“Doctors having to write sick certificates and repeat scripts, as well as provide patients with routine test results, have emerged as priority areas for reform of the $21 billion Medicare Benefits Schedule.
The Turnbull government has been told health professionals question the value of largely routine or administrative consultations, raising the potential for funding and workforce changes to make better use of limited resources.”
An interim report from a government-commissioned MBS review has also highlighted unnecessary diagnostic imaging as a concern, with a quarter of all patients consulted claiming to have been sent off for tests and scans they felt they didn’t need. The increase in referrals has caused Medicare expenditure to surge in recent years.
Health Minister Sussan Ley commissioned the review after the Coalition ditched the concept of a Medicare co-payment. The review, headed by former Sydney Medical School dean Bruce Robinson, is examining the evidence base and usage of about 5700 MBS items.
When health professionals were asked to identify areas of “low-value patient care” that should be prioritised as part of the review, administrative GP consultations were mentioned the most, and 50 per cent more than the second most mentioned area (the range of allied health providers covered by the MBS).
The burden of administrative tasks and paperwork, which could be reduced or given to non-medical staff, included providing certificates for patients to take time off work, repeat scripts for those on medication, and extended referrals for those being treated by a specialist. The review heard emails and text messages could be a more efficient way of dealing with such matters.
An increase in chronic illness — and of consumers, especially older people, seeking to take better care of themselves — has raised the risk of over-servicing. In 2013-14, for every 100 patient encounters, there were 49.1 pathology referrals (an increase from 36.7 in 2004-05) and 10.9 referrals for diagnostic imaging (an increase from 8.3 in 2004-05).
Inappropriate diagnostic imaging was the third most often cited area of low-value care by health professionals — four times the rate for pathology — and 24 per cent of consumers reported themselves, or their acquaintances, being referred for unnecessary care. One consumer reported having multiple blood tests ordered by different doctors due to a breakdown in communication between clinics and the laboratory, while a parent said “my son has had an X-ray for a chest infection four times (and) also had four hip X-rays — he is only 20 months old”.
The government still plans to remove bulk-billing incentives from diagnostic imaging and pathology services next year as it seeks savings across portfolios.
Despite initial scepticism from the Australian Medical Association, a survey found 93 per cent of health professionals believed parts of the MBS were outdated and changes were necessary.
Ms Ley has promised to consider lifting the contentious freeze on Medicare rebate indexation if sufficient savings could be identified through the review and elsewhere.
Despite a torrid election campaign, the Coalition has avoided giving a timeframe for the freeze being lifted, and the interim review demonstrates line-by-line spending reviews are complex. While the review has identified obsolete MBS items, bringing savings of $5.1m over four years, the Department of Health has had to spend $4.95m hiring management consulting firm McKinsey to assist the review.
In stakeholder forums, the issue most raised was “factoring in the costs of delivering a service” — rebates too high or low, depending on the circumstances — with “outcomes-based reimbursement” the third most commonly raised issue.
The second most common area raised was “transparency surrounding usage, variation and fees”, which corresponds with the Health Department’s push for better data collections and analysis to allow officials to identify trends and potential concerns. Asked about MBS rules and regulations, 37 per cent of health professionals believed the entire list, and 60 per cent of individual items, needed attention.
With Malcolm Turnbull in China for G20 talks, Bill Shorten yesterday sought to reignite the Medicare debate, repeating his claim that Labor would protect Medicare but the Coalition would destroy it.
Ms Ley said last night said the review demonstrated that “Labor’s insistence on blocking any changes to Medicare is out-of-date and will only harm Medicare in the long run”.