MBS review changes to phototherapy items
BY DR ANDREW MILLER
From November 1, the MBS review has brought a change to the ultraviolet phototherapy items, consolidating them into one item 14050 with imposed conditions.
It has become clear that there has been both an implementation and a communication failure regarding these changes and all GPs claiming these items since November 1 have had rebates refused. As a result of an intervention from the Australasian College of Dermatologists (ACD), the Department has agreed to reconsider these claims, where the necessary documentation regarding Dermatologist supervision is present, and allow them to be resubmitted. The ACD also requested a moratorium of three months on compliance implementation to allow affected GPs to make the necessary arrangements. This has been refused by the Department, however the AMA will continue to argue this case.
Poor communication has led to affected GPs being unaware of the impending changes. This is a time of frenetic activity in the MBS Review, with numerous cascading recommendations flooding stakeholders, in this instance GP organisations, and clearly overwhelming their capability to appropriately inform their constituencies.
In the instance of the changes to phototherapy items, there is an obvious need for receipting practices to be changed but this needs to be supported by a reasonable lead-in period. The Dermatology, Allergy and Immunology (DAICC)MBS Review working group recommended a grace period which the Department has chosen not to apply, which the ACD supported because of concerns particularly for patients in rural or remote areas, or in areas of Dermatology workforce shortage where appropriate support from a Dermatologist may be difficult to arrange, in the time made available before the changes were put in place.
In the meantime, information on the change is below:
UVA or UVB phototherapy administered in a whole body cabinet or hand and foot cabinet including associated consultations other than the initial consultation, if treatment is initiated and supervised by a specialist in the specialty of dermatology
Applicable not more than 150 times in a 12 month period
A component for any necessary subsequent consultation has been included in the Schedule fee for this item. However, the initial consultation preceding commencement of a course of therapy would attract benefits.
Phototherapy should only be used when:
· Topical therapy has failed or is inappropriate.
· The severity of the condition as assessed by specialist opinion (including symptoms, extent of involvement and quality of life impairment) warrants its use.
Narrow band UVB should be the preferred option for phototherapy unless there is documented evidence of superior efficacy of UVA phototherapy for the condition being treated.
Phototherapy treatment for psoriasis and palmoplantar pustulosis should consider the National Institute of Health and Care Excellence’s Guidelines at https://pathways.nice.org.uk/pathways/psoriasis
Involvement by a specialist in the specialty of dermatology at a minimum should include a letter stating the diagnosis, need for phototherapy, estimated time of treatment and review date.