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Review chair: it’s all about injecting some evidence into Medicare

The review of the Medicare Benefits Schedule aims to ensure better, safer healthcare, according to the review’s chair, Professor Bruce Robinson, Dean of the Sydney Medical School at the University of Sydney.

Beneath his article below, see some reaction from Twitter to the AMA and Federal Opposition’s politicking against the review (as previously reported at Croakey).

***

Bruce Robinson writes:

When I was a medical student – quite a few years ago now – one of the statistics that stayed with me was that 40 per cent of “knowledge” we learned in our medical course and dutifully reproduced in our exams would be obsolete in our lifetime.

For medical students now, we say that 70 per cent of what they learn will be superseded within seven years. The pace of change in medicine and health care; the rate at which new discoveries are being made; new drugs being released; best practice in treatment of diseases – these are all advancing at a greater rate than ever before.

In my own practice, the major advances in genetics have revolutionised the range of tests and treatments for people with cancer. The tests we now routinely use to determine the best treatment were not in existence 10 years ago. Likewise, the treatments are very different.

The pace and extent of change presents an extraordinary challenge to every doctor and health practitioner. How do we keep up to date with the best practice?

An example is the common surgical practice of knee arthroscopy. The evidence tells us that for people over 55 with arthritis, having a knee arthroscopy offers no benefit. Nevertheless, in 2013-14 over 50,000 people of all ages underwent a Medicare-funded knee arthroscopy.

In the same year, over 4 million Australians had a Medicare-funded Vitamin D test. This is despite concerns being raised internationally about whether this test offers any benefits for many patients.

Like most medical tests and procedures, both of these tests are valuable when done for the right reason, but the sheer volume of testing raises concern that this is not always the case.

One answer is to align the list of services funded by the Australian Government with contemporary clinical practice based on the latest evidence. This is the goal of the Medicare Benefits Schedule (MBS) Review Taskforce, which I chair.

Appointed in June by the Minister for Health Sussan Ley, we are bringing together the extraordinary levels of skill and knowledge of Australia’s most able clinicians and researchers, in consultation with patients and consumers, to review the evidence of the procedures and tests subsidised, and make recommendations on their effectiveness in contemporary medicine.

What are the health benefits?

Our number one goal is better, safer healthcare for Australian patients by ensuring that procedures and tests reflect the best clinical practice and evidence.

The Review will, therefore, focus on whether patients are being offered the right service at the right time for the right reason and will truly provide them with a health benefit.

Achieving better value for the services that are currently provided through Medicare will also enable Medicare to fund the new technologies and services that are coming through the pipeline and hold so much promise.

At the moment, the Australian Government subsidises more than 5700 health service items. These range from GP consultations and surgical procedures to pathology tests, x-rays and other diagnostic imaging.

Only three per cent of those items have been assessed or tested to see whether they actually work, are out of date or even harmful. Seventy per cent of them have remained unchanged since their introduction.

Looking through the MBS, many of these items are clearly obsolete and need to be considered for removal from the subsidised list. For example, invasive tests to detect gallstones, kidney stones and blood clots have been replaced by safer, non-invasive tests such as ultrasound and CT.

For others, the decisions are more complicated. Very few clinical interventions are of no value in every clinical circumstance. This is why it’s essential we look at the rules governing how Medicare-funded items and procedures are used, not just the safety and effectiveness of the tests and procedures themselves.

There has been much discussion about whether Australia’s rising health care costs are sustainable and whether the characteristics of our healthcare system are optimal to meet the demands of increased chronic disease and our aging population.

Maximising patient outcomes

The MBS Review plays an important role within this system in maximising patient outcomes for our health expenditure.

By better aligning the MBS with contemporary clinical practice, we will ensure this important part of the health system is supporting patients in the best ways possible.

One of the great joys of working with extremely bright, highly focused medical students and trainee doctors is that you learn very quickly that without evidence you have absolutely no credibility.

We do have a lot of evidence – thanks to advances in data science, in skills of professionals, in the painstaking laboratory, clinical and public health research done over decades – on the best and safest health services.

That knowledge is not yet fully reflected in the current 5,700 items in the Medicare Benefits Schedule.

If we can align the MBS items with the best and safest health care, then we will have made significant progress on ensuring a safer, better health system.

***

From Twitter…

AmArev4AMARev3AMARev2AMAtweetsreview

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