Since the introduction of the Medicare Benefits Schedule (MBS) in 1984 there has never been a review which had the scope to examine all 5700 items on the schedule. The MBS lists the procedures that Medicare will pay a benefit for, along with the amount of that benefit.
Yesterday, the federal government released its first list of items which the review taskforce has recommended cutting from the MBS. Despite claims in the Sydney Morning Herald that 23 items will be cut from the MBS, the list has only been released for consultation purposes, no final decision has been made.
In the first list of items, 23 items have been recommended for removal. Many of these items have been superseded by more modern ways of diagnosing or treating illnesses, with many of the newer methods far less invasive. Some items were being billed separately to other items which should include the procedure and others were deemed unsafe.
Dr Brian Owler, president of the Australian Medical Association which represents doctors said that the medical profession supports the need for a review, but was concerned that I was primarily a vehicle to reduce cost rather than improve clinical outcomes. Dr Owler said doctors wouldn’t support changes which restrict services or increase out of pocket expenses.
Dr Owler also questioned the timing of the announcement, saying “It’s odd that the minister would put out a press release on the first things to be cut from the MBS in the heart of the quietest time between Christmas and New Year. We’ve seen that thing before, making announcements when people are away.”
Items being considered for removal are:
– Intravenous Pyelography: an X-ray of the kidneys, bladder and urinary tract using contrast medium. Has largely been replaced by CT and Ultrasound.
– Cholecystography: an X-ray examination using contrast medium of the gallbladder and bile duct. Has largely been replaced by CT and Ultrasound.
– Pelvimetry: measurement of the female pelvis in relation to a woman’s ability to deliver a baby. Has been replaced by X-ray and MRI.
– Bronchography: an X-ray examination of inside the lung after they have coated in a contrast dye. Has been mostly replaced by CT and bronchoscope.
– Vasoepididymography: involves a contrast dye into the vas deferens to examine the seminal tract in men. Has been replaced by ultrasound.
– Peritoneogram (herniography): Imaging used to detect inguinal hernias which do not show on physical examination.
– Venography: an X-ray of veins using dye which is continuously injected via a catheter into veins or bone marrow. Considered the gold standard for deep vein thrombosis but is rarely performed due to the invasive nature of the procedure.
Ear, nose and throat surgeries:
– Klockoff’s tests: four separate air conduction and speech discrimination tests to measure hearing which the clinical committee claims have largely been replaced by electronic tests.
– Glossopharyngeal nerve injection with anaesthetic. A procedure for numbing the throat and tongue. Usually billed in conjunction with uvulopalatopharyngoplasty and tonsillectomy. There are safety concerns about the procedure, which can lead to upper airway obstruction and diminished gag reflex.
– Cryotherapy to nose: use of extreme cold to treat to nasal haemorrhage. Can be claimed under a different item.
– Cryotherapy to turbinates: use of extreme cold to reduce mucosa of the turbinate (part of the nose which warms the air we breathe). The committee says that the procedure is outdated. Research shows that results of the procedure are temporary and inconsistent.
– Division of pharyngeal adhesions: An operation to the pharynx which can be claimed under another item.
– Direct examination of postnasal space (the area behind nose) with or without removing tissue. Has been replaced by endoscopic procedures and is usually claimed as part of another procedure.
– Direct examination of Larynx, with removal of tissue. Is often claimed in preference to more suitable items or for stroboscopy which isn’t currently covered by the MBS.
– Direct examination of the Larynx’s sub regions. Has been replaced by endoscope.
– Direct examination of Larynx with removal of tumour. Has been replaced by endoscope.
– Gastric hypothermia without gastrointestinal haemorrhage using a refrigerant. The committee says the procedure is obsolete.
– Gastric hypothermia with upper gastrointestinal haemorrhage using a refrigerant. The committee says the procedure is obsolete.
– Biliary manometry: measurement of pressure relating to bile ducts. The committee says the procedure is obsolete.
– Sigmoidoscopic examination under 45 minutes: rectal examination of lower intestine and application of heat or removal of polyps. The committee says the procedure is obsolete and may be claimed under other items.
– Sigmoidoscopic examination over 45 minutes: rectal examination of lower intestine and application of heat or removal of polyps, more than 45 minutes the original source. The committee says the procedure is obsolete.
– Treatment of habitual miscarriage: with injections of hormones, not administered via routine checks during pregnancy. The committee claims that the procedure is obsolete.
– Bronchospirometry: the study of gas exchanged from each lung separately by placing a catheter in one lung’s major air passage. The procedure has been replaced by more appropriate tests of lung function. The committee noted that the procedure is normally charged along with other items.