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MBS Reviews – A long way to go, and a lot of improvement needed

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BY DR ANDREW MULCAHY CHAIR, MEDICAL PRACTICE COMMITTEE

Members will recall that the AMA cautiously welcomed the MBS reviews in 2015, noting it was a far-reaching exercise with an ambitious two-year timeline.

The AMA’s support for the MBS reviews has always been contingent on the review being clinician-led and having direct and early involvement of the specialist colleges, associations and societies (CAS). The AMA has called for the review to be fully transparent from decision making through to implementation, and be underpinned by a scientific approach. There must also be scope to add new items to achieve the overall aim of ‘modernising’ the MBS.

In March, the AMA entered into a compact agreement with the Government for a shared vision for Australia’s health system. We committed to support in principle the ongoing operation of the MBS Review Taskforce, including a transparent, consultative clinician-led approach to high-value care and future-proofing the system. During that time the Government extended the review another three years to 2020.

Under the compact, the AMA is committed to work with the Department of Health to deliver on agreed recommendations arising from the MBS Review in conjunction with the relevant sectors. The AMA will continue to identify areas to improve the review process and recommendations.

The AMA’s approach to the MBS review has always been to defer recommendations relating to specialty items to the relevant CAS groups, and comment on the broader policy.

Now two years into the review, the AMA is continuing to press the Government to ensure that reviews remain more than just a cost-cutting exercise, or a mechanism to meddle with the scope of clinical decision making.

In this context, the AMA reviews concerning recommendations against a set of key principles to determine if a response to the Taskforce is necessary.  This work is undertaken through stakeholder consultation with an AMA Working Group drawing from the broader membership, and the Medical Practice Committee. AMA also facilitates an annual CAS meeting for stakeholders to air concerns and receive information as the reviews progress.

Based on these feedback mechanisms, the AMA has responded to every single MBS review consultation – raising issues from across our membership, while stressing where systematic improvements need to be made. The AMA Secretariat and the President have done this through direct representations with the Health Minister, the Department of Health and in writing to the Chair of MBS Review Taskforce.

In our latest submission to the MBS Review Chair, the AMA highlighted a number clear deficiencies and significant variations in the process adopted by the MBS Review Taskforce and the Clinical Committees.

Noting the commitment made by the profession to sit on the Clinical Committees and Working Groups, the AMA has continued to stress that there must remain absolute transparency of the review process.

In particular: where a decision is being made in contradiction to the advice of the profession, there should be clear evidence and data to support such a decision.

We also called for early engagement of CAS on each of the Clinical Committees to ensure recommendations are practical and consistent. We have called for complete transparency, starting with how Clinical Committee members are selected and details of the Committees’ scope of work. Finally, the AMA has strongly recommended the Clinical Committees engage early with other Department areas including the Medicare Compliance and Professional Services Review to ensure that any changes to the schedule are practical for clinicians and do not result in sub-optimal care for patients. We all know a poorly worded MBS item can set up a practitioner to fail.

What we don’t want to see is a confusing MBS schedule, with medical practitioners as scapegoats.

With more than half the Clinical Committees yet to be established, there is still a long way to go. The next round of public consultations is expected to occur in February, 2018, commencing with the anaesthesia and oncology reports. The AMA continues to monitor with interest, and encourages the profession and the CAS to engage in the consultation and review process early. The full schedule of MBS reviews can be found on the Department of Health website: http://www.health.gov.au/internet/main/publishing.nsf/content/MBSR-about

In the meantime, the AMA has and will continue to hold up our end of the compact with a commitment to a stronger MBS review. Government must ensure the Review does the same through a significant improvement in the way they conduct it.

 

 
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