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Managing the AMA List

The AMA List of Medical Services and Fees (the List) plays a significant role in lobbying Government on what it costs to provide medical care. It also provides an important and valuable tool for doctors to assist us with our fee setting and indexation.

Historically, items in the List have broadly aligned with items on the Medicare Benefits Schedule (MBS) by applying Government decisions for funding of medical services as amendments and additions to the List.

But the Government’s increasing tendency in recent years to look for ways to curb spending on health has changed the nature of its funding decisions. Typically, Government changes are no longer by way of simple amendments and additions, but now involve further restrictions and limits on how items may be used.

Consequently, there has been a need to develop a new approach to managing the AMA List and how it should align with the MBS in the future.

The first significant deviation from the Government’s traditional MBS approach was in 2007 when it introduced a specific age-limited item for the Healthy Kids check on the Medicare schedule.

Since that point, governments of both persuasions have pursued budget and health reform agendas that have severely limited the MBS by not allowing or significantly delaying many clinically appropriate procedures from being included on the Schedule.

A clear example was sacral nerve stimulation for urinary incontinence, which was recommended for MBS funding in 2008 but was not introduced on the Schedule until almost 18 months later.

Governments have also withdrawn MBS funding for clinically relevant services by justifying the measure as a minor procedure that should form part of a standard consultation. We saw this with the removal of joint injections.

In the years since, we have also seen governments include brakes on health spending by imposing further restrictions to item descriptors and placing additional caveats on how services can be delivered. Typically, such restrictions have not been specific recommendations of the Medical Services Advisory Committee, but have been introduced by the Department of Health to limit health expenditure.

As time has passed, it has become more difficult to maintain alignment of the AMA List with the MBS.

To maintain the List as a tool to demonstrate the costs of medical care, and to assist us in our fee setting, there is a need to set key principles for managing the List, rather than just automatically accepting Government policies.

This has included identifying circumstances where the List should no longer automatically align with the MBS because:

  • the Government either delays or withdraws Medicare funding for clinically relevant medical services on the MBS;
  • the medical specialty groups propose changes to MBS items to reflect current clinical practice, and the Government defers implementation of the changes;
  • the service does not reflect appropriate clinical practice or is not listed on the MBS but is considered by the AMA as being a clinically relevant service; or
  • the MBS service:
    • is required to be performed according to specified clinical guidelines;
    • precludes the billing of a consultation on the same day;
    • specifies the training, qualifications and/or competencies of the treating medical practitioner; or
    • is restricted to particular requirements of other Government programs, such as the Pharmaceutical Benefits Schedule.

 

In this regard, the AMA welcomes the Government’s recent announcement of the MBS Review Taskforce and Primary Health Care Advisory Group to consider how services can be aligned with contemporary clinical evidence and improve health outcomes for patients.

We are also pleased that both groups will be led by eminent and highly-regarded clinicians, and will be based on frontline medical evidence and experience. We hope that a positive outcome of these reviews will enable better alignment of the MBS and the AMA List.

 

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