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Government rethinks kick in the guts for patients

Government rethinks kick in the guts for patients - Featured Image

Patients have been saved from being left with huge unexpected out-of-pocket expenses after the AMA intervened to secure a delay in major changes to Medicare benefits for abdominal surgery.

The AMA acted after the Health Department, in a letter sent to AMA President Professor Brian Owler on 17 December, gave just 14 days’ notice of significant amendments to Medicare items for lipectomy services, which involve the removal of large flaps of skin left hanging from the gut following rapid weight loss.

Increasingly, lipectomies have been performed on people who have lost significant weight following lap band surgery or other medical interventions.

A review of Medicare Benefits Schedule items for lipectomy services conducted in 2013 found a large increase in the number of claims made in the previous decade. Most of the procedures were carried out on women between 35 and 54 years of age.

In its letter to Professor Owler, the Department said that the review had found little strong evidence regarding the effectiveness, safety and quality of lipectomies.

“But [the review] concluded that patients with a major abdominal apron following massive weight loss due to bariatric surgery or other weight loss measures were the most likely patient population for clinically relevant lipectomy, with personal hygiene and ulceration as the main clinical issues,” the Department said.

In April, the Medical Services Advisory Committee, which oversees the listing of services on the MBS, supported changes to Medicare items for lipectomies recommended by an expert working group.

But the Government did not act on this advice until deciding to implement the changes as part of its Mid Year Economic and Fiscal Outlook deliberations, and it announced they were to come into effect from 1 January 2016.

In her letter to Professor Owler, Health Department Assistant Secretary Natasha Ryan admitted that the rapid implementation of the changes meant there was little time to give doctors and patients notice. But she argued the nature of the changes meant they were likely to cause “only minimal inconvenience”.

But the AMA told the Department patients already booked in for a lipectomy, particularly those undergoing the procedure in January, were likely to be left badly out-of-pocket as a result of the extremely tight timeframe.

“There may be cases where patients are booked for services in January, who will now not be eligible for Medicare rebates and, therefore, private health insurance rebates,” the AMA warned. “Without proper notice to the relevant medical practitioners, the Department may be exposing some individuals to having to pay the full costs of treatment, [including both] the medical and hospital costs”.

The AMA said the period of notice given by the Department was “unacceptable”, and urged for a delay.

It said there was no material reason why the changes had to be implemented so quickly, and the decision showed “a lack of insight by the Department in how the health system works and how changes need to be planned for.

Following strong representations from the AMA, the Department has announced that the changes will be deferred until 1 April 2016.

Adrian Rollins