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 The Taskforce will also seek to identify any services that may be unnecessary, outdated or potentially unsafe.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:

Δ Affordable and universal access.

Δ Best-practice health services.

Δ Value for the individual patient.

Δ Value 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:

1. Consider whether there are MBS items that are obsolete and should be removed from the MBS.

2. Consider identified priority reviews of selected MBS services.

3. Develop a program of work to consider the balance of MBS services within its remit and items assigned to the Committee.

4. 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.

The Diagnostic Imaging Clinical Committee (the Committee) was established to make recommendations to the Taskforce on the review of MBS items in its area of responsibility, based on rapid evidence review and clinical expertise. The Taskforce asked the Committee to review MBS items for knee ultrasound, X-ray, CT and MRI, including GP-requested MRI of the knee, as priority reviews. The DICC established a Knee Imaging Working Group (the Working Group) to undertake this priority review.

1.1        MBS Review process

The Taskforce has endorsed a process whereby the necessary clinical review of MBS items is undertaken by Clinical Committees and Working Groups. The Taskforce asked all committees in the second tranche of the Review process to review MBS items using a framework based on Appropriate Use Criteria accepted by the Taskforce1. This framework includes the following steps: (i) review data and literature relevant to the items under consideration; (ii) identify MBS items that are potentially obsolete, are of questionable clinical value, are misused and/or pose a risk to patient safety; and (iii) develop and refine recommendations for these items, based on the literature and relevant data, in consultation with relevant stakeholders. In complex cases, full appropriate use criteria were developed for an item’s descriptor and explanatory notes. All second-tranche committees involved in this Review adopted this framework, which is outlined in more detail in Section 2.3.

The recommendations from the Clinical Committees will be released for stakeholder consultation. The Clinical Committees will consider feedback from stakeholders and then provide recommendations to the Taskforce in Review reports. The Taskforce will consider the Review reports from Clinical Committees, along with stakeholder feedback, before making recommendations to the Minister for Health for consideration by the Government.

1.2        Consumer engagement

The recommendations have been summarised for consumers in Appendix B. The summary describes the medical service, the recommendation of the clinical experts and the page references of the rationale behind the recommendations and proposed new items.

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 advice from consumers and decide whether any changes are needed to the recommendations. The Committee will then send the recommendations to the MBS 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.

1.3        Areas of responsibility of the Knee Imaging Working Group

The following MBS item groups were identified for review. A full list of all items and descriptions are listed in Appendix A.

Item group name 1

Magnetic resonance imaging (MRI) of the knee (6 items)

Item group name 2

Ultrasound of the knee (4 items)

Item group name 3

X-ray of the knee (8 items)

Item group name 4

Computed tomography (CT) of the knee (4 items)

1.4        Key recommendations

The most important recommendations are highlighted below. The complete recommendations (and their accompanying rationales) for all items can be found in Sections 5 to 7, and in Appendix A(in table summary form).

1.4.1        MRI of the knee

A recommendation is introducing the principal of an additional age cut-off for knee MRI referrals (N.B. segregation into under and over 16 years of age is currently part of the MBS) to provide separate descriptors and/or restrictions for patients under and over 50 years of age whom a GP may consider appropriate for knee MRI.

A recommendation is that the requirement to undergo plain radiography before MRI for under 16 year olds should be removed and not mandated for any age group, to reduce radiation exposure and the costs associated.

A recommendation is restricting the number of GP-referred MRIs to three per annum. Any further MRI should be requested by a specialist if the referral falls within the 12 month period after the initial GP referred MRI. This may improve appropriate utilisation of GP requested MRI of the knee.

The Committee was unable to decide between two options to address the principal of an additional age cut-off for knee MRI referrals.

Following consideration of the options by the MBS Reviews Taskforce, the following recommendation is made:

To remove the ability for a GP to request MRIs for patients ≥ 50 years of age from the MBS, but retain specialist requesting for any age group.

1.4.2        Ultrasound of the knee

The Committee considered the indications on the current item descriptors to be appropriate, with the exception of ‘injury of collateral ligaments’ because diagnosis of collateral ligament injury severity with imaging does not generally change treatment. The recommendation is the removal of this indication from the current descriptor for items 55828, 55829, 55830 and 55831.

1.4.3        X-ray of the knee

Separate the MBS items for the knee from the current X-ray items, which encompass foot, ankle, leg, knee or femur to allow for utilisation monitoring.

1.4.4        CT of the knee

Separate the MBS items for the knee from the current CT items which encompass all extremities to allow for utilisation monitoring.