AMA Transcript - Medibank Private and Calvary hospital

Subject: Medibank Private and Calvary hospital

LEON BYNER: Thanks for joining us. Now, you've probably heard over the weekend, and you would've just a few minutes ago, that there's now a truce between Medibank Private and the people that operate Calvary Hospitals. And what people were concerned about, patients in particular, was that if this agreement hadn't happened there would've been, I suspect, considerable out of pocket expenses for any patients going into Calvary. It would appear that is not the case as of now. However, the Australian Medical Association have said look, there shouldn't be secrecy about this deal. We want to know some detail.

Let's talk to the CEO of Calvary Mark Doran. Mark, thanks for joining us today.

MARK DORAN: Good morning, Leon.

LEON BYNER: So Nick Xenophon brokered a meeting at Melbourne Airport which went on for some time as I understand it. What does it mean for patients?

MARK DORAN: It means exactly what you said. It's more a treaty than a truce. We're back to normal and we can now concentrate on looking after patients, staff and doctors. No out of pockets.

LEON BYNER: That's what I wanted to know. Because it was getting almost to the eleventh hour, there were patients wondering hey what's going to happen to me?

MARK DORAN: Indeed it was a very anxious time for everybody.

LEON BYNER: So, can you say any more than that? And the reason … I personally, I'm only interested in what happens for the patient, but you've got a very prestigious organisation - not the least of which is the AMA - saying we shouldn't have secrecy about this.

MARK DORAN: Obviously it is a commercial arrangement, and the conditions are confidential …

LEON BYNER: Yes.

MARK DORAN: … but put it this way: Calvary is remaining true to its mission and we won't compromise on our position when it comes to safety and quality. And if we weren't happy we wouldn't have signed, and if we weren't looking after our stakeholders we wouldn't have signed.

But I can tell you this much, that the so called list has subsequently been published by Medibank and they've welcomed feedback. And they've said publicly that they'll continue to modify that based on available evidence, and they will engage probably the most significant stakeholder, which is the Australian Commission on Safety and Quality in Health Care, when they publish their views on what they believe are preventable events. And they've also written to us and they're acting on the call for an independent clinical review process. So they're prepared to have an arm’s length independent review. In cases where they've been picked up by an audit and the hospital has felt it's done everything it could do possible to prevent a complication and we couldn't resolve it, then it can go to the independent umpire.

LEON BYNER: All right. Well, Mark, thank you for talking with us today. Mark Doran, who is the CEO of Calvary, who- and good on him for coming on. As I said, my concern was what happens about out of pocket expenses, he says there won't be any as per the arrangement.

Let's talk to the Vice President of the AMA, Dr Stephen Parnis. Stephen, good morning. Are you happy with what you heard?

STEPHEN PARNIS: Good morning. Look, I've heard a few things that are sounding like they're moving in the right direction, but it largely says, ‘trust us, we'll do the right thing by you.’ Now I'm a doctor and I don't say that sort of thing to patients anymore, I've got to give them the specifics. And I think Calvary and Medibank Private need to do the same here.

LEON BYNER: So what do you want Calvary and the fund to say that they're not saying?

STEPHEN PARNIS: We'd like to understand exactly what the arrangements are with regard to that long list of 165 complications that Medibank were erroneously calling mistakes, to understand what was going on with those as a result of this new agreement.

LEON BYNER: And you haven't been able to get any kind of information other than what we've heard this morning?

STEPHEN PARNIS: No, it's all commercial in confidence, and just what you've been able to get on that completed interview.

LEON BYNER: So how is the patient disadvantaged by not knowing more?

STEPHEN PARNIS: Well the concern, of course, is that- you know, if you're insured it's what detail tells you what you're covered for and what you're not, as well as for that matter the treating doctors need to understand what their patients will be covered for so that they can treat them in the appropriate setting. Up to now it's been hard ball by Medibank. We rarely intervene in these sorts of disputes, but because it has such wide reaching implications for the health system, both private and public, we have regarded this as essential that, one, it gets sorted out, and, two, that it does so in a transparent way.

LEON BYNER: All right. If you can't get what you're after, what then?

STEPHEN PARNIS: Look, we've got to keep pushing with that. I mean, one thing that I did hear from Mr Doran which was a positive was involvement of the Commission for Safety and Quality in Health Care. They're doing this the right way, where these complications are being assessed to try and reduce risk rather than what was happening up until Sunday, where Medibank was saying these are not complications, they're mistakes, and if they occur we're not funding them or we're dramatically reducing our funding. So we need more detail here because it doesn't just affect Calvary and it doesn't just affect Medibank Private. Every other player in the health system is watching on here, and if this sets a good precedent, wonderful. If it doesn't, then it's going to have repercussions for everyone.

LEON BYNER: So you're saying that unless we can find out … you see if other funds don't know, and you don't know, and we don't know, then it can't really set much of a precedent because nobody knows anything.

STEPHEN PARNIS: Well, that's it. And if I were a Medibank Private member I would have some trepidation when I'm going into hospital in case I still get one of those complications. We need to know what this means a little bit more than just, ‘trust us, it's going to be fine.’

LEON BYNER: Whose job it is to tell you do you think?

STEPHEN PARNIS: Well, I think, the involved parties. I certainly think that both Medibank Private and Calvary should be able to explain this to the relevant parties, and that's the patients and the doctors who treat them.

LEON BYNER: Well, surely, if you attend Calvary and you have a Medibank Private health policy you can ask them at the front desk, before starters, am I going to be in for any out of pockets for this?

STEPHEN PARNIS: Absolutely, but again the concern is when do you find these things out? We'd hate for them to be found out on the morning of planned surgery, or for that matter in a private hospital emergency department where someone comes in and then they later find out that their condition is not covered. So that is something that we can do without finding out at the last minute, I think.

LEON BYNER: All right. Stephen Parnis, thank you. Nevertheless, I guess in a general sense it's good news that it appears that if you are a Medibank Private Health insured customer then when you go to your hospital you will be covered as you were before. But I'd still ask.

31 August 2015

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