Intensive Care & Emergency Medicine
Table of Contents
3.About the Intensive Care and Emergency Medicine Clinical Committee
The Intensive Care and Emergency Medicine Clinical Committee (the Committee) is part of the second tranche of Clinical Committees. It was established in June 2016 to make recommendations to the Taskforce on MBS items within its remit, based on clinical expertise and rapid evidence review. The Taskforce asked the Committee to review MBS items related to emergency medicine and intensive care.
The Committee consists of 14 members and an ex‐officio representative from the Taskforce. Members’ names, positions/organisations and declared conflicts of interest are listed in Section 3.1. All members of the Taskforce, Clinical Committees and Working Groups were asked to declare any conflicts of interest at the start of their involvement and are reminded to update their declarations periodically.
3.1 Committee members
|A/Prof Sally McCarthy (Chair)||Senior Emergency Physician, Prince of Wales Hospital
Medical Director, Emergency Care Institute NSW
Clinical Lead, NSW Whole of Hospital Program
NSW Health Former President, Australasian College for Emergency
|Dr Andrew Holt||Deputy Director & Supervisor of Training, Department of
Critical Care Medicine, Flinders Medical Centre
Director, Critical Care Unit, Flinders Private Hospital
Director, Intensive Care Unit, Ashford Hospital
Director, South Australian Home Parenteral Nutrition
Senior Lecturer, School of Medicine, Flinders University
Chairman, Medical Advisory Committee, Adelaide
Community Healthcare Alliance
|A/Prof Andrew Turner||Director, Department of Critical Care Medicine, Royal
|Dr David Ward||Emergency Physician, Brisbane Northside Emergency
Centre (Holy Spirit Northside)
Deputy Chair, Accreditation Committee, Australasian
College for Emergency Medicine
|Ms Eileen Jerga AM||Consumer Representative||None|
|Dr Greg McDonald||Director, Emergency Care, Sydney Adventist Hospital
Member, Private Practice Committee, Australasian
College for Emergency Medicine
|A/Prof Jane Tolman||Associate Professor of Aged Care, University of Tasmania||None|
|Dr Matthew Anstey||Intensive Care Specialist and Director of ICU Research,
Sir Charles Gairdner Hospital
Medical Advisor, Australian Commission on Safety and
Quality in Health Care
Board Member, Choosing Wisely Australia
|Dr Michael Ben‐Meir||Director, Emergency Department, Cabrini Health
Chair, Private Practice Committee, Australasian College
for Emergency Medicine
|Prof Michael Parr||Intensive Care Unit, Liverpool Hospital, University of
New South Wales
|A/Prof Reza Ali||Director, Emergency Medicine Blacktown and Mount
Druitt Emergency Department
|Dr Simon Towler||Clinical Co‐Lead, Fiona Stanley Hospital, Medical Co‐
Director, WA Department of Health
|Prof Stephen Bernard||Director of Intensive Care, Knox Private Hospital
Chair, Medical Advisory Committee, Knox Private
Honorary Senior Intensive Care Physician, The Alfred
Adjunct Professor, Monash University Department of
Epidemiology and Preventive Medicine
Senior Medical Advisor, Ambulance Victoria
|Dr Yusuf Nagree||Emergency Physician, Fiona Stanley Hospital
Chair, Scientific Committee, Australasian College for
|Dr Michael Coglin
|MBS Review Taskforce
Chief Medical Officer, Healthscope
It is noted that the majority of Committee members share a common conflict of interest in reviewing items that are a source of revenue for them (i.e., Committee members claim the items under review). This conflict is inherent in a clinician‐led process, and having been acknowledged by the Committee and the Taskforce, it was agreed that this should not prevent a clinician from participating in the review.
3.2 Conflicts of interest
All members of the Taskforce, Clinical Committees and Working Groups are asked to declare any conflicts of interest at the start of their involvement and reminded to update their declaration periodically.
3.3 Summary of the Committee’s review approach
The Committee completed a review of its items across four full Committee meetings and seven Working Group meetings, during which it developed the recommendations and rationales outlined in Sections 4–6. 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 published literature, all of which is referenced in the report.
3.3.1Working Group structure
The Committee reviewed 29 items and made recommendations based on the best available evidence and clinical expertise, in consultation with relevant stakeholders. The Committee formed three Working Groups with broader membership to provide greater content expertise on specific domains of clinical practice:
- ΔThe Emergency Medicine Working Group (EDWG).
- ΔThe Intensive Care Working Group (ICUWG).
- ΔThe End‐of‐Life Care Working Group (EoLWG).
The Committee’s major recommendation involves restructuring Emergency Department (ED) attendance items into three tiered base items with add‐on items.
Minor recommendations include the removal of an obsolete item (for gastric lavage); removal of unnecessary distinctions between items (between first and subsequent days of management of counterpulsation by intraaortic balloon); clarifying items to encourage best practice (use of ultrasound with vascular catheterisation); clarifying items to distinguish between different services (circulatory support using ventricular assist devices [VAD] or extracorporeal life support); and adding items to support access to best‐practice health services (professional attendances for rapid response system / code blue referrals, and services relating to defining the goals of care for potentially end‐of‐ life patients before deciding to admit them to hospital or intensive care).
The Committee also recommended leaving a number of items unchanged (including the daily management items for intensive care and the invasive pressure monitoring item).
All recommendations focus on the objectives of the MBS Review: improve access to medical services, encourage best practice, increase value for consumers and the health system, and simplify the MBS to improve both patient and provider experience (for example, through improved transparency around services billed), as well as the efficiency with which the MBS is administered.
An inclusive set of stakeholders is now engaged in consultation on the recommendations resulting from this process, which are outlined in this report. Following this period of consultation, the Committee will consider stakeholder feedback before finalising the recommendations and presenting them 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.
3.3.2Structure of the report
The recommendations in this report are organised by the primary deliberating body that developed the recommendations, with the exception of the recommendation regarding goals of care (discussion, decision‐making and documentation). This recommendation was developed primarily by the EoLWG but has been integrated into the relevant emergency medicine and intensive care sections of this report.
- ΔSection 4 – Emergency medicine recommendations on issues relating to:
- – Emergency Department attendance items.
- – Consistent item structure for all Emergency Department attendances.
- – MBS item use for Short Stay Units.
- ΔSection 5 – Intensive care recommendations on issues relating to:
- – Intensive care daily management items (13870 and 13873) and the invasive pressure monitoring item (13876).
- – Management of counterpulsation by intraaortic balloon (items 13847 and 13848).
- – Circulatory support items (13851 and 13854) and coverage of ventricular assist devices and extracorporeal life support.
- – Vascular catheterisation items (13815 and 13842) and use of ultrasound.
- – An item for goals‐of‐care services provided by Intensive Care Physicians.
- ΔSection 6 – General recommendations on issues relating to:
- – Gastric lavage item (14200).
- – An MBS item for rapid response system / code blue attendance services.
- – Items for which no concerns were raised.
- – Remuneration of Emergency Physicians.
3.3.3Numbering of proposed items
Throughout the report, the Committee recommends new or substantially changed items, most of which involve restructuring current items. These proposed items are often referred to using letters to differentiate them for ease of reference. If the recommended items are ultimately added to the MBS, the Department of Human Services (DHS) will assign new numbers in the usual format. The Committee is not recommending changes to the MBS numbering system.