Introduction by Croakey: Changes to around 900 Medicare Benefits Schedule orthopaedic, cardiac and general surgery items are due to be introduced from 1 July as part of the detailed five-year review by the MBS Review Taskforce.
The changes hit the headlines last week, sparked by concerns by health groups and experts about the rollout timing and process of this latest tranche, but with Labor coming out against the changes themselves, describing their introduction and potential impact on out-of-pocket fees as “the biggest attack on Medicare in decades”.
The Australian Medical Association (AMA) warned it was concerned health funds, hospitals, doctors and patients wouldn’t be ready for the changes due to a tight timetable and “poor implementation”, but quickly announced what was described by some media as a “peace deal” with the Government.
Former Federal Health Department secretary Stephen Duckett, director of the Grattan Institute’s Health Program, backed the AMA call for a delayed introduction, warning that otherwise the changes could lead to greater out of pocket costs for consumers.
However, writing at The Conversation, he said the Government should stress the delay was about implementation, not about reopening the debate about what is included in the revisions to the MBS.
The Australian Healthcare and Hospitals Association (AHHA) also said more consideration was needed for the impact on consumers who may be faced with greater out-of-pocket costs, and to providers who have been left to explain this to them.
The AHHA also criticised the Health Department’s “cavalier suggestion” in the media that providers should take into account their patients’ financial circumstances when quoting fees, describing it as “an abdication of their responsibility to ensure affordable healthcare for all Australians”.
“It is this disregard of affordability that weakens Medicare, not the MBS review process,” AHHA CEO Alison Verhoeven said.
The Consumers Health Forum of Australia (CHF) also backed the AMA’s call for a short delay, saying surgeries would have already been scheduled with patients having an expectation about what it meant for them financially, which would now change.
However, CHF CEO Leanne Wells writes below that the worry about implementation should not obscure the need for the changes and the rigorous process behind the MBS Taskforce Review‘s work “to strengthen, modernise and protect Australia’s world class health system”.
Leanne Wells writes:
The controversy that erupted this week over proposed changes to the MBS benefits should not be allowed to obscure the invaluable directions for reform set out in the exhaustive MBS Taskforce Review report.
It was that report, released last December, which contained the changes recommended to take effect next month that will include reduction or removal of Medicare benefits for some procedures found no longer to be of evidence-based value.
Consumers Health Forum of Australia (CHF) along with the Australian Medical Association (AMA) and other commentators have called for more time to ensure adequate informed consent is made available for consumer and providers before the changes are implemented.
What needs to be made clear however is that the assessment and consultation which went into the taskforce report was a deep, wide-ranging exploration of Medicare costs and practices to an extent without precedent in Australia.
Over five years from 2015, the Review, headed by Chair Professor Bruce Robinson, studied more than 5,700 items on the MBS and made more than 1,400 recommendations to strengthen, modernise and protect Australia’s world class health system.
While the process inevitably generated fierce debate among health stakeholders, it is a measure of its success that the drive for change across such a wide arena has gone ahead without major obstruction. Already, many of these recommendations have been accepted and implemented by the Government, and the Taskforce anticipates that many hundreds more will be accepted in the coming months and years, ensuring safer, more modern care for all Australians.
Vital developments
Some of the key achievements the Taskforce can report so far include supporting GPs and improving patient access to aftercare following surgery and enabling rural and regional patients to receive life-saving kidney dialysis in their remote communities from nurses, Indigenous practitioners and Indigenous health workers.
Changes have been made to reduce unnecessary colonoscopies and improve access for patients who need them and expand access to psychological and dietetic services for patients with severely debilitating eating disorders.
Reforms have also been made to improve urgent after-hours services, which had been driven by a throughput-focused corporate model and advertised to consumers on the basis of convenience. As a result, patients now receive the most appropriate care for their medical needs, the report says.
The more than 900 changes to take effect on 1 July include updates to orthopaedic, cardiac and general surgery to better reflect modern practice, reduce low value care and incentivise advanced techniques with improved patient outcomes, for example new items for complex aortic procedures.
