Table of Contents
1. Executive Summary
The Medicare Benefits Schedule (MBS) Review Taskforce (the Taskforce) is undertaking a program of work that considers how more than 5,700 items on the MBS can be aligned with contemporary clinical evidence and practice and improves health outcomes for patients. The Taskforce will also seek to identify any services that may be unnecessary, outdated or potentially unsafe.
The Taskforce is committed to providing recommendations to the Minister for Health that will allow the MBS to deliver on each of these four key goals:
- ΔAffordable and universal access.
- ΔBest-practice health services.
- ΔValue for the individual patient.
- ΔValue for the health system.
The Taskforce has endorsed a methodology whereby the necessary clinical review of MBS items is undertaken by Clinical Committees and Working Groups. The Taskforce has asked the Clinical Committees to undertake the following tasks:
- Consider whether there are MBS items that are obsolete and should be removed from the MBS.
- Consider identified priority reviews of selected MBS services.
- Develop a program of work to consider the balance of MBS services within its remit and items assigned to the Committee.
- Advise the Taskforce on relevant general MBS issues identified by the Committee in the course of its deliberations.
The recommendations from the Clinical Committees are released for stakeholder consultation. The Clinical Committees will consider feedback from stakeholders and then provide recommendations to the Taskforce in a Review Report. The Taskforce will consider the Review Report from Clinical Committees and stakeholder feedback before making recommendations to the Minister for Health, for consideration by Government.
1.1 Areas of responsibility of the Endocrinology Clinical Committee
The Endocrinology Clinical Committee (the Committee) was established in April 2016 to make recommendations to the Taskforce regarding MBS items in its area of responsibility, based on rapid evidence review and clinical expertise. The Taskforce asked the Committee to review endocrinology-related items.
The Committee reviewed 17 endocrinology items. An inclusive set of stakeholders is now engaged in consultation on the recommendations outlined in this report. Following this period of consultation, the recommendations will be finalised and presented to the Taskforce. The Taskforce will consider the report and stakeholder feedback before making recommendations to the Minister for Health for consideration by the Government.
1.2 Key recommendations
The Committee has highlighted its most important recommendations below. The complete recommendations (and their accompanying rationales) for all items can be found in Section 51. A complete list of items, the nature of the recommendations can be found in Appendix A (in table summary form).
The Committee’s recommendations for stakeholder consultation are that one item should be deleted2 and its services should no longer be provided under the MBS, and 16 items should be changed3. The changes focus on encouraging best practice and simplifying the MBS to improve patient care by (i) consolidating item numbers; (ii) improving the clarity of descriptors (with support from explanatory notes); and (iii) providing clinical guidance for appropriate use through explanatory notes. The key recommendations are summarised below.
- ΔThyroidectomy items. Improve clinical quality by encouraging the use of total thyroidectomies and hemithyroidectomies—which have been shown to be superior to partial and subtotal thyroidectomies. This will be done by the following: (i) consolidating item 30309 under item 30296, (ii) consolidating items 30308 and 30310 into one item number for partial and subtotal thyroidectomies with a clear item descriptor, (iii) and adding explanatory notes for all thyroidectomy item numbers explaining when they should be used.
- ΔParathyroidectomy items. Make items clearer and easier to use in order to address inappropriate co-claiming. This involves re-wording parathyroidectomy items 30315–30320.
- ΔSynacthen stimulation test. Address low-value testing by requiring the use of basal cortisol measurement prior to performing a Synacthen stimulation test.
- ΔEndocrine tumour removal items. Improve clinical quality and simplify the MBS by consolidating items 30321 and 36500 (items for less extensive removal or excision of tumour or adrenal gland, respectively) under items 30323 and 30324 (extensive or complete removal of tumour or adrenal gland, respectively).
- ΔThyroglossal cyst items. Improve clinical quality and modernise the MBS by deleting item 30313, which is obsolete. The cyst recurrence rate for simple removal under item 30313 is three times higher than the recurrence rate for radical removal (item 30314). Patients will instead receive services under item 30314.
1.3 Consumer engagement
The Committee believes it is important to find out from consumers if they will be helped or disadvantaged by the recommendations – and how, and why. Following the public consultation the Committee will assess the feedback from consumers and decide whether any changes are needed to the recommendations. The Committee will then send the recommendations to the Taskforce. The Taskforce will consider the recommendations as well as the information provided by consumers in order to make sure that all the important concerns are addressed. The Taskforce will then provide the recommendation to government.
The Committee’s recommendations encourage agreed best practice for interventions and the most reliable and relevant testing to aid diagnosis. As consumers contribute to the work of the Committee we hope that the outcomes of the review, including clearer descriptors, are a resource which will support consumers to ask the necessary questions to participate more actively in their health care.
There is a list of all the items in plain English in Appendix C - Summary for consumers.
1Recommendations that are eventually made for consideration by the Government will not necessarily reflect the final recommendations made to the Taskforce by the Committee after consultation. As stated, the Taskforce will consider these recommendations, and it may alter recommendations to bring items in line with broader changes that are being made. Additionally, the wording or structuring of item descriptors and explanatory notes may be changed to ensure consistency with the language and structure of the MBS. It should also be noted that the recommendations focus on the services provided by the items. Specific item numbers may be altered during implementation of the eventual recommendations proposed by the Minister for Health. For example, where the Committee has requested that services for item A be consolidated under item B, the actual item number for item B may be changed in some circumstances.
2Describes when an item is recommended for removal from the MBS and its services will no longer be provided under the MBS.
3Describes when the item and/or its services will be affected by the recommendations. This could result from a range of recommendations, such as: (i) specific recommendations that affect the services provided by changing item descriptors or explanatory notes, (ii) the consolidation of item numbers, and (iii) splitting item numbers (e.g., splitting the current services provided across two or more items).