SIRA amends workers’ compensation surgeon fees

The State Insurance Regulatory Authority (SIRA) has corrected high surgeon and orthopaedic fees in the New South Wales (NSW) workers’ compensation scheme, effective July 01, 2022.

SIRA amended the fees because surgery rates in the NSW workers’ compensation scheme were dramatically higher than fees in the broader market. Therefore, the change brought workers’ compensation fees into line with the Australian Medical Association (AMA) rates and fees paid in the NSW motor accidents scheme.

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

Read more: SIRA to implement new publishing policy for NSW insurance schemes

SIRA revealed that 80% of top-earning surgeons in the NSW workers’ compensation scheme are already performing work at AMA rates in the NSW motor accidents scheme rather than charging more – returning savings of between $26 million and $42 million. However, the regulator amended the fees to improve regulatory and fee setting approaches to ensure injured people have access to value-based healthcare.

The changes form part of Regulatory Requirements for Healthcare Arrangements in the NSW workers’ compensation and motor accidents schemes and align with recommendation 35 of the McDougall Review to address excessive medical fees in areas where no benefit exists to injured workers from the fee disparity.

The fee changes follow SIRA’s announcement to implement a new publishing policy to improve the transparency and accountability of insurers and regulated entities in three insurance schemes in NSW.