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 The Taskforce will also seek to identify any services that may be unnecessary, outdated or potentially unsafe.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

 Affordable and universal access

 Best practice health services

 Value for the individual patient

 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 consideration by Government.

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 Taskforce. 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 Working Group did not have a consumer representative. However, the Committee had a consumer representative. The Working Group recommendations have been summarised for consumers (Appendix C). The consumer items table describes the medical service, the recommendation of the clinical experts, and why the recommendation has been made.

The proposed changes to the MBS will improve the accuracy and quality of care being provided to patients.

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 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 Pulmonary Embolism (PE) and Deep Vein Thrombosis (DVT) Working Group

The Working Group’s brief was to review Pulmonary Embolism (PE) and Deep Vein Thrombosis (DVT) related imaging items (Appendix A and B) and make recommendations to the Diagnostic Imaging Clinical Committee (the Committee) based on evidence and clinical expertise. The Working Group reviewed PE items, and items relating to DVT imaging tests. All recommendations relating to these items are included in this report for 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 primarily from Choosing Wisely Australia.

An inclusive set of stakeholders is engaged in consultation on the recommendations outlined in this report. Following this period of consultation, the recommendations will be presented to the MBS Review Taskforce. The Taskforce will consider stakeholder feedback before making recommendations to the Minister for Health for consideration by the Government.

1.4        Key recommendations

The complete recommendations (and their accompanying rationales) for all items can be found in Sections 5 and 6, and in Appendix C (in table summary form).

The changes focus on encouraging best practice and simplifying the MBS to improve patient care by (i) improving the clarity of descriptors (with support from explanatory notes), and (ii) providing clinical guidance for appropriate use through explanatory notes. The recommendations are summarised below.

1.4.1        MBS explanatory notes for imaging for DVT and PE

Draft MBS explanatory notes were developed for the MBS items dealing with diagnostic imaging for DVT and PE as below:

 medical practitioners referring patients for duplex ultrasound for suspected lower limb DVT (items 55221, 55244) should read and consider The Royal Australian and New Zealand College of Radiologists RANZCR 2015 Choosing Wisely recommendations, or such clinical RANZCR Choosing Wisely recommendations as succeed it; and

 medical practitioners referring patients for imaging for suspected PE (items 57351, 57356, 61328, 61340, 61348) should read and consider The Royal Australian and New Zealand College of Radiologists RANZCR 2015 Choosing Wisely recommendations, or such clinical RANZCR Choosing Wisely recommendations as succeed it.

Education of requesters on the Choosing Wisely Recommendations should be implemented. The provision of educational strategies is not within the remit of the MBS but rather the MBS could leverage off educational strategies developed by the Colleges or a third-party organisation such as NPS MedicineWise whose primary role is to provide general education to health professionals.

1.4.2        Co-claiming duplex scanning for DVT and chronic venous disease

In the case of a same provider undertaking venous ultrasound for the same patient on the same day that:

 it is inappropriate to claim ultrasound items for both acute DVT and chronic venous disease on the same leg in the same patient on the same day

 the only exception to the above recommendation is a patient being actively prepared with ultrasound for superficial varicose vein ablation (by whatever method), where the deep venous system of the same leg has to also be scanned on the same day to exclude fresh DVT

 the multiple services rules for diagnostic ultrasound apply and should be adhered to

1.4.3        Redundant items for PE and DVT imaging

It is recommended a mechanism is identified to reduce the number of NK (services performed on old equipment), which duplicate regular items and lengthen the Diagnostic Imaging Services Table (DIST), as a class solution. The Committee will separately consult on recommendations about capital sensitivity.