4. Areas of responsibility of the Committee

The Committee reviewed 60 MBS items: 17 endocrinology items, and 43 endocrinology-related pathology test items. The review of the 43 endocrinology-related pathology test items was performed from the perspective of doctors requesting these tests and in cooperation with the Pathology Clinical Committee (PCC; the providers), who are progressing the recommendations prior to public consultation. The Committee also provided input on 16 other items that will be referred to their primary reviewing clinical committee to assist with their recommendations for consultation.

The 17 endocrinology items primarily cover endocrinology-related surgical procedures. In FY 2014/15, these items accounted for approximately 11,000 services and $7 million in benefits. Over the past five years, service volumes for these items have grown at 5.3 per cent per year, and the cost of benefits has increased by 6.0 per cent per year.[2] This growth is largely explained by an increase in the number of services per capita (Figure 2).[3] Thyroidectomy and parathyroidectomy services account for 83 per cent of the total services (Figure 3).

Figure 2: Endocrinology items drivers of growth

Figure 2 is a graph that shows the increase in percentage for each of the drivers ofendocrinology from 2010 to 2015. The total benefits increased at 6.0%, due to a 5.3% increase on the number of services and 0.7% increase on the average benefits per service. The increase on the number of services was due to a 1.3% increase on the population and the 4.0% increase on services per 100,000.

1 Compound annual growth rate, or the average annual growth rate over a specified time period.
SOURCE: MBS data and ABS data – “3101.0 Australian Demographic Statistics Jun 2010 and Jun 2015”

Figure 3: Endocrinology item groups

Figure 3 lists the endocrinology items by service volume for financial year 2014-15. There are 4 columns:  1st column lists the item numbers starting from the highest total number of services, 2nd column shows total number of services by thousands, 3rd column shows percent of total services for financial year 2014-15, 4th column shows services 5-year compound annual growth rate, and 5th column is the total benefits for financial year 2014-15 in millions. The graph shows that the top two rows for items 30296-30310 Thyroidectomy (59% of total services) and 30315-30320 Parathyroid group (24%) are significantly larger than the remaining items. The next two are 30097 9% and 30321-30324 3%, with the remaining 2 items less than 3% each.


4.1 Summary of the Committee’s review approach

The Committee completed a review of its 17 allocated items across four meetings, during which it developed the recommendations and rationales outlined in Section 5. The review of the 43 endocrinology-related pathology test items was performed from the perspective of doctors requesting these tests and in cooperation with the PCC (the providers), who finalised the recommendations for consultation. Two working groups were also established to review TSH, TFT and thyroid antibodies items, as well as issues regarding the low volume of thyroid surgery performed annually by certain providers. The membership of these working groups is outlined in Section 3.2. These working groups made recommendations to the Committee, which were endorsed and included in this draft review report and in referrals to other clinical committees prior to stakeholder consultation.

The review drew on various types of MBS data, including data on utilisation of items (services, benefits, patients, providers and growth rates); service provision (type of provider, geography of service provision); patients (demographics and services per patient); co-claiming or episodes of services (same-day claiming and claiming with specific items over time); and additional provider and patient-level data, when required. The review also drew on data presented in the relevant literature and clinical guidelines, all of which are referenced in the report. Guidelines and literature were sourced from relevant medical associations or colleges highlighted by Committee members, including the American Thyroid Association; medical journals, such as the BMJ; and other sources, such as Choosing Wisely Australia.

An inclusive set of stakeholders is now engaged in consultation on the recommendations which are outlined in this report. Following this period of consultation, the Committee will consider stakeholder feedback before finalising and presenting the recommendations 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.