MBS Review implementation – a watchful eye on unintended consequences
BY ASSOCIATE PROF ANDREW C MILLER, CHAIR, MEDICAL PRACTICE COMMITTEE
Co-claiming attendance items with T8 surgical operation items
AMA surgical colleagues will be acutely aware that from November 1, 2017, subsequent attendance items (eg 105,116, 119 etc) have had a block put on them so they can no longer be claimed with Group T8 surgical operation items that has a schedule fee of $300 or more. The AMA has no issue with the principles behind this change as it is premised on the complete medical service rule, whereby the attendance component of the service is inherent in the surgical operation MBS item.
However, recognising that there may be instances where it is necessary for a subsequent consultation and an unrelated procedure to be claimed for the same patient on the same day, the November 2017 changes provided new items for attendances for such situations – that is, they are not inherently related to the surgical operation. Three new subsequent attendance items (111, 117 and 120) were introduced and can be claimed if during the attendance, the specialist or consultant physician determines the need to perform an operation on the patient that had not otherwise been scheduled, and the schedule fee for the operation is $300 or more. The new structure does not preclude claiming an initial attendance in association with a procedure; in recognition of occasions when treatment is urgent.
It was through the AMA’s engagement with its members that we determined that there was a gap in this new structure. It was clear that there were unforeseen consequences such as disadvantage to rural and remote patients; and where access block and workforce shortages applied – there was no consultation item that allowed for a planned procedure AND an attendance for another clinical purpose. Accordingly, the AMA worked closely with the Australian Department of Health (the Department), over the last 18 months, which resulted in the successful introduction of a new item (115) on April 1, 2019, that mirrors the intent of items 111, 117 and 120.
Item 115 can be claimed where there is a scheduled operation and a subsequent attendance item for an unrelated matter. It is important that the clinical purpose of the attendance is unrelated to the conduct of the procedure and that delay of the consultation represents a clinical risk to the patient. In all situations, the specialist or consultant physician must be satisfied that there is a clinical risk to defer the consultation for the patient to another time, and patient records clearly identify why the consultation is considered necessary for the patient, including the clinical risk to defer the consultation.
The Department has advised that item 115 would not be appropriate to be claimed where there is a routine review attendance and an unscheduled procedure such as a capsulotomy is performed as a result of the review. Similarly, 115 should not be claimed for routine extended consultations with procedures.
Thoracic Medicine - Respiratory and Sleep study items
On November 1, 2018, the MBS implemented changes to respiratory function test and sleep study items. The Department is planning a review of initial claiming data for the new and amended thoracic items. As part of this review process, the Department will consider any clinical or implementation concerns raised following November 1, 2018, through formal submissions from relevant organisations. The Department has advised that as some issues about implementation have already been raised, organisations such as the AMA should commence discussions around a possible submission ahead of the formal review.
If members wish to raise any significant issues (eg reduced patient access to services) with the new thoracic medicine items please report these to the AMA via Ms Tham Vo, Senior Policy Adviser at firstname.lastname@example.org
Published: 13 Jun 2019