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21 Sep 2015

The MBS Reviews Roundtable hosted by the AMA in Canberra last month produced a united front across the medical profession on how to participate in, and respond to, the Government’s Reviews of the Medicare Benefits Schedule (MBS).

The Reviews are due to report back to the Minister by the end of the year. In the meantime, the profession has some concerns that need to be aired – and have been, directly to the Minister.

The AMA is concerned that the Reviews will be undertaken in the absence of an overarching vision and specific direction for the Australian healthcare system to guide the final outcomes. 

In addition, as there are no specific and quantifiable aims, other than delivering better patient outcomes, there is a risk that the scope of the Reviews will extend into dangerous territory, whereby the fundamental structure of our healthcare system will be interfered with.

We have learnt that the Reviews will now also consist of groups to review “macro issues and rules”, and that this will consider issues such as referral arrangements and the potential removal of surgical assistance fees.

Given that the referral arrangements are the most fundamental feature of our healthcare system, providing the gateway to clinically necessary tertiary care, it is incredible that such a change might be contemplated in an environment where the Government wants to reduce expenditure. 

In addition, the surgical assistance fees support the very basis of vocational training in Australia. Removal of them will have a significant impact on the training opportunities and, therefore, the future medical workforce. It is equally incredible that a change to these arrangements is being contemplated.

On both these issues it is not clear what the objective is, and therefore why they would even be on the table for review.

The profession is very concerned that the working groups will not comprise a representative from the relevant specialist college, association, or society.

While working group members will be able to “confer with colleagues”, it is more appropriate for professional organisations to be formally included in the working groups. We believe this is critical to professional buy‑in to the outcomes of the Reviews, as well as continuity of the professions’ participation in the ongoing maintenance and management of the MBS into the future. 

The medical profession supports an MBS that facilitates patient access to evidence-based modern medical procedures and practice. This cannot occur if the review process is limited to removing obsolete and infrequently used items, and working groups are not able to consider and recommend the inclusion of new items on the MBS.

While there is scope to update items, this may not always be the best way to bring the MBS up to date, and the objectives of the Reviews will be only partly achieved. 

In many cases, completely new items for procedures that have evolved in the 20-plus years since they were first included on the MBS will be the only sensible outcome.

If this is not resolved, the Reviews could thwart patient access to services that have been provided for several years, even though they are not explicitly catered for in existing items. If the rapid review questions are appropriately framed, these services should be substantiated by the relevant literature.

There must be capacity to include new items on the MBS as a result of the Reviews, which does not involve a full health technology assessment and consideration by the Medical Services Advisory Committee.

The AMA will be vigilant, to say the least.


Published: 21 Sep 2015