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Worrying MBS changes could be more than skin deep

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The AMA has voiced strong concerns about significant changes the Federal Government has made to the Medicare Benefit Schedule without the input of clinicians.

As part of the Government’s 2016 Budget repair plans, the Health Department has used the outcomes of a recent Skin Services review to implement a number of changes to the MBS, including axing 48 skin service items and replacing them with 28 new items recommended by the Medical Services Advisory Committee (MSAC).

Separate to this, an internal decision was made by the Department, without consultation, to reclassify a number of items into a new “banding”. These changes effect the clinical setting in which services can be delivered in order to be still eligible for private health insurance rebates.

Though the development of new MBS skin item numbers arose from constructive engagement between the Department and medical profession stakeholders, there was no discussion of the banding of items under the Private Health Insurance Act.

It is not surprising then that, in absence of advice from the medical profession, the changes to banding classification are now having a deleterious effect on patient care.

The banding classification disadvantages patients, in particular children and patients with complex medical needs who may require these procedures to be carried out in the hospital setting. Under the new banding classifications, these items are no longer indicated for hospital stay unless a written certification is carried out, which is still no guarantee of complete insurance coverage.

The harm caused by these changes has been magnified by the Department’s decision to announce them just days before they were due to come into effect on 1 November, seriously undermining informed financial consent. In many cases, patients had already been scheduled for procedures, including the excision of malignant melanomas which, after 1 November, were no longer automatically eligible for private health coverage when carried out in a private hospital setting.

In some instances, MBS rebates have also been reduced, resulting in many patients now being potentially out-of-pocket.

These changes, and the manner in which they were undertaken, do not instil confidence in the current MBS Taskforce reviews, which follow a similar process.

Alarm bells are ringing because it seems that clinical input is not being taken into account when the final policy decisions are made.

Hopefully this past process will not be replicated in the future MBS Taskforce Review work, as it would drive a wedge between the Government, doctors and their patients by undermining the collaborative decision making required to deliver an efficient and sustainable health system.

The AMA has consistently sought that MBS clinical committees and working groups conduct a complete review. To that end, the Government needs to address how they will accurately link clinician recommendations to implementation throughout the MBS Taskforce reviews – in each and every tranche.

AMA President Dr Michael Gannon has already written to the Minister for Health calling for a rollback of the problematic banding determinations relating to skin items, while also reinforcing the need for transparency and collaboration with medical profession before further substantive changes to the MBS are made.

The AMA’s support for the MBS Taskforce reviews continues to be contingent upon our concerns, and those of our colleagues, being addressed.

The AMA is urging members, together with the medical colleges, associations and societies to keep the Government accountable by highlighting the key principles considered necessary to enable complete reviews. This includes:

  • seeking reassurance that the reviews will not have unintended consequences for patients;
  • being vigilant in shaping the clinical narrative and review framework to ensure the reviews do no negatively impact clinician scope of practice;
  • engaging clinical committees and working groups in translating their findings to policy design; and
  • supporting the clinicians who are directly involved in the review.

The AMA will continue to influence the MBS reviews through meetings with the Minister, in public commentary, and in more direct engagement with the Health Department.

A forum of the AMA and the colleges, associations and societies is planned for the first quarter of 2017 to provide stakeholders with an update and policy direction regarding the MBS reviews.

Eliisa Fok, AMA Policy Officer