Trish: Hey Podcasters, I’m here today with Dr Anand Deva and Dr Deva heads what they call The Access Program which is an amazing program that’s available for some patients in New South Wales. I’m just going to pass straight over to him and he can tell us a bit about it and I’ll ask the questions that you guys have got in your mind. Welcome Dr Deva. How are you?
Anand Deva: I’m very well, thank you. Thanks for having me.
Trish: Thank you for taking time out. I know you’re in between cases in surgery and you’re about to do an access case now you said so thank you so much for taking this quick time and answering some of our questions.
Anand Deva: Sure, no it’s good timing. We’ve got a case lined up actually, she’s been waiting a few months now and we’re about to an abdominoplasty. She’s a weight loss patient. She’s lost over 70 kilogrammes of weight and it’s great to be able to offer her the surgery. It’s terrific.
Trish: Fantastic. Tell us about it. What is the access program?
Anand Deva: You say that I’m in charge of the access program and it’s probably not quite right. The idea came, I guess, a few years back when we started to look at Macquarie University at some of the factors that might block patients to getting surgery. I think if we live in Australia today, we’re seeing an increasing affordability gap. Some of the out of pockets costs, even if you’ve been paying your private insurance, premiums seem to be going up and up.
Access was formed when we sort of brainstormed ideas as to how we can make things work better. We are a not for profit at the university and so I think that gives us a very different mindset when we get into plastic surgery or aesthetic surgery because it’s got to be really clear at the outset that we’re not a business. We’re actually here to make the system better and to make patient’s journey through the health system better, more efficient and more cost effective.
When we began to look at these out of pocket costs, we said, “How can we help the right patient because a lot of people are paying their insurance premiums, month after month, stretching to make ends meet, but then when they go and see a specialist, the extra costs blocks them.” In effect, what Access has done is it’s unblocked it. Patients can apply online and the applications are assessed independently, not by commissions like myself. We don’t have anything to do with selection of patients. Once they pass the affordability test and they have adequate health insurance cover, then the good news is that there are a few of us now including myself and including colleagues like Louis Wessels in New South Wales and in fact a few other colleagues now in two states that are putting their hand up and saying for the right patient, we’re happy to reduce the out of pocket costs to ensure that these patients can get quality of life improving surgery.
I think this is great. It reflects a mentality, I think, that’s less commercial, that’s more driven through patient need and to me, that’s what health care should be. It’s about providing benefits to people when they need it.
Trish: Totally. I love that you’re making changes and creating ways in the industry, because it’s definitely needed. With the people that get quote selected, I know it’s an independent body that does it, what are the criteria? Why would they choose say, Mary, who’s lost 70 kilos over Jane who’s lost 80? How is that sort of-
Anand Deva: I think it’s a very, very good question. I think like with everything the demand is so huge and clearly any system we put in place, patients will say, “Why was the person chosen over me?” We have to start somewhere. The instrument that’s been designed online and the application form was done through Macquarie University so they’ve got some very clever people here that do online assessment of people’s ability to pay. It’s broadly stratified into combined household income and I’m not the best person to speak about numbers, because I’m not that good with numbers, but nevertheless, we’ve got a robust instrument that is used then to look at assets, household income, what sort of other financial stresses that are taken into account.
That’s, I guess, the first port of call. Once we’ve got some sort of stratification, then the patients that are most financially disadvantaged are given a green light to see one of us, one of the surgeons who’ve signed up with the Access program. I want to make it really clear that it’s not an automatic. I’ve seen patients through the Access program that are still smoking, for example. Now clearly, surgery like this needs to have patients skin in the game, it’s not just a simple reward. They have to show us that they’re willing to modify respectives that ensure a good outcome.
Certainly we see patients with weight loss surgery that are still losing weight. There’s no point doing surgery until they’ve reached a plateau and held a particular weight for a specific time. Once they’ve passed that initial access online assessment, they’ll be matched to a surgeon like myself. They’ll come in and see me in the office and we’ll talk about the surgery, the risks. Very clear in terms of the pros and cons and it’s only then that they’re offered a spot on the Access program through the subsidised costs.
We’ve thought about this a lot. We’ve thought about what is the fairest way to help these people. The demand is massive as you can imagine. What I’m really heartened by is a few colleagues now are starting to think like I do that there’s more to your career than simply a profit of making money. There’s another side to practising medicine. It’s something I think that sometimes get lost in the noise of the heady world of cosmetic surgery where people have huge demands of course for their procedures.
