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How changes to the Medicare Benefits Schedule could improve the practice of cardiology and save taxpayer money

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The Australian Medicare system is a government-funded fee-for-service system that is highly regarded by the general public. A major advantage of the system is that low-income non-insured patients have ready access to approved ambulatory medical services at little or no cost to them, with public inhospital care provided at no charge. However, a disadvantage is the potential for over servicing. This may occur when new technology or new knowledge lessens or eliminates the indications for a test, without such a development being reflected by a change in the criteria for the particular Medicare Benefits Schedule (MBS) item number. In these circumstances, a medical practitioner may disregard advances in the medical evidence base and continue to practice in the same way, particularly if it is financially advantageous to do so. The examples we discuss in this article reflect this phenomenon. Computed tomography coronary angiography (CTCA), a new, safer and much less expensive technology, should replace invasive coronary angiography (ICA) for the diagnosis of coronary artery disease (CAD), but based on Medicare item reports for 2010–2014,1 this is happening only slowly. Measurement of the fractional flow reserve (FFR) clearly improves the practice of percutaneous coronary intervention (PCI) and saves both money and lives; however, the uptake in Australia has been slow.1 A nuclear stress test has a high…

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