6.General recommendations and comments

The following recommendations were developed by the Committee and accepted unanimously.

6.1Gastric lavage item (14200)

Table 9: Item introduction table for item 14200

Item Descriptor Schedule
fee
Volume of
services
FY2014/15
Total
benefits
FY2014/15
Services 5‐
year‐
average
annual
growth
14200 Gastric lavage in the treatment of ingested
poison.
$59.80 15 $746 ‐12.9%

Recommendation 8
  • ΔRemove item 14200 from the MBS.

Rationale

This recommendation focuses on ensuring patient safety and supporting best‐practice health services. It is based on the following observation.

  • ΔThere is clinical consensus (based on the available evidence) that this is an unsafe practice. Removing this rarely used item is expected to have minimal impact on patient access and minimal cost impact on the MBS, with only $797 paid in MBS benefits in FY2014/15 for 16 services (declining at a five‐year compound annual growth rate of ‐11 per cent).

6.2An MBS item for rapid response system / code blue attendance services

Recommendation 9
  • ΔConsider an expedited MSAC assessment for listing an MBS item for rapid response system / code blue attendances.
  • The proposed item descriptor and explanatory notes are provided below.

Item ABCD2:

Professional attendance by a specialist or consultant physician on a patient in a private hospital, outside an Emergency Department or Intensive Care Unit, involving rapid response to a referral made by a registered health practitioner, such as in response to an arrest or medical emergency team (“MET”) call or code blue.

Including assessment of the patient, investigation and management, and all procedures performed in conjunction with such an attendance (such as rapid IV access, administration of fluid, vasopressors, point‐of‐care ultrasound, central line access, and ventilation).

Claimable only by the medical practitioner taking overall responsibility for the patient in the course of the call or code response.

Not claimable in conjunction with items 13870, 13873, ED attendance items, or the goals of care item by the same provider.

Rationale

This recommendation focuses on supporting access to best‐practice health services. It is based on the following observations.

  • ΔThe Committee acknowledged that medical professional attendances for arrest calls and rapid response system alerts (such as MET calls) represent the best‐practice standard of care.
  • ΔSignificant professional involvement is required when attending to such patients—over and above other referred attendances—because the patient is unknown to the provider, the patient is in an unstable clinical condition or is critically ill, and the provider needs to attend immediately (disrupting his or her existing workflow). The amount of professional involvement required is similar to the complex ED attendance item in conjunction with the resuscitation add‐on item.
  • ΔIf the patient is subsequently transferred to the ED or ICU under the care of the same provider, MBS benefits for the provider’s professional involvement are payable under the ED attendance items and add‐ons or the ICU daily management items (13870 and 13873), respectively.

6.3Items for which no concerns were raised

Table 10: Item introduction table for items 13818, 13830, 13857 and 13881–13888

Item Descriptor Schedule
fee
Volume of
services
FY2014/15
Total
benefits
FY2014/15
Services 5‐
year‐
average
annual
growth
13818 Right heart balloon catheter, insertion of,
including pulmonary wedge pressure and
cardiac output measurement.

(Anaes.)
$113.70 338 $29,020 ‐5.9%
13830 Intracranial pressure, monitoring of, by
intraventricular or subdural catheter,
subarachnoid bolt or similar, by a specialist
or consultant physician – each day.
$75.35 2,208 $124,877 6.7%
13857 Airway access, establishment of; and
initiation of mechanical ventilation (other
than in the context of an anaesthetic for
surgery), outside of an Intensive Care Unit,
for the purpose of subsequent ventilatory
support in an Intensive Care Unit.
$146.40 521 $59,356 3.2%
13881 Airway access, establishment of; and
initiation of mechanical ventilation, in an
Intensive Care Unit, not in association with
any anaesthetic service, by a specialist or
consultant physician for the purpose of
subsequent ventilatory support.
(H)
$146.40 4,283 $470,270 0.7%
13882 Ventilatory support in an Intensive Care Unit,
management of, by invasive means, or by
non‐invasive means where the only
alternative to non‐invasive ventilatory
support would be invasive ventilatory
support, by a specialist or consultant
physician who is immediately available and
exclusively rostered for intensive care, each
day.
(H)
$115.25 80,099 $6,924,367 2.7%
13885 Continuous arterio‐venous or veno‐venous
haemofiltration, in an intensive care unit,
management by a specialist or consultant
physician who is immediately available and
exclusively rostered for intensive care – on
the first day.
(H)
$153.65 1,301 $149,929 5.8%
13888 Continuous arterio‐venous or veno‐venous
haemofiltration, in an intensive care unit,
management by a specialist or consultant
physician who is immediately available and
exclusively rostered for intensive care – on
each day subsequent to the first day.
(H)
$76.90 6,050 $349,066 4.8%
Recommendation 10
  • ΔLeave items 13818, 13830, 13857 and 13881–13888 unchanged.

Rationale

This recommendation is based on the following observations.

  • ΔNo concerns were raised regarding access to these items or the safety, obsolescence, value or misuse of these items.
  • – Right heart balloon catheter insertion (item 13818) was recently the subject of an MSAC review. The low usage pattern reflects specialised use by those with the particular skill (for example, it is used in some post‐cardiac surgical patients) and is not an indicator of item obsolescence.
  • – The item for intracranial pressure monitoring (item 13830) is rarely used and is at low risk of misuse. The service is indicated in a specific and well‐defined patient population, and providers are typically vigilant in ensuring that intracranial pressure monitoring lines are removed as quickly as possible.
  • – The distinction between first and subsequent days in items 13885 and 13888 (continuous hemofiltration management in ICU) should be retained as this accurately reflects variation in effort involved (which is greater on the first day).

6.4Remuneration of Emergency Physicians

  • ΔThe Committee noted that the overall level of remuneration for Emergency Physicians providing services in private EDs is not commensurate with the professional involvement required. Specifically, it does not recognise that emergency medicine is characterised by:
  • – A higher proportion of afterhours / unsociable‐hours work than other medical professionals.
  • – A high‐intensity environment.
  • – A higher average number of work hours per week (approximately 53 hours) than most other medical specialties.
  • – Resultant high burnout rates.


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