Informed Financial Consent Policy - Royal Australasian College of by linxiaoqin


									                                                                     Royal Australasian College of Surgeons
Manual:                Policies and Procedures                             Ref. No.:          FES_PST_2027_P
Division:              Fellowship and Standards                            Approval Date:     OCTOBER 2006
                                                                           Review Date:       OCTOBER 2009
Subject:               INFORMED FINANCIAL CONSENT POLICY                   Revision No.:      0
                                                                           Page:              1 of 4


This policy outlines the College’s position on Informed Financial Consent


As a fellowship based organisation, the Royal Australasian College of Surgeons commits to ensuring the
highest standard of safe and comprehensive surgical care for the community we serve through
excellence in surgical education, training, professional development and support.

3.        VALUES

      •   Service and Professionalism
              o       performing to and upholding the highest standards
      •   Integrity
              o       upholding professional values
      •   Respect and Compassion
              o       being sympathetic and empathetic
      •   Commitment and Diligence
              o       being dedicated, doing one’s best to deliver
      •   Collaboration and Teamwork
              o       working together to achieve the best outcome
4.        BACKGROUND

          The RACS considers that it is a professional responsibility of surgeons to obtain informed
          financial consent from their own private patients and to facilitate the obtaining of informed
          financial consent in relation to other practitioners involved in an episode of surgical care.

5.        BODY OF POLICY

5.1       The Royal Australasian College of Surgeons’ Position

5.1.1     The RACS fully supports the principle that surgeons should obtain Informed Financial Consent
          prior to any medical treatment, including any elective procedures, and emergency procedures
          where this is practicable.

5.1.2     The RACS believes that by providing information to patients in advance, the imparting of likely
          financial implications of the proposed treatment is sound ethical, professional and business
          practice. It indicates respect for individual patients and their rights, and avoids negative
          perceptions of private medical practice.

5.1.3     Wherever possible the surgeon should give the patient sufficient information regarding his or her
          likely fees and the associated recoverable expenses so that the patient is able to make an
          informed financial decision prior to the provision of medical services.

5.1.4     The principle of Informed Financial Consent should apply to all medical services for which a fee
          can be charged but is most critical in relation to medical services provided to privately insured
          patients in hospital and in circumstances where there is potential for additional costs to be
          cumulative. With such in-patient services, fees and additional costs tend to be larger and the
          patients are less likely to have an appreciation of the potential costs of particular procedures and
          of the proportion of fees covered by Medicare and their private health insurers.
                                                                 Royal Australasian College of Surgeons
Manual:          Policies and Procedures                                 Ref. No.:           FES_PST_2027_P
Division:        Fellowship and Standards                                Approval Date:      OCTOBER 2006
                                                                         Review Date:        OCTOBER 2009
Subject:         INFORMED FINANCIAL CONSENT POLICY                       Revision No.:       0
                                                                         Page:               2 of 4

5.1.5   The RACS strongly supports the voluntary implementation of Informed Financial Consent
        policies and practices in Australia. It is recognised that in New Zealand the situation is covered
        by the Code of Health and Disability Services Consumers’ Rights.

5.1.6   The RACS is opposed to the introduction of legislative or regulatory requirements in Australia
        that place a direct legal requirement on surgeons to obtain Informed Financial Consent from their
        patients or includes sanctions for non compliance, and considers such legislative compulsion
        unwarranted and inappropriate.

5.1.7   The RACS will strongly support the principle of Informed Financial Consent, and assist its
        Fellows to maintain or (where necessary) improve their practices and procedures.

5.1.8   Further, the RACS will work cooperatively with government, health funds, private hospitals and
        the private health insurance industry to promote the voluntary adoption of appropriate Informed
        Financial Consent practices in Australia.

5.2     Recommendations on Informed Financial Consent Procedures and Practice

5.2.1   Informed Financial Consent is the dialogue undertaken between the surgeon, or his/her
        representative, and a patient so that the patient understands –

        (a)    the potential fee for the surgical procedure;

        (b)    the potential fee associated with other medical providers in the procedure, including
               anaesthetists, assistant surgeons, pathologists, radiologists and allied medical

        (c)    the potential rebate for the services from Medicare and/or to the patient’s private health
               insurer. The situation in New Zealand with respect to reimbursement is different, however
               the principle is the same in both countries.

        However, where there are fees associated with other professional services, it is not the
        responsibility of the surgeon or his/her representative to provide specific information on the fees
        for these health care professionals.

5.2.2   The surgeon may engage an assistant surgeon and if so should inform the patient that

        (a)    an assistant surgeon will be present

        (b)    a fee will be involved, and how this will be billed (either as part of the surgeon’s
               fee or as a separate bill from the assistant directly)

5.2.3   The surgeon’s rooms should provide contact details where possible, of the assigned anaesthetist
        or the anaesthetic practice group to the patient, along with the suggestion that the patient
        contacts the anaesthetist for detailed financial and other information. Whilst precise information
        may not be available initially as to the exact anaesthetist involved, information should be
        provided when this becomes clear.

