Tim Usherwood

Professor of General Practice The University of Sydney Chair, General Practice and Primary Care Clinical Committee, MBS Review I acknowledge the Traditional Owners of the land on which we are meeting. I pay my respects to their Elders, past and present, and to Aboriginal and Torres Strait Islander people here today.

Review of the MBS

• On 22 April 2015, the Minister of Health and Sport announced that a Medicare Benefits Schedule (MBS) Review Taskforce would be established.

• The Taskforce is considering how the MBS can be aligned with contemporary clinical evidence and practice, and improve health outcomes for patients.

• The review is clinician-led and there are no targets for savings attached to the review.

• The Taskforce recommendations will be made to the Minister.

10 May, 2017 4

Australia achieves very strong outcomes compared to peer systems

82

82828282

808080

83

83

7980

81818181818181818282

8282

83

8384

USA Slovenia Chile Denmark Belgium Netherlands Ireland Greece United Kingdom Portugal Germany Finland Austria Sweden Israel South Korea Norway New Zealand Luxembourg Iceland France Canada Switzerland Spain Italy Australia Japan

Life expectancy at birth (years) Years per capita, 2013

Self-reported health score (%) of population aged 15+ who report their health to be good/very good, 20111

89

68

71

6365666667

686970

7474747575767779818283848588

90

Slovenia Germany

Finland France Italy Turkey Austria Denmark Luxembourg Spain Belgium United Kingdom Greece Netherlands Iceland Norway Sweden Switzerland Ireland Israel Australia USA Canada New Zealand

Mexico Slovak Republic

2

4

1 2011 data for most countries. Exceptions: for some countries only prior data is available (2006-2010). Newer data is used (2012-2013) where available. SOURCE: World Health Organization (life expectancy), OECD (self-reported health score)

SOURCE: OECD data, 2014

Slov

enia

Aust

ralia

Uni

ted

King

dom

8,611

5,184

Spai

n

Italy

6,354

Finl

and

Cana

da

8,224 7,055

Irela

nd

7,011

5,638

New

Zea

land

Icel

and

Belg

ium

7,132

8,030 Lu

xem

berg

7,674

Fran

ce

8,467

7,665

Aust

ria

7,802

Denm

ark

9,288

Germ

any

Net

herla

nds

11,257

8,946

Swed

en

9,531

Switz

erla

nd

Uni

ted

Stat

es

11,210

Nor

way

9,452

Mex

ico

1,759

Chile

1,607

Turk

ey

Latv

ia

2,070 2,711

Pola

nd

Hung

ary

Japa

n 3,028

3,551

Esto

nia

Slov

ak R

epub

lic

Kore

a

3,544 3,696

Port

ugal

3,001 2,787

Gree

ce

Isre

al

4,115 4,445

6,790

Czec

h Re

publ

ic

4,379 4,295

Total Public

Health spending per capita, USD, 2014

The Taskforce vision

To ensure that the Medicare Benefits Schedule provides affordable universal access to best practice health services, that represent value for both the individual patient and the health care system. o Affordable and universal access o Best practice health services o Value for the individual patient o Value for the health system

Structure of the MBS Review

o Taskforce – Clinicians, health economist, consumer representative

o Clinical Committees – 36 in six tranches o Consumer Panel o Principles & Rules Committee o Over 440 clinicians, consumers & others involved

to date

11

Members of the GPPCCC

• Professor Tim Usherwood (Chair) – Professor of General Practice, University of Sydney • Dr Elizabeth Marles – Senior Staff Specialist, General Practice & Director, Hornsby-Brooklyn GP Unit • Dr Mark Morgan – General Practitioner and Associate Professor, Bond University, Queensland • Associate Professor Kathryn Panaretto – Research Fellow, Centre for Chronic Disease, The University of Queensland Medical

School of Medicine • Ms Karen Booth – Registered nurse and general practice manager, President Australian Primary Health Care Nurse

Association • Dr Steven Hambleton – MBS Review Taskforce (Ex-Officio). • Associate Professor Caroline Laurence – Head of the School of Public Health at the University of Adelaide • Dr Noel Hayman – Clinical Director of the Inala Indigenous Health Service, Association Professor University of Queensland