And encouragingly, Health Minister Hunt and the AMA have announced that the MBS Review process will now shift to a more business-as-usual footing, embedding a new continuous review into the ongoing management of the MBS schedule as recommended by the Robinson Taskforce.
For consumers, that is all Australians, a vital development of the review process has been the inclusion of consumer representatives on many of the advisory panels.
CHF has been actively involved in nominating representatives and responding on a range of pivotal Taskforce target areas including primary care, mental health, diagnostic medicine, nurse practitioners and allied health.
The consumer involvement was a recognition of the central part the consumer perspective plays in balancing the competing influences in health care in the best interests of the patient.
The Taskforce designed and established a process whereby clinical experts and consumer representatives came together on a regular basis to undertake clinical area-specific reviews.
It formed more than 100 clinical committees and working groups, which engaged with more than 700 clinicians, health sector experts and consumer representatives. These committees included a Consumer Panel to support consumer engagement.
Ambitious and consumer-focused
The Taskforce stated in its report that its focus was on ensuring MBS items meet the goals of affordable and universal access, best practice healthcare, and value for both the individual patient and the health system.
Given the fragmented state of much health care, the Taskforce unsurprisingly states there was also considerable scope to review and provide advice on all aspects that would contribute to a modern, transparent and responsive system.
“The Taskforce has made a conscious decision to be ambitious in its approach, and to seize this unique opportunity to recommend changes to modernise the MBS at all levels, from the clinical detail of individual items, to administrative rules and mechanisms, to structural, whole-of-MBS issues, including alternative funding models,” the report states.
The Taskforce also recommends embedding a consumer-centric focus in the MBS and in any future changes and “rebalancing” healthcare financing from near exclusive reliance on ‘fee-for-service’ to complementing with ‘block’ and ‘blended’ payments in order to support more clinically appropriate modes of patient care.
The Taskforce says its Review considered a range of broader systemwide issues that warrant further investigation and work to improve patient outcomes. With MBS expenditure forecast to reach over $30 billion a year from 2022-23, it will be crucial that the MBS delivers care that is of high value to consumers, that meets their needs and is based on the latest evidence and best practice.
And it states:
One of the key opportunities for an enhanced MBS is the continued involvement of consumers. The Review’s consumer-focused processes have helped to place consumer views at its centre and this will be crucial in the future review and reform of the MBS.
Consumers consistently raised the challenges encountered in navigating a complex, and at times fragmented, health system, with care being delivered by a multitude of service providers and funded by different levels of government. Consumers also expressed concerns about increasing out of pocket expenses and the lack of transparent information on fees, treatment options, risks and outcomes.
The Taskforce acknowledges the steps the Government has taken to reduce out of pocket expenses and provide more transparent information for consumers.”
The Taskforce recommended a range of actions to build on these efforts including the further investigation of the Extended Medicare Safety Net (EMSN) and mandatory provision of clear and understandable fee and treatment information to help consumers participate in decision-making about their care.
The Taskforce also recommends creation of an independent Medical Fee Complaints Tribunal to deal with consumer grievances about high or unwarranted out of pocket medical costs.
It says both consumers and providers recognised the need for better data and information on not just the health care services delivered, but the outcomes of such services, to ensure the provision of high value care and to reduce incidents of low value care. While the Taskforce recognises that most health care delivered in Australia does provide high value to patients, there are few examples of this being systematically recorded and analysed.
The Taskforce recommends establishing data collection to assist with measures of outcome, risk and value. These data would enable more informed consumer choice, efficient allocation of health funding and provide better patient outcomes.
This would complement the collection of Patient Reported Outcome Measures (PROMS) and Patient Reported Experience Measures (PREMS). Building on this information would be a new set of publicly available data detailing the cost and quality of MBS services to allow consumers to more easily make informed choices about their care.
There is much more in the report than can be covered here, including on the crucial issue of alternative funding models to support healthcare delivery, GP stewardship (affirming the central role of GPs), harnessing innovation to deliver contemporary care, telehealth and more.
With healthcare, the more complex our needs become and the more we advance medical and health care know-how, the more changes we have.
See Croakey’s archive of stories about the MBS Review.
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