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Vitamin D mania puts pathology budget under pressure

The Federal Government has slashed its rebate for vitamin D tests after massive growth in the procedure helped drive a hefty blow out in Medicare’s budget for pathology services. The Government and pathology companies have agreed on a $3.50 cut in the Medicare rebate for vitamin D tests and an across-the-board 0.67 per cent reduction in all pathology rebates as part of efforts to claw back an over-spend of $72 million on all pathology services in 2011-12.

17 Dec 2012

The Federal Government has slashed its rebate for vitamin D tests after massive growth in the procedure helped drive a hefty blow out in Medicare’s budget for pathology services.

The Government and pathology companies have agreed on a $3.50 cut in the Medicare rebate for vitamin D tests and an across-the-board 0.67 per cent reduction in all pathology rebates as part of efforts to claw back an over-spend of $72 million on all pathology services in 2011-12.

Under the terms of the Pathology Funding Agreement struck between the Government and pathology firms in 2011, any blow out in the budgeted Medicare pathology rebate is to be recovered from future spending.

The agreement allowed for spending of almost $2.17 billion in 2011-12, rising by 4.9 per cent this financial year to $2.27 billion, and reaching $2.38 billion in 2013-14. Annual Medicare pathology rebate spending is expected to reach $2.63 billion in 2015-16, the fifth and final year of the deal.

But the surge in vitamin D testing is helping put these budget targets under pressure.

An analysis of vitamin D testing published in the Medical Journal of Australia earlier this year found that the number of such procedures grew by an average of 59 per cent a year last decade.

Underlining the impact on health spending, the study by Kelie Bilinski and Steven Boyages showed that Medicare Benefits Schedule payments for the test swelled from a little more than $1 million in 2000 to $96.7 million in 2010.

According to Catholic Health Australia, spending on vitamin D testing reached almost $130 million last year, a jump of almost 20 per cent in 12 months, vastly outstripping an average annual gain of 6 per cent across all pathology services.

The huge growth in vitamin D testing has come despite a lack of evidence regarding its efficacy for more than a small proportion of the population.

Vitamin D deficiency has been linked with a strong of conditions and diseases but, in a study published in the journal Clinical Biochemistry earlier this year, one of Australia’s leading vitamin D experts, Royal Perth Hospital endocrinologist Dr Paul Glendenning, pointed out that in most cases these associations were yet to substantiated.

“Many diseases are associated with vitamin D deficiency, but randomised clinical trial data demonstrating the benefit of un-activated sterol supplementation only exists for the prevention of falls and fractures,” Dr Glendenning and his co-author, Dr C.A. Inderjeeth, wrote.

“Consequently, 25 hydroxyvitman D (OHD) measurement should be restricted to high falls or fracture risk patients.”

Dr Glendenning and his colleague advised that, until there was consensus on the test as a target of therapy, “widespread adoption of screening programs and measurement of 25OHD in patients at risk of non-musculoskeletal disease is premature, costly and not supported by evidence”.

Catholic Health Australia sits on the committee that advises on the Pathology Agreement, and its Director of Policy, Patrick Tobin, said that, with the likelihood of further fee reductions across the pathology sector in future, growth in vitamin D testing “certainly deserves close scrutiny”.

AR

 


Published: 17 Dec 2012