If just a few of us can start to think like this and put their hands up. As I said, I’m delighted we have surgeons now in other states coming to me and saying, “Look, we’re happy to do a few cases a month.” That’s all it takes, one or two cases a month. I do more than my fair share because I really believe in the program and … To succeed and pass on benefits.
Trish: Yep. It’s so honourable. How do you make your money then? Like my business, we not a not for profit, but-
Anand Deva: I think it’s always a balance. I don’t think anyone in medicine is starving. Do you know what I mean? I think we’re all trying hard. We spend time at university and there’s always people that are going to get sick and need a doctor. I think medicine is one of those professions that there’s a steady income. It’s a question of how much is enough? I think, for me, I made the decision a few years back that you give and take. At this stage in my life there are more important things than the bottom line so I can do things like this. Through altruism, through being a bit generous and I think that’s a good thing.
It’s a mindset, Trish, it’s not about making a sacrifice, it’s saying there are more important things and there are actually greater rewards than financial rewards in life, not just in medicine.
Trish: Yeah. Actually I totally agree. We work with closely with a plastic surgeon in Brisbane who we love sending people to him that are massive weight loss patients, because for him it’s not actually about the money and the absolute joy that he gets from transforming these people’s lives and I hear in his voice and I’ve seen him do surgery as well and it’s like, “Wow, it’s not actually all about the money.”
Anand Deva: You know what? I think these are some of the most grateful patients I’ve ever treated in my practise. I’ve been in practise for close to 20 years and patients are grateful, sometimes they’re not of course, but for these Access patients, it’s a door that’s open. That’s why I love the word Access. It’s like opening a door to these people. They thought they’d never be able to get the surgery they often send them to specialists and they’ve had a mild heart attack when they got the quote. To open this door for these patients, opens a lot of gratitude and as you said, they’re very grateful. They’re happy patients. It’s not an easy surgery, of course, but it’s given me, I guess, a really good reason to wake up sometimes in the morning.
As I said, we’re back on one this afternoon and she’s about to go into surgery. She’ll do well. The gratitude that flows from her and her case is payment enough for me.
Trish: They’re long surgeries too, these weight loss surgeries aren’t they? It’s not like an hour and a half-
Anand Deva: Yeah.
Trish: Breast augmentation or reduction, it’s like they’re hours.
Anand Deva: They’re complicated operations. There’s a lot of recovery time. There’s a lot of risk and there’s a lot of healing and scarring actually that patients need to deal with. It’s not a walk in the park by any means. You do need to hold these patients’ hand. They’re often in the hospital for three, four, five days and I can understand why colleagues charge a lot for these cases, because it is a lot of work. I’m not saying that that’s right or wrong, I’m just saying that Access offers a different way of thinking about it.
Trish: Yep. Tell me, you mentioned about some colleagues in other states doing it as well. Does that mean they come to you or you can access the Access program-
Anand Deva: Any doctor, if you go onto the Access website, accessprogram.org.au, if you’re a doctor and you want to put your hand up, look, we’ll take you with open arms. There is actually a doctor sign on form, so this is actually a call to all of my colleagues out there who want to do even one case a month is better than none. You can send the details through the form. Once again, it’s not me, but it’s the Access committee that would look at the applications and the credentials and the capacity to deliver some of these procedures and it’s as simple as that. Once you say yes, then Access will send patients that have come through the process and hopefully get them done.
My hope is that we are spreading now to other states. Obviously there are a few of us now doing it in New South Wales. I’m happy to say Queensland has one, maybe two hopefully in the next few weeks. Western Australia has one. South Australia has one. It’s slow and hard going and as you said, it’s politically a bit disruptive. I think some colleagues don’t see what I see which is fine, but for those that do, then come join us. I can only recommend it highly and the more surgeons that sign, the more patients we can do.
Trish: Of course. Also, what a great way to get some experience from a surgeon’s point of view, what a great way to get some experience working on massive weight loss patients because it is a different demographic. The skin is different, their nutrition is different. Everything’s different.
Anand Deva: It is, but I’d also caution it’s a not a training program. This is something that only professionally qualified and properly skilled surgeons can sign on for. I do think that there is some benefits certainly to colleagues that I guess are early in their practise. I’m a mere 20 years down the track, it’s not that I need more work, but I think some of my junior colleagues and young consultants who are starting. I agree with you, looking after these patients will teach you a lot about, not the surgery, but caring for patients through some pretty major operations.
The more skill and experience you get through your surgical career, the better surgeon you become. Yes, I see that aspect of it, but I want to also caution that it’s not a program that we do vet the surgeons very carefully.
