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 The Taskforce will also seek to identify any services that may be unnecessary, outdated or potentially unsafe.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

Although the Spinal Surgery Clinical Committee (the Committee) was established in July 2016, the MBS Review of Spinal Surgery commenced before the Taskforce’s establishment with a Spinal Surgery Review Working Group (the Working Group) leading the review since January 2015. When the MBS Review of Spinal Surgery came under the Taskforce’s program of work, the Committee was established to provider broad clinician and consumer expertise.

1.1        Areas of responsibility of the Spinal Surgery Clinical Committee

The following 74 MBS items were identified for review by the Committee. A full list of items and descriptions are listed in Appendix A.

 Therapeutic procedures: Neurological – Spinal Disorders

 40300 to 40351 (24 items)

 Therapeutic procedures: Orthopaedic – Spine

 48600 to 48694 (36 items)

 Therapeutic procedures: Orthopaedic – Treatment of Fractures

 47681 to 47717 (14 items)

 Paediatric spinal items are not included (items 50600 to 50644).

 Based on advice from the Working Group, these 12 items were determined to be better suited to the general review of paediatric services.

1.2        Key recommendations

1.2.1        New schedule of MBS items for spinal surgery

The Committee recommends a new schedule of items for spinal surgery. In practice, the 74 existing items for spinal surgery will be replaced by 59 new items. The complete new schedule of items with its specific structure and guidelines can be found at Section 5.

Data investigation has revealed issues pertinent to spinal surgery, including multiple item claiming and variation in claiming amongst providers. It is hypothesized this variation in MBS billing practices is due to several factors, including that the schedule is antiquated and does not reflect current practice and that individual item descriptors are poorly written and can be ambiguous.

The proposal for a new schedule of spinal surgery items represents significant work from the Working Group. The new schedule has attempted to address the issues above, providing a logical MBS claiming system that better describes spinal surgeons’ practice. Greater clarity and usability, in addition to new rules that will underpin the schedule, will increase consistency in how items are claimed by providers, reducing any potential differences in Medicare benefits provided to patients for the same surgery.

1.2.2        New rules to underpin the new schedule of MBS items for spinal surgery

The Committee recommends that the proposed schedule of items for spinal surgery is accompanied by two rules that will underpin the operation of the schedule, as well as a third rule specific to combined anterior and posterior surgery. The three rules are described in Section 6.1.

The rules support the intention that the proposal operates as a system of integrity, preventing inappropriate claiming of multiple items in a single episode of care.

1.2.3        Obsolete items

The Committee has identified three obsolete items. The Committee recommends these items be removed from the MBS, that is, the items will not be covered by the new spinal surgery schedule. Further detail is provided in Section 7.

1.3        Consumer engagement

The Committee’s membership includes a consumer representative. The Committee recommendations have been summarised for consumers in Appendix B. The summary describes the medical service, the recommendation of the clinical experts and why the recommendation has been made for all major changes and proposed new items.

Importantly however, 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.