Financial Consent
The Commonwealth Government and the AMA both strongly encourage doctors to fully inform patients of any out-of-pocket expenses prior to any recommended treatment.
The Health Legislation (Gap Cover Schemes) Act (2000) requires doctors who participate in Gap Cover Schemes to provide written estimates, which in turn must be acknowledged in writing (i.e. signed) by patients. The AMA provides a proforma for such estimates which is available from their website.
The legislation accepts emergency treatment as a circumstance in which financial consent is not practicable, but in such cases doctors are required to inform patients of any extra charges as soon as is reasonable after the event.
Because it is not usual practice for Intensivists to see patients (including elective patients) prior to their ICU admission, a somewhat modified approach is necessary. After discussion with the AMA solicitor, the following recommendations are made by the ANZICS Practice and Economics Committee and endorsed by the AMA. Intensivists participating in Gap Cover Schemes should pay particular attention to these, as there is a legal requirement in these cases.
Elective ICU referrals
Regular referrers of elective patients should be informed that it is your usual practice to charge a gap fee, and you should provide an estimate of the typical amount of that gap. It then becomes the duty of the referring doctor to inform the patient of this additional cost. It may be convenient to provide copies of a printed explanation or to incorporate such an explanation in a more general information leaflet, which the referring doctor can provide to patients on your behalf.
For infrequent referrers, the recommendations for non-elective referrals are sufficient.
Non-elective ICU referrals
Under the legislation, these can be regarded as emergencies, but a reasonable effort to inform non-elective patients or their relatives of any gap charges should be made. Suggestions for this include appropriate signage or the provision of leaflets (as described above) in the ICU waiting area, preoperative wards or via the hospital admission clerks. Alternatively, such information can be provided directly by ICU clerical or secretarial staff. Information in writing is preferable, and should include an invitation to discuss with you any concerns about the gap charges. Written acknowledgement or signoff is not essential in these cases.