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Mind the gap

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The head of the Federal Government’s MBS Review Taskforce has admitted there is “a bit of a risk” of a gap developing between the deletion of old Medicare items and the listing of up-to-date replacements.

In a frank assessment of the difficulties of modernising the MBS, Professor Bruce Robinson admitted there existed a tension between his taskforce and the Medical Services Advisory Committee (MSAC) over their respective roles in deleting and adding items to the Schedule.

The taskforce head said that while many of the clinicians who had volunteered to take part in the MBS review were impatient for change, the “extraordinarily rigorous” process used by MSAC in approving the listing of new services and procedures raised the prospect of a lengthy delay between the axing of an old item and its replacement by a new or updated one.

The issue was highlighted by AMA President Professor Brian Owler in his opening remarks to a forum on the MBS Review organised by the peak medical organisation.

Professor Owler warned of the risk that the Medicare review initiated by the Federal Government could result in an incomplete MBS unless the process to add new items to the schedule could be expedited.

“The concern is the ability of the MSAC process to deal with the number of recommendations that are going to be made – clearly there’s going to be quite a number to come out of this process – and the time it takes through that process before procedures are put on,” he said. “That means that you do have the potential for items to be taken away, and a potential gap before new items are put on.”

The source of concern is two-fold: that the meticulous MSAC approval process will result in lengthy delays in the listing of new items; and that the Health Minister, keen to hold down spending, will be reluctant to approve new items.

On the former, Professor Robinson questioned whether MSAC itself was becoming an obstacle to reform of the MBS, and needed an overhaul, or at least a significant change in approach.

“Is the MSAC process so rigorous that it is becoming an impediment to progress?” he asked.

The Minister has indicated that “no-brainer” changes that require a simple re-write should be expedited, but Professor Owler said consideration also needed to be given to fast-tracking clarifications or improvements that do not require a major MSAC review – an idea endorsed by Professor Robinson.

The MBS review taskforce head also sounded an optimistic note on the Government’s openness to listing new items.

Professor Robinson told the AMA forum that Health Minister Sussan Ley was now “more open to new MBS items than she was a few months ago”.

Adrian Rollins