6.           Recommendation impact statement

The recommendations to replace current spinal surgery items with a new schedule of 59 items and add three rules to the health regulations will benefit:

 Providers, as they will have a system that offers greater clarity and usability, with items that better describe the surgery they undertake.

 Patients, as there will be reduced variation in Medicare benefits provided for the same surgery.

6.1        Recommended rules to underpin the new MBS schedule of items for spinal surgery

Recommendation 2

The Committee recommends that the proposed schedule of items for spinal surgery (see Section 5.2) 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 rules are as follows:

 An item from Tables 1 to 7 cannot be claimed with another item from the same table.

- In practice, if item 101 is claimed from Table 1, items 102, 103, 104 and 105 will be ineligible for Medicare benefits.

- Table 8 is excluded from this rule, i.e. one or more items can be claimed from Table 8.

 

 Items from the spinal surgery schedule cannot be claimed with any other item in the MBS outside the spinal surgery schedule.

- In practice, if a surgeon claims a spinal surgery item, for example item 101, all other items in the MBS, for example other neurosurgery items, will be ineligible for Medicare benefits.

- Paediatric spine surgery items are excluded from this rule (MBS items 50600 to 50644).

 

 An item from Table 6 cannot be claimed with another item from Tables 2, 3 or 4.

- In practice, a surgeon undertaking anterior and posterior (combined) spinal fusion under a single anaesthetic should claim the appropriate item in Table 6. Additional items from Tables 2, 3 and 4 will be ineligible for Medicare benefits.

- Table 6 assumes that an anterior and posterior combined procedure includes anterior and posterior bone grafting and instrumentation.

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