation surgeon fees

SIRA cuts workers’ compensation surgeon fees

18 July 2022

The NSW State Insurance Regulatory Authority (SIRA) has introduced workers’ compensation changes to reduce costly surgeon fees to market ra

The amendments aim to bring workers’ compensation surgical fees in line with rates set by the Australian Medical Association (AMA) and fees paid in the NSW motor accident scheme.

“Surgeons operating in the NSW workers’ compensation scheme have been receiving payments significantly higher than their own industry standard for many years,” SIRA Acting CEO Petrina Casey said.

“This change is about ensuring that every healthcare dollar spent delivers value and quality care, as the evidence shows that higher fees in NSW do not result in better surgery quality or access.”

Dr Casey says 80% of top-earning surgeons operating in the workers’ compensation scheme were already working on AMA rates despite being able to charge more.

SIRA says it will save between $26 million and $42 million in surgeon costs, which will be redirected back to the workers’ compensation scheme.

Other changes include removing loadings on surgical proceedings and consolidating surgeon fee costs into a single fee order.

The changes were first recommended in November last year as part of SIRA’s Review of Regulatory Requirements for Healthcare Arrangements aimed at improving fee setting and regulatory approaches to ensure affordable healthcare.