School of Medicine • Dr Simon Willcock – General Practitioner, and Clinical Director of the Macquarie University GP Clinic • Dr Ewen McPhee – General Practitioner and President of Rural Doctors Association of Australia • Mr Gary Smith – Practice Manager • Mr Tim Perry – Consultant Pharmacist • Professor Jon Adams – Professor of public Health, University of Technology Sydney • Ms Thy Cao – Physiotherapist, President of the NSW Branch of the Australian Physiotherapy Association • Mr Peter Gooley – Consumer advocate, Alzheimers’s and Dementia Coach • Professor Steve Jan – Professor of Health Economics at the Sydney Medical School, University of Sydney • Dr Emma Kennedy – General Practitioner, Senior Lecturer General Practice – NT Clinical School, Flinders University • Professor Lyn Littlefield – Executive Director of the Australian Psychological Society and Professor of Psychology, La Trobe

University • Professor Claire Jackson – Professor in General Practice and Primary Care Research, University of Queensland • Ms Nadia Moffatt – Consumer advocate

Process of the MBS Review 1. Consumer and stakeholder consultation 2. Allocation of items to clinical committees 3. Recommendations to Taskforce 4. Further consumer & stakeholder consultation 5. Taskforce – final recommendations to the Minister Concurrent: o Practice Incentives Program review o Health Care Home design process

13

Improving clinical value-Colonoscopy • 30 times difference in per capita use across Australia

• Over 50% of patients have a repeat colonoscopy within 6-years

• Well accepted Australian clinical practice guidelines about appropriate use

• NHMRC approved in 2011, endorsed by GESA, CSSANZ and Cancer Council Australia

14

Item Short descriptor MBS Fee No. of

services 2014-15

No. of patients 2014-15

No. of providers 2014-15

Bulk billing rate (OOH)

MBS benefits paid

Service change 11-12 to

14-15 (%)

32090 Fibreoptic colonoscopy with or without biopsy (Anaes)

$334.35 335,488 332,144 1,756 92% $85,072,891 3%

32093 Fibreoptic colonoscopy for the removal of polyps or other treatments (Anaes)

$469.20 255,606 249,945 1,643 93% $91,346,459 29%

15

16

Number of MBS-funded colonoscopy services per 100,000 people, age standardised, by local area, 2013–14

Colonoscopy recommendations

• Wide variation in use is not justified - colonoscopy is a low value service for many patients

• Clinical practice guidelines make clear which patients should undergo initial diagnostic colonoscopy, which patients require continuing surveillance and the intervals between testing

• Gastroenterology Clinical Committee has recommended changes to MBS items to align with contemporary Australian clinical practice guidelines

17

Differential benefits for GPs and other specialists

• 31 items where a different item number and level of benefit are allocated to GPs and other specialists for the same service.

• 31% of services claimed under the GP items were for patients located in rural or

remote areas. • This includes:

– 39% of services claimed for item 30041 - repair of wound of the skin or subcutaneous tissue – 42% of services claimed for item 30067 – removal of foreign body in the muscle, tendon or other

deep tissue – 25% of services claimed for item 37622 – vasotomy or vasectomy

• The Taskforce has recommended removal of the differential fee structure for GP and Other Specialist items, so that the same MBS fee is paid for the service (at the specialist rate), regardless of who performs it.

Addressing poor access • Many haemodialysis patients in remote Australia are required to relocate

long distances from their homes to access dialysis • There is no secure funding for haemodialysis provided in very remote

Indigenous communities

• The Taskforce has approved, for consultation, MBS funding for a primary care model of haemodialysis for patients in remote Australia

Status of MBS item level progress

41.0%

44.2%

9.5%

0.0% 0.6%

1.9% 0.4% 2.4%

MBS Review Progress - Item Level

To be reviewed

Under review

Preliminary Recommendations

Public consultation

Taskforce endorsement

Government agreed

Implemented

Does not require review

Consultation • There have been 6 committee reports released for public

consultation. Over 950 responses were received. These consultations inform the final recommendations of the Taskforce.

Round of public consultation

Clinical Areas Dates consultation was open

1 Various obsolete items – diagnostic imaging, ear, nose and throat surgery, gastroenterology, thoracic medicine, obstetrics.

18 Dec 2015 to 8 Feb 2016

2 Principles and Rules; Obstetrics; Gastroenterology; Thoracic Medicine; Ear, nose and throat surgery; Diagnostic imaging: • Spinal x-rays; and • Bone densitometry

9 Sept 2016 to 7 Oct 2016.

3 The Taskforce has approved consultation on a range of clinical committee reports which are due to be released in 2017.

2017

Mechanisms to support GP stewardship of the MBS

Questions & Feedback Website: www.health.gov.au/internet/main/publishing.nsf/Content/MBSR-consult Email: MBSReviews@health.gov.au