Reversal of changes to MBS Cardiac Imaging Services that came into effect 1st August 2020

Reversal of changes to MBS Cardiac Imaging Services that came into effect 1st August 2020

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Dr Paul Lunney started this petition to Hon. Mark Coulton MP and

Dear Colleagues,

I seek your support for the following letter to be sent to our local Federal Member, Hon. Mark Coulton MP - Minister for Regional Health, and Hon. Greg Hunt MP - Minister for Health:

 

Re:         Changes to MBS Cardiac Imaging Services effective 1st August 2020

 

I write to you to express my concern regarding the recently introduced changes to the Medicare Benefits Schedule (MBS) Cardiac Imaging Services that came into effect on 1st August 2020. Specifically, I draw your attention to two shortcomings that threaten the ongoing provision of safe, timely, accessible and evidence-based patient care to all Australians, particularly those living in regional and rural areas.

 

1. Electrocardiography (ECG) changes

Item number 11700 (12-lead ECG, tracing and report) has been deleted, with a replacement item number 11707 (12-lead ECG, tracing only) being the sole MBS fee available to General Practitioners (GPs). ECG is an important diagnostic tool in detection and monitoring of heart disease and arrhythmia. It is frequently undertaken in primary care settings for appropriate evaluation of acute cardiovascular symptoms, surveillance of known heart disease and pre-operative assessment. The effective removal of Medicare support for GPs to undertake reporting of this investigation serves to:

i. restrict patients' access to medical investigative services previously readily available

ii. delay diagnosis and subsequent management of potentially life-threatening health conditions

iii. overload already stretched non-GP specialist services (particularly pronounced in rural and regional Australia) by necessitating all ECG reporting be undertaken by “specialist” or “consultant physician”

iv. promote increased primary care referral of patients to already overcapacity emergency departments for ECG investigation

v. de-skill GPs in ECG interpretation, a fundamental domain of professional medical practice

vi.  reduce Medicare funding from $27.45 to $16.15 for each ECG service rendered, producing a higher ‘’gap’’ or ‘’out of pocket’’ expense to the patient (given GPs’ duty of care may well necessitate immediate interpretation and action upon ECG results, despite no formal MBS recognition of this)

 

2. Echocardiograph changes

Item numbers 55113 - 55115 (echocardiographic examinations) have been deleted. These are superseded by the item numbers 55126, 55128, 55133 for echocardiography services referred or requested by GPs. Echocardiography is an important sonographic (ultrasound) investigation that is able to assess heart function in real-time. It provides important diagnostic and prognostic information surrounding structural, valvular and functional heart lesions, with application to most all cardiac health conditions. The restructure of MBS echocardiography listings effectively limits GP referral for this investigation to a rebate being payable to the patient once every two years (55126), with the exception of serial examination for valvular dysfunction (55128 – available to Modified Monash Model (MMM) 3 to 7 areas only); or isolated pericardial effusion/pericarditis or cardiotoxic medication monitoring for the purpose of PBS compliance only (55133).

 

This effectively removes the ability of GPs to refer patients under the MBS for serial echocardiography related to known heart failure or structural heart disease (outside of a two year period). This is extremely problematic, as it serves to:

i.  restrict and delay patients' access to appropriate diagnostic imaging in the context of primary care presentation with symptoms indicative of decompensated heart failure or deteriorating structural heart disease

ii. delay diagnosis and subsequent management of potentially life-threatening health conditions

iii. overload already stretched specialist cardiology services (particularly pronounced in rural and regional Australia) by disincentivising appropriate GP-based investigation, surveillance and evidenced-based management of heart failure

iv. promote increased primary care referral of patients to already overcapacity emergency departments for symptoms indicative of decompensated heart failure or deteriorating structural heart disease

v. impose increased healthcare costs upon patients by means of non-provision of Medicare rebate for clinically appropriate GP-referred echocardiography services (in the order of $234.15 per service)

 

Furthermore, the distinction between “GP” and “specialist or consultant physician” with regard to referred/requested services under the MBS is arbitrary and unnecessary, with the implication being that GPs are unable to render clinically appropriate, cost effective care. This is, quite frankly, absurd and insulting. It also undermines the stated Medicare objective to “reduce low value care” by in fact mandating greater patient referral to non-GP specialists and emergency departments for management of health presentations otherwise well within the scope of practice for GPs. This ultimately results in higher cost healthcare for patients and the health system alike.

 

These changes to Cardiac Imaging Services concern and disappoint me, with respect to the direct negative impact they will have on all Australians seeking healthcare. They are set to disproportionately disadvantage those living in regional Australia due to their relatively limited access to non-GP specialist medical services. To illustrate this point, I provide an example from Dubbo, where I practice:

i. the sole public cardiology service's books are closed (they are not accepting any new patients to their service)

ii. there is only one private cardiologist residing in town

iii. the remainder of cardiology service provision is rendered by fly-in-fly-out specialists, who for this reason are largely unable to fulfil care beyond planned routine patient follow up (and their already limited availability is further compounded by the current COVID-19 pandemic)

 

I implore your assistance in reversing these dangerous MBS changes and seek your commitment moving forward to safeguard against further erosion of Medicare funding. This is of the highest importance to ensure that healthcare remains accessible to all Australians – including those living in regional and rural communities – in a timely, affordable and clinically appropriate manner.

Yours sincerely,

 

Dr Paul Lunney

General Practitioner | Dubbo Family Doctors

Lecturer (Clinical Education) | The University of Sydney, Rural Clinical School (Dubbo/Orange)

BN MBBS(Hons) DCH CertPrimCareDerm FRACGP

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