Anand Deva: The last thing we want is to offer substandard quality.
Trish: Of course, of course. Yeah, no I’m thinking more of the mental state of the patient that’s been through the massive weight loss journey. They’re quite fragile and it’s a different patient.
Anand Deva: Oh, yeah, look, in some ways they’re quite fragile, but they’re very strong.
Trish: True, so true.
Anand Deva: I mean these patients that have really gone through … They’ve made, often, not just the physical and emotional commitment to fairly major surgery, but they’ve also been financially quite stretched. Some of the cost of bariatric surgery, in other words, the initial weight loss surgery have also been creepy up. I’m happy to say that as of actually last month, we’ve now signed on three bariatric surgeons in Sydney who are now willing to do the initial weight loss surgery on Access. You can see how this program will actually spread, not just for weight loss contouring and breast reduction, they’re the two procedures offered to date, but we will open bariatric surgery soon. We’ve got wait list of patients who’ve already applied and then we’re looking at other things like joint replacements, robotic prostate surgery.
The ideas that we’ve started here at Access are strong ones. They come from a pure motivation that we together through thinking differently and thinking less about a profit motive can actually help the system and help patients. My hope is that not just surgeons, but other procedures will start to be offered through Access. Slowly, but surely, we make the system more affordable and reset the gaps, we reset the financial criteria. This is, to me, a part of a much bigger picture Trish, as you may or may not know. I’ve obviously delivered a lot of work through translational surgery on breast implant surgery through many years. Ideas can actually affect thousands and thousands of patients.
Access is another part of a big health system change that we’re looking at in integrated care. We could spend another hour talking about that if you wanted to.
Trish: Yes, yes.
Anand Deva: It’s important to realise that it’s not just driven by me, it’s driven by like minded health care workers, doctors, nurses, administrators, governments now that are beginning to see that the current system is unsustainable. To continue to bleed patients financially to continue to hammer the insurance companies to continue to drive public hospital with increasing amount of chronic disease. These are big, big issues and if we don’t come to terms with it, these good ideas, we’re going to face completely unsustainable health care challenges as we go forward.
Trish: Of course. Tell me, I know that there’s lots of applications, so can you give me a percentage or a ratio of like at the moment what the capacity is like? What percentage of people who apply-
Anand Deva: Sure. Currently, I can give you some rough numbers. As I said, I’m not the right person to talk about numbers and in fact, I don’t see the applications. I’m not involved in the application process. It’s important for the robustness of the program, but that is completely handled separately by non-doctors. We don’t look at that. I can that on average roughly half the patients do not have adequate private health cover. I just pick a number, let’s say there 1,000 applications that come in over the next few months. We know that a lot of people think they have proper private health cover, but when we actually look into it, their policies don’t cover some of the surgeries.
A lot of the time Access will then contact them and say, “Look, we received your application, but unfortunately your insurance cover’s not adequate. There’s two courses of options, one is to stay where you are, but then Access can’t help you. The other is to go and increase your cover, which of course, will increase your cost.” It think that’s kind of a good guide as to roughly what we see. Then of course once they pass that, then it’s a question of what their affordability is and we’re targeting people with combined household income under 40,000 a year, which is remarkable, isn’t it?
They’re still paying for private insurance because they think it’s important, but yet their combined household income is low. These are patients we really want to help because they believe in the private health care system and we need to support them as best we can. They’re the ones which are being prioritised at the moment. I can say to you, as of today, there’s still a few thousand patients we need to get through. With the surgeons that are joining Access, we are moving patients more and more. I’m doing more than my fair share of this. I’m trying to do at least two to three a week which is a lot and it is a bit of a pay cut, but that’s fine.
Some of my other colleagues have started to lift their numbers, as well. I can’t stress enough that Access works through surgeons seeing what I see. If my colleagues are feeling altruistic and generous, please join us. The more surgeons we have sign up, the more patients we can start to move.
Trish: Absolutely, that sounds fantastic. Look, I won’t take up more of your time, but I’m going to ask you one quick question.
Anand Deva: Sure.
Trish: As far as health funds go, if you were to sign up … Because I get asked this all the time, if you were to go with a health fund or the top three health funds you think are the best in Australia, are you happy to share a couple of those names with us or … ?
