Swiss billable-hour cap puts specialists’ earnings under scrutiny

A new cap on billable medical services is triggering protests from specialists, who warn that it could limit patient care. Under the rules, doctors will be able to bill a maximum of 12 hours of medical services per day, averaged over a month. SRF reported the dispute.

Doctors may continue working after reaching the limit, but they will not receive additional payment for their medical services. Cardiologists say the rule could leave them able to treat only six or seven patients a day. In an open letter to Federal Councillor Baume-Schneider, they warned that patient care could suffer.

The cap applies only to the medical service provided directly to a patient. Doctors may continue to bill separately for outpatient flat rates, emergencies, documentation, and accident patients whose treatment is billed through disability insurance.

Under the billing system, some services are paid according to the time actually spent, while others have a predefined billing time. Practices can also bill technical services, which cover costs including staff, rent, information technology, equipment and inexpensive supplies.

The 12 billable hours do not represent a full 12-hour working day. Other duties, including staff management, waiting time, administrative work, breaks, practice overhead and quality work, are included indirectly through a productivity factor. With productivity set at between 70 and 80 percent, 12 hours of billed medical services correspond to 15 to 17 hours of actual work.

Marjam Rüdiger, managing director of the Swiss Society of Cardiology and a co-signatory of the letter, said the cap would prevent doctors from providing certain services. She could not say how many cardiologists would actually be affected.

Gilles Rüfenacht, managing director of private clinic group Hirslanden, also warned that the limit could force clinics to postpone medically necessary examinations. He said some doctors could reach the cap as early as midday.

Christoph Kilchenmann, deputy director of health insurers’ association Prio.swiss, helped implement the parliamentary decision on the cap with the doctors’ association. He considers it unlikely that a doctor could already have billed 12 hours by midday.

“In that case, the doctor has either billed the patient too much or the tariff is wrong,” Kilchenmann said.

Outdated tariffs under scrutiny

Health economist Tobias Müller of Bern University of Applied Sciences said the statement points to a broader problem: some specialists may be able to bill substantially more time than they actually need and therefore earn more than intended.

Retinal examinations are a prominent example. Ophthalmologists can bill around 60 minutes for the procedure, although it now takes an average of only 10 to 15 minutes. They can therefore bill up to four times as much time as they actually need and earn accordingly.

Müller described the resulting charge as a “fantasy price” and said retinal examinations were not an isolated case. The tariff is outdated and based on rates from 20 years ago, he said.

He described the cap as a limit on reimbursement. Primary care doctors, psychiatrists and paediatricians would be little affected, while specialists could face a shock treatment and bill up to 40 percent less.

The dispute also highlights differences in earnings. Philippe Luchsinger, a former president of the primary care doctors’ association, said the current tariff allowed substantial income gaps. Specialists could earn up to 800,000 Swiss francs a year, compared with around 200,000 francs for primary care doctors.