3.      About the Renal Clinical Committee

The Renal Clinical Committee (the Committee) is part of the second tranche of Clinical Committees. It was established in April 2016 to make recommendations to the Taskforce on MBS items within its remit, based on rapid evidence review and clinical expertise. The Taskforce asked the Committee to review renal-related MBS items.

The Committee consists of 16 members, whose 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

Table 1. Committee members

Name

Position/Organisation

Declared conflict of interest

Professor Alan Cass (Chair)

Director, Menzies School of Health Research

Director, Top End Area Health Services

President, ANZ Society of Nephrology

None

Dr Neil Boudville

Sir Charles Gairdner Hospital and University of Western Australia

None

Associate Professor Martin Gallagher

Head, Renal Department, Concord Repatriation & General Hospital

Professor of Medicine, Concord Hospital Clinical School (Sydney Medical School)

Senior Director, Renal and Metabolic Division, The George Institute

None

Professor Kirsten Howard

Professor of Health Economics, School of Public Health, University of Sydney

None

Professor Matthew Jose

Renal physician, The Royal Hobart Hospital

Professor of Medicine, School of Medicine, The University of Tasmania

Adjunct Professor, The Menzies Institute for Medical Research

None

Dr Troy Kay

Renal physician, John Flynn Private Hospital, private practice

None

Professor Peter Kerr

Director of Nephrology, Monash Medical Centre

None

Professor Robyn Langham

Director of Nephrology, St Vincent’s Hospital, Melbourne

Professor of Medicine, Monash University

Secretary-General, International Society of Nephrology

None

Ms Alison Marcus

Registered nurse

Consumer representative

None

Professor Stephen McDonald

Director of Dialysis & Senior Staff Nephrologist, The Central Northern Renal and Transplantation Service, The Royal Adelaide Hospital

Clinical Director, Renal Services, Country Health Region, SA Health

Executive Officer, Australia and New Zealand Dialysis and Transplant Registry

Clinical Professor, The University of Adelaide

None

Dr Amanda Robertson

Director of Nephrology Surgery, Royal Melbourne Hospital

None

Ms Lesley Salem

Nephrology and chronic disease nurse practitioner

None

Dr Paul Snelling

Renal physician, Royal Prince Alfred Hospital

None

Professor Tim Usherwood

Professor, General Practice, Westmead Clinical School, The University of Sydney

None

Dr Amanda Walker

Director, Department of Nephrology, The Royal Children's Hospital, Melbourne

None

Professor Paul Glasziou (Taskforce Ex-Officio)

Professor of Evidence-Based Medicine, Bond University

None

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       Areas of responsibility of the Committee

The Committee was assigned seven MBS items to review. A complete list of these items can be found in Appendix A. The seven assigned items cover procedures and services related to renal medicine. In the 2014/15 financial year (FY), these items accounted for approximately 98,000 services and $7 million in benefits. Over the past five years, service volumes for these items have grown at 5.8 per cent per year, and the cost of benefits has increased by 5.7 per cent per year. This growth is largely explained by an increase in the number of services per capita (Figure 2). Dialysis supervision items 13100 and 13103 account for 80 per cent of total services (Figure 3).

Figure 2: Drivers of growth

 Figure 2 is a graph for the drivers of growth. It shows the increase in percentage for each of the drivers of renal items from 2010 to 2015. The total benefits increased at 5.7%, due to a 5.8% increase on the number of services whereas the average benefits per service only had  -0.1% movement. The increase on the number of services was due to a 1.3% increase on the population and the 4.5% increase on services per 100,000.

Figure 3: Renal items by service volume

 Figure 3 shows the Renal items by service volume for financial year 2014-15. There are 5 columns:  column 1. lists the Renal item groups from the highest to lowest service volume, column 2. Percentage of the total  number of services, column 3: Percentage of total services, column 4: Services 5-year compound annual growth rate, and column 5. Total in millions of the benefits for year 2014-15 . The graph shows that the highest of the grouped items are for supervision dialysis which accounts to 79% of the total services and management of home dialysis at 19%. The rest of the grouped items only account to 1% and below of the service volume for Renal items. The growth of item 13103 is 8.1% per year.

3.3       Summary of the Committee’s review approach

The Committee completed a review of its seven items across five meetings, during which it developed the recommendations and rationales outlined in Section 4. Recommendations were also developed for referral to other committees. These are outlined in Section 5.

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 medical journals (such as the BMJ) and other sources, such as the Central Australian Renal Study and KHA-CARI Renal Guidelines.

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.