The AMA has told the Federal Government its plan to update the Medicare Benefits Schedule to eliminate inefficiencies and reflect advances in medical practise should not be used to cut health spending and warned it could be undermined by the ongoing Medicare rebate indexation freeze.
Health Minister Sussan Ley has launched a review of the Schedule, to be led by Sydney Medical School Dean Professor Bruce Robinson, to scrutinise and assess the appropriateness of the more than 5500 services listed.
In parallel, the Minister has also appointed immediate-past AMA President Dr Steve Hambleton to head a Primary Health Care Advisory Group to recommend improvements in providing care, particularly for patients with mental health problems and chronic and complex illnesses.
AMA President Associate Professor Brian Owler said doctors supported the MBS review, but it should not be simply a cost-cutting exercise.
“There’s no doubt that the Government is looking for savings, but as I’ve said to both the [Health] Minister and the Prime Minister, we’re not going to participate in a review that simply is about saving money,” A/Professor Owler told ABC radio. “What we’re happy to do is participate as a profession to make sure that we get a schedule that reflects modern medical practice, but it’s not going to be a hit-list of savings. It’s not going to be something that just looks at trying to take money out of the system.”
Ms Ley sought to allay fears the review was solely driven by the need to pare back health spending, insisting that “this is not a savings exercise”.
“I expect that savings and efficiencies may well come from it, but I’m not going to predict that because, while we start this process, we don’t know exactly what our initial scoping of the MBS will determine,” the Minister said, adding that no savings target had been set.
But A/Professor Owler said that while ever the Government’s four-year freeze on Medicare rebate indexation remained in place, there was justifiable concern that the Government’s overriding objective was to cut health spending.
“The AMA and the medical profession will work closely with the Government and the [MBS Review] Taskforce to ensure Medicare reflects best practice clinical care and provides the highest quality and easily accessible services to patients,” he said. “But the ongoing freeze of Medicare rebates threatens to undermine the good intentions of these reviews.”
A/Professor Owler indicated in early March that he was in discussions with Ms Ley about how restructuring aspects of the MBS could improve patient outcomes and achieve efficiencies that would obviate the need for an extended rebate freeze.
He said the freeze would threaten the viability of many GP practices, cut bulk billing rates and push up patient out-of-pocket expenses.
“Freezing Medicare rebates for four years is simply winding back the Government’s contribution to patients’ health care costs. The freeze will also have a knock-on effect that could ultimately lead to higher private insurance premiums and higher out-of-pocket costs for patients,” he said. “If doctors absorb the freeze, their practices will become unviable.”
Ms Ley told ABC radio she regretted the freeze, but added it was necessary for “fiscal responsibility”.
She said the freeze would not be withdrawn in the May Budget, but expressed hope that it could be removed earlier than 1 July 2018, as currently planned.
“I would like it to be removed earlier than that. I’ll be working towards removing it earlier than that, and I very much hope that it will be,” the Minister said. “Yes, it’s here in the up-coming Budget…but I would like to see it go. It freezes what I might call an inefficient Medicare system.”
A/Professor Owler said it was reassuring that the MBS Review and the Primary Health Care Advisory Group were both being led by eminent and highly-regarded clinicians, making it likely their recommendations would be based on frontline medical evidence and experience.
“We’ve got some eminent people that are going to be involved in these reviews. And this has to be clinician-led. It has to be based on evidence,” he said. “And if the review delivers some savings – and there will be some savings I expect that can be found – then we’d be very happy to participate in that, as long as some of those savings are actually re-invested back into health care as well.”
Ms Ley said there were several examples where the MBS system did not support best clinical practice, such as creating incentives for GPs to order x-rays for patients with lower back pain, and to encourage en masse tests for vitamin D and folate deficiencies.
“I believe the biggest modernisation that needs to happen is because the clinical practices and the equipment and the technology are moving faster than the MBS updates,” the Minister said. “So, where you use scopes to look down people’s throats and look at cancers, they weren’t done in the same way years ago. They’re now much different.”
The MBS Review and the Primary Health Care Advisory Group’s work will also be accompanied by a crackdown on Medicare rorting.
Ms Ley said that although the “vast majority” of doctors acted appropriately and conscientiously, a “small number do not do the right thing in their use of Medicare. Their activities have a significant impact on Medicare and may adversely affect the quality of care for patients”.
Shadow Health Minister Catherine King said the Opposition cautiously welcomed the MBS review, but remained “deeply suspicious” about the Government’s intentions.
Ms King said Labor began an MBS review while in Government, and changes it made would save $1 billion over the next five years.
But she said it was “crucial [the review] not be used as just another excuse to rip money out of health”, and called for any savings made to be reinvested in the health care system.
Ms Ley said each of the three taskforces was expected to provide recommendations by late this year.
“Basically, there’s wide agreement the Medicare system in its current form is sluggish, bloated and at high risk of long-term chronic problems and continuing to patch it up with bandaids won’t fix it,” Ms Ley said. “Not imposing a savings target allows us to work with doctors and patients to deliver high-quality health policies that focus on delivering the best health outcomes for every dollar spent by taxpayers.”