Anand Deva: Once again I don’t want to be advertising go and join a health fund. That’s not my role. I think that the most important thing is there’s a lot of product and policies out there. I think the federal government’s trying to make it certainly a lot clearer in terms of the tier of cover. I think that the best way is kind of do it backwards. Access is quite happy to give patients item numbers to cover some of the surgery for weight loss surgery or breast reduction surgery and now for bariatric surgery. If you contact Access and you’re not sure, then Access can send you, these are the item numbers you need covered. Then I would go to each of the health funds and try and work out what policy, in terms of costs cover these items.
There’s no point in signing up for a policy applying for Access and then finding you’re not covered for these particular items. Short of recommending specific health funds, I think it’s important that you do your homework. Shop around because there are many different option, but ensure that the policy you buy covers what you actually want to get done. Usually, the wait time’s about 12 months.
Trish: Oh, that’s a great idea. Basically if they do contact Access or look on the website, you’ll actually see item numbers for what they might want done. Contact the different health funds and see who covers what and that’s probably your safest bet.
Anand Deva: Exactly. I’ll give you a proper example. Let’s say a patient wants a breast reduction and they’ve gone to see a colleague and say the gap’s 10,000 or something just for argument’s sake and they say, “Well, I can’t afford that.” They hear about Access so they go and log in. Oh, I don’t have health fund so then they can email Access and say, “Look, I’m looking to get covered for a breast reduction.” Access will send you the two item numbers and you can then take that information and go to maybe at least three or four different health funds, private health insurers and say, “Okay, what policy do I need and what are the options to cover this in 12 months?”
I’d go backwards. In other words, rather than sign up for something, then apply for Access and find 12 months later you’re still not covered. It’s really important to make sure the policy covers the surgical procedure.
Trish: Yep, that’s so true and what I might do is do a little article and list a couple of the item numbers as well so when people are-
Anand Deva: Yeah, sure, happy to share that for you. They’re standard item numbers. Very important to remember Access only covers, these are not cosmetic procedures, these are medical ones. It is based on procedures that improve quality of life and hopefully quantity of life too, if you lose weight.
Trish: Of course, of course. Thank you so much Dr Deva. I really appreciate your time talking to us today and I know that they’ll be lots of ladies and men out there that want to find out more.
Anand Deva: Absolutely, absolutely. If you need more information, I’d say go to the website www.accessprogram.org.au, I’m sure you’ll put that up and we’ve now finally scraped the pennies and we have staff now that can actually answer inquiries. I do apologise, for a long time it was kind of a bit solids on our side, but it was not because we were trying to be difficult, it’s just that to build programs of this cost money and so we were always out with cabinet. We’ve got some partners now around the table. Interestingly spoken to private hospital operators that are starting to help us. Obviously Macquarie University is supporting us. They came up with the program so there’s some funding that we can access there and then insurers, it’s been interesting. We’ve had early conversations with them.
They’re in really two minds. I mean, on the one hand, they’re happy to take premium payments, but when it comes to paying it out, it’s a different matter.
Trish: And then you got the lowest of the low where they send them overseas. That’s just like crazy, but anyway.
Anand Deva: This is a symptom of and I just read an article in the MJ about the latest private health insurance changes. When you look at health care, there’s so many different adversarial groups trying to fight out there. You’ve got private health insurers fighting with each other, fighting with surgeons. You’ve got surgeons fighting with colleagues. You’ve got public fighting with private. You’ve got private health operators fighting with industry in terms of joint manufacturers. You’ve got the regulator trying to whack a stick in. When you’ve been in health care for as long as I have, it’s this adversarial relationship that is actually now hurting the patient.
We’ve talked about a concept of cooperating across the divide. Cooperative alliances, is the term I’ve spoken a lot about in innovation forums in the last few years. We need a different mindset. Rather than going and saying, “Well, if I do this, I’m going to get this and you’re going to miss out.” In health care it’s about well actually, that sort of behaviour results in patients missing out. It’s not about who wins in this, right? It’s about how we can work across each of the sectors, build alliances where the system wins and the patient wins. We put ourselves last, that what should happen in health care.
Trish: Absolutely. There’s enough for everyone. That’s what I always say. There’s always enough for everyone, it’s kind of like … That’s true, it’s a jungle out there.
Anand Deva: Yes, it is. There’s little green shoots of innovation, lateral thinking, cooperative integrated thinking and hopefully, it’s not easy, I’m telling you, but we have to do it. It is an imperative.
Trish: Yep, chips away, chips away. Thank you so much for your time and listeners out there, so you can access the Access program at accessprogram.org.au. If you have any problems just drop me an email to firstname.lastname@example.org. Thanks Dr Deva, have a good day.
Anand Deva: Pleasure. Okay, terrific, see you.
Anand Deva: Bye.