5.2.4   The surgeon’s rooms should notify the relevant anaesthetist or anaesthetic practice of patient
        details promptly once the patient is booked for the procedure. In this way, the anaesthetist can
        then forward the appropriate financial and other information to the patient prior to their admission
        to hospital;

5.2.5   Part of Informed Financial Consent includes advice given to patients in the public system who
        may wish to discuss alternate venues for care. This involves uninsured or self insured patients
                                                                    Royal Australasian College of Surgeons
 Manual:            Policies and Procedures                                 Ref. No.:           FES_PST_2027_P
 Division:          Fellowship and Standards                                Approval Date:      OCTOBER 2006
                                                                            Review Date:        OCTOBER 2009
 Subject:           INFORMED FINANCIAL CONSENT POLICY                       Revision No.:       0
                                                                            Page:               3 of 4

           and those who have private health insurance who have come to the public system in a variety of

           Surgeons should give accurate advice about waiting times in public hospitals and accurate
           information about the alternate forms of care and the subsequent costs. There should never be
           coercion (or the impression of coercion) for patients to be treated in the private health care

 5.2.6     As a result of this information the patient would be expected to have an indication of costs in
           writing of what his/her additional costs might be, subject to variations in fee estimates due to
           unforseen circumstances, and variations that may be necessary in the course of the procedure
           that may vary the fees incurred.

 5.2.7     The RACS recommends that wherever practicable:-

           (i)     information about fees and charges for proposed in-patient surgical services should be
                   provided to patients in writing;

           (ii)    the surgeon obtain a signed acknowledgement of receipt of the consent from the patient;

           (iii)   there be an acceptance to pay the fees disclosed.

 5.2.8     It is important that surgeons provide patients with an indication of associated Medicare (in
           Australia) and private health fund rebates to the extent that they are able. This is in addition to
           disclosing their fees and charges for proposed procedures. The information provided should
           include the relevant Medical Benefits Schedule (MBS) Item Numbers for each of the proposed
           procedures involved and the fee for each procedure to enable the patient’s health fund to confirm
           the level of rebate that will apply. This also gives the patient the ability to consider any financial

           Such information should always be accompanied by the advice that indications of rebates are
           based on what normally applies, and each patient should confirm his/her own entitlements with
           their health fund.

           Even where the medical practitioner proposes to use a health fund “gap” cover scheme where a
           “known gap” applies, it is important to include the above caveat and advice about the likely gap.

 5.2.9     The RACS also feels that it is good practice to disclose financial interests in facilities where the
           medical treatment is to be provided and where investigations are to be undertaken etc.

 5.2.10 Wherever practicable, information should be provided in advance of the proposed treatment to
        allow the patient to confirm both the Medicare rebate and the private health insurance rebate if
        they wish.

5.3      Prostheses Charges

         Whilst the vast majority of surgically implanted prostheses and devices are covered under the
         Private Health Insurance Scheme and attract full health insurance coverage, some prostheses may
         involve less than full insurance cover with a gap to be paid by the patient.

         Under these circumstances it is important that the surgeon informs the patient of the expected
         extra charges on the prosthesis and why this is the situation.

5.4      Emergency Care
                                                                Royal Australasian College of Surgeons
Manual:          Policies and Procedures                               Ref. No.:          FES_PST_2027_P
Division:        Fellowship and Standards                              Approval Date:     OCTOBER 2006
                                                                       Review Date:       OCTOBER 2009
Subject:         INFORMED FINANCIAL CONSENT POLICY                     Revision No.:      0
                                                                       Page:              4 of 4

      With a number of emergencies and exceptional circumstances there will be an occasion, for
      example an emergency admission, where it will not be possible to obtain Informed Financial
      Consent before the service is provided. In these cases, information about fees and additional costs
      should be provided to the patient as soon as possible after the service is provided or to relatives
      and family members at the time of admission.

This document does not constitute legal advice. It is also recognised that there are different requirements
in Australia and New Zealand.
This document has been prepared having regard to general circumstances, and it is the responsibility of
the practitioner to have express regard to the particular circumstances of each case, and the application
of this document in each case.
Professional documents are reviewed from time to time, and it is the responsibility of the practitioner to
ensure that the practitioner has obtained the current version. Professional documents have been
prepared having regard to the information available at the time of their preparation, and the practitioner
should therefore have regard to any information, research of material which may have been published or
become available subsequently.
Whilst the College endeavours to ensure that professional documents are as current as possible at the
time of their preparation, it takes no responsibility for matters arising from changed circumstances or
information or material which may have become available subsequently.

Approver        Directors
Authoriser      Council

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